益肾壮骨通痹汤治疗类风湿性关节炎临床观察

[目的]评价中医药对类风湿性关节炎的疗效。[方法]将44例患者随机分成两组,观察组24例,采用益肾壮骨通痹汤(主要由制附子、淫羊藿、补骨脂、川芎、当归、独活、川断、黄芪、熟地、茯苓、白术、骨碎补、赤芍、白芍、狗脊、桑寄生、鸡血藤、伸筋草、防风等中药组成)内服外烫;对照组20例,服用英太青;治疗8周后,观察两组关节功能的恢复情况、药物的不良反应及对血沉(ESR)、类风湿因子(RF)、C-反应蛋白(CRP)、免疫球蛋白的影响;有效病例继续治疗,并随访1-3年,以观察远期疗效。[结果]观察组对关节疼痛、肿胀、压痛及晨僵的改善优于对照组(P<0.05),而对ESR、CRP、IgG的影响也优于对照组(P<0.01)。有效病例随访3年,观察组22例中复发5例,占22.7％;对照组12例中,复发8例,占66.7％,两组比较具有显著性差异(P<0.05)。8周内观察组出现不良反应2例,占8.33％;对照组出现6例,占40％,两组比较有显著性差异(P<0.05)。[结论]益肾壮骨通痹汤内服外烫治疗类风湿关节炎的消炎、止痛、消肿和改善患者关节功能的疗效比英太青好,而且不良反应发生率低,远期疗效好。

Clinical Observation of Yishen Zhuanggu Tongbi Decoction in the Treatment of Rheumatoid Arthritis

[Objective] To evaluate the therapeutic effect of Chinese herbal medicine of Yishen Zhuanggu Tongbi Decoction (YZTD), a formula mainly composed of Radix Aconiti Lateralis Preparata, Hema Epimedii, Fructus Psoraleae,Rhizoma Chuanxiong, Radix Angelicae Sinensis, Radix Angelicae Pubescentis and Radix Dipsaci, for rheumatoid arthritis (RA). [Methods] Forty-four cases of RA were randomized into two groups: group A ( n = 24) was treated with YZTD for oral use and with the residue of YZTD for external application; group B ( n = 20) was treated with diclofenac sodium. After 8-week treatment, function of joint, adverse reactions, erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), C-reactive protein (CRP) and immunoglobulins levels were observed. Continuous treatment was given for the effective cases and a follow-up was conducted for 1 - 3 years to observe its long-term effect. [ Results ] Pain, swelling, tenderness and morning rigidity of the joints were improved much more in group A than those in group B ( P < 0.05); the effects of YZTD on ESR, CRP and IgG in group A were superior to those in group B ( P < 0.01). The 3-year follow-up in the effective cases showed that 5 cases of 22 in group A relapsed, accounting 22.7%; 8 cases of 12 relapsed in group B, accounting 66.7%; the difference was statistically different between two groups ( P < 0.05). During 8-week treatment, adverse reactions were found in 2 (8.33% ) cases of group A and in 6 (40% ) of group B, the difference being significant (P < 0.05). [Conclusion] The effects of YZTD for oral use and external application is better than that of diclofenac sodium in relieving inflammation and pain, subsiding swelling and improving function of joint, the incidence of adverse reactions being low and the long-term effect being good.