萆薢汤加减治疗类风湿关节炎寒湿痹阻证临床观察

目的:探讨萆薢汤加减治疗类风湿关节炎寒湿痹阻证的疗效及其对血沉(ESR),血尿酸(UA),C反应蛋白(CRP)和超氧化物歧化酶(SOD)的影响。方法:将114例符合条件的患者按随机数字表法随机分为对照组和观察组,每组各57例。两组患者均给予甲氨蝶呤片,10 mg/次,1次/周进行治疗。在此基础上,对照组口服白芍总苷胶囊,0.6 g/次,2次/d;观察组口服萆薢汤加减,1剂/d。疗程均为3个月。观察两组患者治疗前后疾病活动指数(DAS28),Oswestry功能障碍指数量表(ODI),健康评估问卷(HAQ)和中医辨证类风湿关节炎寒湿痹阻证评分量表(中医证候)评分;检测治疗前后两组患者ESR,UA,CRP和SOD变化;比较两组疗效及不良发应发生率。结果:对照组脱落3例,观察组脱落6例。观察组总有效率94.1%,明显高于对照组的79.6%(P0.05);观察组DAS28,ODI,HAQ和中医证候评分较对照组改善更为明显(P0.05);观察组血清指标ESR,UA,CRP和SOD改善程度明显优于对照组(P0.05);不良反应(胃肠道反应、肝损伤、口腔溃疡、皮炎、单纯疱疹、白细胞下降)发生率比较,观察组(7.8%)低于对照组(20.4%)(P0.05)。结论:在甲氨蝶呤片治疗基础上,口服萆薢汤加减可有效改善风湿性关节炎寒湿痹阻证的临床症状,ESR,UA,CRP和SOD水平,不良反应发生率低。

Clinical Observation on Bixietang in Treatment of Rheumatoid Arthritis Cold-dampness Syndrome

Objective: To explore the clinical efficacy of Bixietang in treatment of rheumatoid arthritis (RA) cold-dampness syndrome and investigate its effects on levels of erythrocyte sedimentation rate (ESR), blood uric acid (UA), C-reactive protein (CRP) and superoxide dismutase (SOD). Method: A total of 114 eligible patients were randomly divided into control group and observation group, 57 cases in each group. Methotrexate tablets were given in both groups (10 mg/time, 1 time/week). Based on this, control group also received paeonia capsule (0.6 g/time, 2 times/d); and the observation group received Bixietang (1 dose/d). The treatment course was 3 months in both groups. The disease activity scores 28-joint counts (DAS28), the oswestry disability index (ODI), the health assessment questionnaire (HAQ) and the traditional Chinese medicine (TCM) differentiation RA cold-dampness syndrome (TCM symptom) scores were applied to estimate the efficacy. The changes in ESR, UA, CRP and SOD were detected in two groups, and the efficacy and incidence of adverse reactions were compared between two groups. Result: The 3 cases were withdrawn in control group, and 6 cases were withdrawn in observation group. The total effective rate was 94.1% in observation group, better than 79.6% in control group (P<0.05). After treatment, the improvement in scores of DAS28, ODI, HAQ, and TCM symptom was more obvious in observation group (P<0.05); improvement in ESR, UA, CRP and SOD was also more significant in observation group (P<0.05). The incidence of adverse events (gastrointestinal reactions, liver damage, oral ulcers, dermatitis, herpes simplex, and white blood cell decline) in observation group (7.8%) was lower than that (20.4%) in control group (P<0.05). Conclusion: Bixietang combined with western medicine in the treatment of RA cold-dampness syndrome was effectiveness to improve the clinical symptoms of RA, ESR, UA, CRP and SOD and decrease the adverse events.