独活寄生汤和归脾汤分别联合西药治疗类风湿关节炎贫血的对照研究

目的 筛选治疗类风湿关节炎(RA)贫血的有效方剂. 方法 将60例RA贫血患者随机分为治疗组和对照组各30例,治疗组用独活寄生汤联合甲氨蝶呤、来氟米特治疗,对照组用归脾汤联合甲氨蝶呤、来氟米特治疗；两组均以4周为1个疗程,3个疗程后观察临床综合及疾病疗效,进行RA主要症状体征及贫血症状评分,同时进行实验室指标检测及健康指数调查(HAQ),并观察药物的不良反应. 结果 对照组临床综合疗效总有效率70.0％,治疗组总有效率90.0％,治疗组优于对照组(P＜0.05).两组治疗后临床症状及体征均较治疗前有所改善(P＜0.05),并且治疗组改善程度优于对照组(P＜0.05).治疗组患者治疗后贫血症状积分及HAQ积分较治疗前明显减少(P＜0.05),两组治疗后各积分比较差异有统计学意义(P＜0.05),两组治疗后血红蛋白含量升高,而血小板、类风湿因子、血沉、C反应蛋白下降(P＜0.05),两组治疗后组间比较差异有统计学意义(P＜0.05).治疗组美国风湿病学会( ACR)指定标准50％改善率为86.7％,优于对照组的66.7％ (P＜0.05).两组不良反应均较轻,均能完成临床观察.结论 独活寄生汤治疗RA贫血疗效优于归脾汤.

A Clinical Observation on Duhuo Jisheng Decoction or Guipi Decoction Combined with Western Medication Respectively for Rheumatoid Arthritis with Anemia

Objective To select the effective formulas for rheumatoid arthritis(RA) with anemia.Methods Sixty RA patients with anemia were randomized into the treatment group and control group,with 30 in each.The treatment group was given Duhuo Jisheng Decoction(Pubescent Angelica and Mistletoe Decoction) combined with leflunomide and methopterin.The control group was given Guipi Decoction(Spleen-Returning Decoction) and the same chemotherapy as the treatment group.One treatment course lasted for 4 weeks in both groups.After 3 courses of treatment,rest pain,time of morning stiffness,grasp force,tender joint count(TJC),swollen joint count(SJC),evaluation by patients or doctors,symptoms of TCM,blood routine,rheumatoid factor(RF),erythrocyte sedimentation rate(ESR),C-reaction protein(CRP),liver function,renal function,urine routine and adverse effect were observed.Results There were one case of cure,13 cases of excellence,7 cases of validity and 9 cases of invalidity in the control group,with a total effective rate of 70.0%.There were 4 cases of cure,16 cases of excellence,7 cases of validity and 3 cases of invalidity in the treatment group,with a total effective rate of 90.0%.The difference in the total effective rate was statistically significant between groups(P<0.05).After treatment,the differences in rest pain,time of morning stiffness,grasp force,TJC,SJC and the evaluation by patients or doctors were statistically significant both between groups and in group(P<0.05).The content of hemoglobin increased and the levels of platelet,RF,ESR and CRP decreased significantly in both groups(P<0.05),especially in the treatment group(P<0.05).Symptoms of anemia were significantly relieved in both groups(P<0.05),especially in the treatment group(P<0.05).The quality of life significantly improved in both groups(P<0.05),especially in the treatment group(P<0.05).26 cases(86.7%) and 20 cases(66.7%) were improved by 50% improvement of American College of Rheumatology(ACR) outcome measures in the treatment group and control group respectively,with a significant difference between groups(P<0.05).Conclusion Duhuo Jisheng Decoction is more effective than Guipi Decoction for RA with anemia.