从痰瘀湿毒论治类风湿关节炎的临床研究

目的探讨从痰瘀湿毒论治类风湿关节炎（RA）的临床疗效和安全性。方法RA患者100例随机分为观察组和对照组各50例。对照组给予甲氨蝶呤、来氟米特治疗，观察组给予化痰祛瘀利湿解毒中药及甲氨蝶呤、来氟米特治疗。分析治疗前及治疗第24周对疼痛目视模拟测试表（VAS）评分、患者对自身健康状况的总体评估（PGA）、医生对患者健康状况的总体评估、压痛关节数（TJC）、肿胀关节数（SJC）、健康评估问卷（HAQ）评分，以及血、尿常规、血生化、血沉（ESR）、C反应蛋白（CRP）等实验室指标。结果观察组46例、对照组44例完成24周治疗，观察组上述指标方面优于对照组，差异有统计学意义（P〈0．05）。达到ACR20，ACR50，ACR70缓解率组间比较差异有统计学意义（P〈0．05）；观察组不良反应较对照组少且轻，组间比较差异有统计学意义（P〈0．05）。结论化痰祛瘀利湿解毒法能显著改善RA患者的病情，且安全性、耐受性高，不良反应的发生率低。

CLINICAL STUDY ON TREATING RHEUMATOID ARTHRITIS BY DISSIPATING PHLEGM,REMOVING BLOOD STASIS,PROMOTING URINATION AND DETOXICATION

Objective To explore the clinical efficacy and safety treating rheumatoid arthritis （RA） by dissipating phlegm, removing blood stasis, promoting urination and detoxication. Methods 100 patients with RA were randomly divided into the observation group and the contrast group. The contrast group was treated with methotrexate and leflunomide, while the observation group was treated with the therapy of dissipating phlegm, removing blood stasis, promoting urination and detoxication in addition to methotrex- ate and leflunomide. The visual analogue score （VAS）, PGA, the physician＇s global assessment （PGA） score, the tender joint counts（TJC）, the swollen joint counts（SJC）, the Health Assessment Questionnaire scores（HAQ） ,and the indexes of blood and urine routines, blood biochemical indexes, erythroeyte sedimentation rate and c-reactive protein （CRP）were compared before treatment and 24 weeks after treatments. Results 46 patients in the observation group and 44 patients in the contrast group completed 24 weeks of treatment. The observation group showed much better results in terms of all indexes than the con- trast group （ P 〈0. 05）. The difference in remission rate got at ACR20, ACR50 and ACR70 between the two groups was statistically significant （P 〈 0. 05）. The observation group showed fewer and slighter adverse reactions than the contrast group（ P 〈0.05）. Conclusion Dissipating phlegm, removing blood stasis, promoting urination and detoxication can effectively re- lieve RA, have high safety and tolerance and few adverse effects.