化痰祛瘀蠲痹方治疗类风湿关节炎随机对照探究.doc

化痰祛瘀蠲痹方治疗类风湿关节炎随机对照探究摘 要：目的:观察中药化痰祛瘀蠲痹方治疗类风湿关节炎(RA)的临床疗效、促进西药减量及稳定病情作用，以初步探讨中药化痰祛瘀蠲痹方治疗RA疗效及的机理。方法:70例RA患者随机分为两组，中药化痰祛瘀蠲痹方加西药治疗组（中药治疗组）35例，西药对照组35例，其中西药对照组口服甲氨喋呤（MTX，每周1次，每次7.5mg），柳氮磺吡啶片（每天3次，每次0.5g），美洛昔康片（莫比可，每天2次，每次7.5mg）。中药治疗组在口服上述西药的同时，加用化痰祛瘀蠲痹方治疗，疗程3个月。观察临床疗效，治疗前后症状、体征及实验室指标变化，西药用量和治疗后3个月病情复发情况。结果:中药治疗组的总有效率优于西药对照组（P＜0.05）；在改善症状体征（关节疼痛度、肿胀度、压痛度、活动度、握力、晨僵）的积分，与治疗前及对照组治疗后比较差异有显著性（P＜0.05或P＜0.01）；中药治疗组的美洛昔康及MTX的用量（P＜0.05或P＜0.01）。两组在改善RF、ESR、CRP、PLT、Ig等指标，与治疗前比较差异有显著性（P＜0.05或P＜0.01），中药治疗组治疗后上述指标改善优于西药对照组（P＜0.05或P＜0.01）。结论:中药化痰祛瘀蠲痹方加西药治疗RA的疗效优于单独西药治疗，具有促进西药减量作用。温化蠲痹方具有抗炎等免疫调节作用，可能通过抑制RF、Ig等达到治疗RA的作用。 关键词：化痰祛瘀蠲痹方；类风湿关节炎 中图分类号：R593.21文献标识码：B文章编号：1673-7717(2011)12-2808-03 Effects of Wenhua Juanbi Rescription on TNF-α and IL-1β in Peripheral Blood of Rheumatoid Arthritis Patients HAN Shuli1, SONG Yawei2 (1.Xixi Community Health Center, Hangzhou 310012,Zhejiang,China; 2.Lingyin Community Health Center Hangzhou 310003,Zhejiang,China) ________________________________________ 收稿日期：2011-07-15 作者简介：韩树利（1962-），男，辽宁大连人，副主任医师，研究方向：全科、综合内科临床。Abstract:Objective:To observe the clinical effect on promoting doses decrease of western medicine and stabilizing patients condition of Wenhua Juanbi Rescription in treating rheumatoid arthritis(RA).To study the effects of Wenhua Juanbi Prescription on TNF-α,IL-1β and anti-cyclic citrullinated peptide(CCP) antibody in peripheral blood of RA patients,and to explore the mechanism of Wenhua Juanbi Prescription treating RA preliminary.Methods:One hundred patients with RA were randomly divided into 2 groups,50 in each group:the control group were treated with oral administration of methotrexate （MTX，7.5mg，qw），sulfasalazine（0.5g，tid），meloxicam（Mobic，7.5mg，bid）.The Chinese herbs treatment group were treated with Wenhua Juanbi Prescription and western medicine.The therapeutic course for both groups was 3 months.Clinical effect after treatment,changes of symptoms and physical signs before treatment,the doses of western m