历节清饮治疗类风湿关节炎(湿热痹阻证)的临床研究

摘要

目的 观察历节清饮治疗类风湿关节炎(湿热痹阻证)的临床疗效并探讨其机制.方法 将64例患者按随机数字表法分为观察组与对照组各32例.对照组予甲氨蝶呤、来氟米特等常规抗风湿治疗,观察组在对照组基础上服用历节清饮,疗程均为12周.比较两组患者治疗前后关节肿胀数、关节压痛数、晨僵持续时间、视觉模拟量表(VAS)评分、双手握力、20 m步行时间等临床指标,血沉(ESR)、类风湿因子(RF)、C反应蛋白(CRp)等实验室指标及血常规、尿常规、大便常规、肝肾功能等安全性指标.结果 两组治疗后关节肿胀数、关节压痛数、晨僵持续时间、VAS评分、双手握力及20 m步行时间等,与本组治疗前比较均显著改善 (P<0.05),观察组改善程度均优于对照组(P<0.05);两组治疗后RF、ESR、CRp均显著降低(P<0.05),观察组降低程度大于对照组(P<0.05).观察组治疗总有效率为93.75%,明显高于对照组的75.00%(P<0.05).观察组有2例胃肠道不良反应,对照组有4例胃肠道不良反应、3例肝功能异常.结论 历节清饮联合西医治疗类风湿关节炎(湿热痹阻证),可有效缓解临床症状体征、降低炎症反应、减缓病情进展,且不良反应少.%Objective:To observe the clinical effect of Lijieqing Decoction on RA with moist heat arthralgia spasm syndrome. Methods:64 cases Rheumatoid Arthritis were randomly divided into the observation group(32 cases)and the control group (32 cases)according to random number table method.The control group was treated with Methotrexate and Leflunomide Tablets. The observation group were given Lijieqing Decoction on the basis of the control group. The course of treatment was 12 weeks.The clinical indexes,including the number of joint swelling,joint tenderness,duration of morning stiffness,VAS score,two-hand grip and 20 m walking time,the lab-oratory indicators,including erythrocyte sedimentation rate,rheumatoid factor and C-reactive protein,and the safety indicators,including blood routine,urine routine,stool routine and liver and kidney function were compared between the two groups before and after treatment. Results:Compared with before treatment,it was significantly improved in joint swelling,joint tenderness,duration of morning stiffness,VAS score,two-hand grip and 20 m walking time,and so on (P<0.05). The improvement of the observation group was better than that of the control group(P<0.05). RF,ESR and CRp were significantly decreased after treatment in the two groups(P<0.05). The degree of reduction in the observation group was greater than that of the control group (P<0.05). The effective rate of treatment in the observation group was 93.75%,significantly higher than that of the control group(75%)(P<0.05).There were 2 cases of gastrointestinal adverse reactions in the observation group,4 cases of gastrointesti-nal ADR in the control group and 3 cases of abnormal liver function in the control group. Conclusion:The treat-ment of Lijieqing Decoction combined with Western medicine on RA with moist heat arthralgia spasm syndrome can effectively alleviate the clinical symptoms and signs,reduce inflammation,slow down the progress of the dis-ease,with fewer adverse reactions.