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目的:探讨宣痹消痛方联合甲氨蝶呤片治疗类风湿关节炎(湿热痹阻证)的临床疗效及对抗环瓜氨酸肽抗体(抗-CCP),抗聚角蛋白微丝蛋白抗体(AFA)和肿瘤坏死因子-α(TNF-α)的影响。方法:95例RA患者随机按数字表法分为对照组46例和观察组49例,两组均给予口服甲氨蝶呤片,7.5~20mg/次,1次/周;美洛昔康片,7.5~15mg/次,1次/d;对照组口服白芍总苷胶囊,2粒/次,3次/d;观察组采用宣痹消痛汤内服。两组疗程均为4个月。记录治疗前后关节晨僵时间、休息痛(采用视觉模拟评分法,VAS),关节压痛数和肿胀指数(包括28个关节)、肿胀关节指数、双手握力及日常生活能力健康评估(HAQ)变化情况;检测治疗前后血沉(ESR),C-反应蛋白(CRP),类风湿因子(RF),抗-CCP,AFA和TNF-α水平。结果:经Ridit分析,观察组临床疗效优于对照组(P<0.05);治疗后观察组关节晨僵时间、休息痛、关节压痛数和肿胀指数、肿胀关节指数和HAQ和双手握力的改善优于对照组(P<0.01);观察组ESR,CRP和RF水平均低于对照组(P<0.01);观察组抗-CCP,AFA和TNF-α水平均低于对照组(P<0.01)。结论:在甲氨蝶呤片等治疗的基础上加服宣痹消痛汤能减轻临床症状、体征,控制疾病的活动度,减轻RA骨和软骨损坏,临床疗效优于白芍总苷胶囊。
Objective: To investigate the clinical efficacy of Xuanbi Xiaotong Decoction combined with methotrexate in the treatment of rheumatoid arthritis (damp-heat block syndrome) and its clinical efficacy and anti-cyclic citrullinated peptide antibody (anti-CCP) (AFA) and tumor necrosis factor-α (TNF-α). Methods: Ninety-five patients with RA were randomly divided into control group (n = 46) and observation group (n = 49) by digital table method. Both groups were given oral methotrexate tablets, 7.5-20mg / time, once / , 7.5 ~ 15mg / time, 1 time / d; the control group oral administration of total glucosides capsule of paeony, 2 capsules / time, 3 times / d; Two groups of treatment are 4 months. Resting pain (visual analogue scale, VAS), joint tenderness and swelling index (including 28 joints), swollen joint index, two-hand grip and changes of daily living ability (HAQ) were recorded before and after treatment. (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-CCP, AFA and TNF-α were measured before and after treatment. Results: The Ridit analysis showed that the clinical efficacy of the observation group was better than that of the control group (P <0.05). After the treatment, the morning stiffness time, rest pain, joint tenderness and swelling index, swelling joint index, HAQ and handshake improvement (P <0.01). The levels of ESR, CRP and RF in the observation group were lower than those in the control group (P <0.01). The levels of anti-CCP, AFA and TNF-α in the observation group were lower than those in the control group . Conclusion: Adding Xuanbi Xiaotong Decoction on the basis of methotrexate tablets can reduce clinical symptoms and signs, control disease activity, and alleviate the damage of RA bone and cartilage. The clinical efficacy is superior to that of total glucosides of paeony.