血小板数量与中西医治疗类风湿关节炎疗效关系的探讨

目的 探讨血小板数量变化与中西医治疗类风湿关节炎（RA）疗效的相关关系。方法 来自9个临床中心的356例确诊活动期RA病例，随机分成中药治疗组（184例）和西药治疗组（172例）。西药治疗方案包括非甾体抗炎药和慢作用药，中药治疗包括基础治疗（口服雷公藤多甙片、益肾蠲痹丸）和辨证用药。以双手X线分级作为RA关节损伤程度的判断指标。以ACR20作为疗效评价标准，分别对不同X线分级RA患者血小板数量的变化与疗效之间的相关关系进行分析。结果 血小板数量与X线分级相关，血小板数量高的患者关节损伤程度也高；经过中西医治疗方案治疗后。X线分级为Ⅱ、Ⅲ级、中药治疗有效的患者血小板数量普遍低于无效患者；X线分级为Ⅲ级、西药治疗有效的患者血小板数量普遍低于无效患者。结论 血小板数量与药物治疗的疗效密切相关，可作为RA治疗方案适应证优化的一项重要指标。

Exploration on Relationship between Platelet Count and Efficacy of Chinese Medicine and Western Medicine in Treating Rheumatoid Arthritis Patients .

OBJECTIVE: To explore the correlationship between platelet count and efficacy of traditional Chinese medicine (TCM) or Western medicine (WM) in treating rheumatoid arthritis (RA) patients. METHODS: A total of 356 patients with confirmed diagnosis of active RA from 9 clinical centers were randomly assigned to the TCM group (184 cases) and the WM group (172 cases). The TCM group was treated with basic therapy (administration of glucosidorum tripterygll totorum and Yishen Juanbi Pill) and TCM syndrome differentiation dependent treatment, while the WM group was treated with non-steroidal anti-inflammatory drugs and slow-acting anti-rheumatic drugs. The therapeutic efficacy was assessed with ACR20, the joint damage degree of both hands was evaluated by X-ray. RESULTS: The platelet count was positively correlated to the X- ray grading of joint damage, namely, patients with a more severe joint damage often presented a higher platelet count. After treatment, in patients with joint damage of X-ray grade II or III and effectively treated with TCM, also in patients with joint damage of grade III and effectively treated with WM, the platelet count was lower than that in those treated ineffectively. CONCLUSION: Platelet count is closely correlated to the efficacy of drug therapy, therefore, it may be taken as an important index for judging the curative effect of therapeutic approach in treating RA patients.