解毒通络祛湿法治疗活动期类风湿性关节炎的临床研究

目的:探讨解毒通络祛湿法治疗类风湿性关节炎(RA)的综合临床疗效和安全性。方法:将106例活动期的RA患者随机分为中西结合组54例与西药组52例。中西结合组采用中医解毒通络祛湿法结合柳氮磺吡啶(SASP)治疗,西药组采用甲氨喋呤(MTX)加SASP治疗。比较观察2组关节晨僵时间、压痛指数、肿胀指数、功能指数、双手握力和20m步行时间,以及血沉(ESR)、类风湿因子(RF)、C反应蛋白(CRP)、补体C3、免疫球蛋白(IgG、IgA、IgM)等指标,总结其临床疗效与副作用发生情况。结果:中西结合组的临床显效率为77.78%,总有效率为90.74%,明显高于西药组(59.62%和71.15%,P<0.01)。治疗后2组关节晨僵时间、压痛指数、肿胀指数、功能指数、双手握力和20m步行时间(s)等均明显缓解(P<0.01),中西结合组临床表现缓解更为显著(P<0.05);两组ESR、RF、CRP均有明显改善(P<0.05);中西结合组在ESR、RF、CRP、补体C3和IgA的改善方面均优于西药组(P<0.05)。副作用主要有胃肠道反应、白细胞减少、肝功能异常、皮疹和月经失调等,中西结合组的总发生率为7.41%,显著低于西药组(15.38%,P<0.01)。结论:解毒通络祛湿法结合MTX治疗活动期RA的临床综合疗效优于MTX加SASP等单纯西药治疗,且副作用低,安全性好,值得临床推广应用。

The Cclinical Research of the Jiedu Tongluo Qushi Principle on Treating the Rheumatoid Arthritis in Active Stage

Objective:To explore the clinical curative effect and safety of Jiedu Tongluo Lishi decoction on treating active rheumatoid arthritis(RA).Methods:106 cases of RA in active period were randomly divided into the integrated Chinese and western medicine group(n=54) and western medicine group(n=52).The former group were treated by Jiedu Tongluo Lishi decoction combined with SASP,the latter by MTX combined with SASP.The arthritis morning stiffness time,ache indexes,tumidness indexes,function indexes,hands grip,20-m walking time and experimental indexes including ESR,RF,CRP,C_3,immune globin of both groups were observed and compared.Results:The obviously clinical effective ratio and the total clinical effective ratio in the former group were 77.78% and 90.74% respectively,which are better than those in the latter group(59.62% and 71.15% respectively)(P<0.01).The arthritis morning stiffness time,ache indexes,tumidness indexes,function indexes,hands grip and 20-m walking time in both groups were obviously released after treatment(P<0.01).The clinical release in the former group was better than that in the latter group(P<0.05).ESR,RF and CRP in both groups were markedly improved(P<0.05).The improvement of ESR,RF,CRP,C_3 and IgA in the former group were better than those in the latter group(P<0.05).The side effect includes gastroenteric tract reaction,decrease of leucocyte,abnormity of liver function,tetter and catamenia maladjustment.The occurent ratio in the former group was 7.41%,which was obviously lower than that in the latter group(15.38%)(P<0.01).Conclusion: The compositively clinical curative effect of Jiedu Tongluo Lishi decoction combined with MTX on treating RA is obviously better than that of western medicine only such as MTX and SASP,with less side effect and higher safety,which is worth applying in clinics extensively.