【摘要】 目的:探讨应用独活寄生汤联合美洛昔康治疗类风湿性关节炎(RA)的临床疗效以及对血清中白细胞介素-1(IL-1),肿瘤坏死因子-α(TNF-α)和黏附分子(ICMAM-1)水平的影响。方法:选取南京中医药大学第一附属医院2012年4月—2014年12月收治的92例类风湿性关节炎患者,按照随机数字表法分为两组,对照组45例患者给予美洛昔康口服(15 mg/次,1次/d)以及对症支持治疗,试验组47例患者在对照组治疗的基础上加服独活寄生汤进行治疗。疗程均为12周。观察并记录两组患者治疗前后的临床症状,如晨僵时间、肿胀指数、压痛指数、20 m步行时间、双手握力和日常生活能力的健康评价问卷评分(HAQ);同时检测治疗前后患者的C-反应蛋白(CRP),血沉(ESR),类风湿因子(RF),IL-1,TNF-α,ICMAM-1的水平。结果:根据美国风湿病学会所推荐的关于RA病情改善标准进行临床疗效的判定,试验组患者的总有效率为97.9%,明显高于对照组的82.2%(P<0.05)。治疗12周后,两组患者的晨僵时间、肿胀指数、压痛指数、20 m步行时间、双手握力和HAQ指标均明显改善,与治疗前比较差异显著(P<0.01);试验组患者上述各指标方面的改善程度较对照组明显(P<0.01)。两组患者的CRP,ESR,RF,IL-1,TNF-α,ICMAM-1水平均明显降低,与治疗前比较差异显著(P<0.01);试验组患者上述各指标降低程度较对照组更为明显(P<0.01)。结论:独活寄生汤联合美洛昔康治疗RA临床效果良好,并能够显著改善患者的临床症状,同时对机体的炎症反应也有一定的抑制作用,值得临床推广使用。更多还原

【Abstract】 Objective: To investigate the clinical efficacy of Duhuo Jisheng Tang combined with meloxicam in the treatment of rheumatoid arthritis( RA),and observe its effect on serum interleukin-1( IL-1),tumor necrosis factor-α( TNF-α) and intercellular adhesion molecule( ICMAM-1) levels. Method: The 92 cases of rheumatoid arthritis in our hospital from April 2012 to December 2014 were selected as the research objects,and were divided into two groups according to the random number table method. Patients in control group( 45 cases)were treated with meloxicam( 15 mg·time- 1,1 time·d- 1) by orally taking,and also with symptomatic and supportive treatment. Patients in test group( 47 cases) were also given with Duhuo Jisheng Tang based on treatment in control group. Treatment course was 12 weeks for both groups. Clinical symptoms in both groups were observed and recorded before and after treatment,such as morning stiffness time,swelling index,tenderness index,20 m walking time,two-hand grip and activities of daily living score in Health Assessment Questionnaire( HAQ). In addition,C-reactive protein( CRP) treatment,erythrocyte sedimentation rate( ESR),rheumatoid factor( RF),IL-1,TNF-α and ICMAM-1 levels were detected before and after treatment. Result: According to standards on RA conditions recommended by American College of Rheumatology,total effective rate was 97. 9% in test group,significantly higher than 82. 2% in control group( P < 0. 05). After treatment for 12 weeks,duration of morning stiffness,swelling index,tenderness index,20 m walking time,hand grip and HAQ indexes were significantly improved in both groups,with significant difference when compared with conditions before treatment( P < 0. 01).Improvement degree in above indexes in test group was more significant than that in control group,with significant difference( P < 0. 01). Levels of CRP,ESR,RF,IL-1,TNF-α,and ICMAM-1 were significantly decreased in both groups,with significant difference when compared with the conditions before treatment( P < 0. 01). Decrease degree in above indexes in test group was more significant than that in control group,with significant difference( P < 0. 01). Conclusion: Duhuo Jisheng Tang combined with meloxicam in the treatment of RA has good clinical effect,significantly improves the clinical symptoms of patients,and has certain inhibitory effect on the body’s inflammatory response,worthy of clinical use.更多还原