武晔++王晓磊++姜淑华++左俊水++刘核达++胡丽伟

【摘 要】目的：观察银苓消肿丸对湿热痹阻型类风湿关节炎的临床疗效及对外周血中白细胞介素（IL）-1、IL-6和B淋巴细胞刺激因子（BlyS）的影响。方法：将100例湿热痹阻型类风湿关节炎患者随机分为治疗组和对照组，每组50例。对照组采用来氟米特和甲氨蝶呤治疗，治疗组在对照组的基础上加用银苓消肿丸治疗。2组均以16周为1个疗程。观察2组临床疗效及治疗前后晨僵时间、关节压痛数、关节肿胀数、红细胞沉降率（ESR）、C-反应蛋白（CRP）、IL-1、IL-6、BlyS的变化。结果：治疗组显效8例，有效17例，改善22例，无效3例，总有效率为94.00%；对照组显效6例，有效14例，改善19例，无效11例，总有效率为78.00%。2组比较，差异有统计学意义（P < 0.05）。治疗后，2组晨僵时间、关节压痛数、关节肿胀数、ESR、CRP、IL-1、IL-6、BlyS含量较治疗前均有改善（P < 0.01或P < 0.05），且治疗组优于对照组（P < 0.05）。结论：慢作用抗风湿药联合银苓消肿丸治疗类风湿关节炎具有较好的临床疗效，对改善关节功能及降低活动期炎性指标具有较好的作用，且能明显降低外周血清中IL-1、IL-6、BlyS的表达水平。

【关键词】 关节炎，类风湿；银苓消肿丸；湿热痹阻型；IL-1；IL-6；BlyS

【ABSTRACT】Objective：To observe the effect of Yinling Xiaozhong Wan（银苓消肿丸）on the expression

of IL-1，IL-6 and BlyS in serum of patients with damp-heat-bi-obstruction rheumatoid arthritis.Methods：One hundred cases of damp-heat-bi-obstruction rheumatoid arthritis were randomly and equally divided into a treatment group and a control group.The control group was treated with leflunomide and methotrexate，and the treatment group was treated with Yinling Xiaozhong Wan based on the treatment for the control group.Both groups were treated for 16 weeks as a course，observing their clinical efficacy and the changes of the time of morning stiffness，joint tenderness，swollen joint count，erythrocyte sedimentation rate（ESR），C-reactive protein（CRP），IL-1，IL-6 and BlyS before and after treatment.Results：In the treatment group，8 cases were markedly effective，17 cases were effective，22 cases were improved，and 3 cases were ineffective.The total effective rate was 94%.In the control group，6 cases were markedly effective，14 cases were effective，19 cases were improved，

11 cases were ineffective，and the total effective rate was 78%.The difference between the two groups was statistically significant（P < 0.05）.After treatment，the time of morning stiffness，joint tenderness，joint swelling，ESR，CRP，and the contents of IL-1，IL-6 and BlyS in both groups were improved compared with those before treatment（P < 0.01 or P < 0.05），and the treatment group was better than the control group（P < 0.05）.Conclusion：Yinling Xiaozhong Wan，in combination with other medicinals with slow action，has a good clinical effect of improving joint function，reducing the inflammatory activity index and lowering the expression levels of IL-1，IL-6 and BlyS in peripheral serum.

【Keywords】 arthritis，rheumatoid；Yinling Xiaozhong Wan（银苓消肿丸）；damp-heat-bi-obstruction type；

IL-1；IL-6；BlyS

类风湿关节炎（rheumatoid arthritis，RA）是一种主要侵犯小关节，以慢性、对称性、周围性多关节炎症为主要临床表现的自身免疫性疾病，病理特征为滑膜炎。RA患者关节破坏可影响生活质量，同时更容易发生心血管事件。目前，在RA发病机制中，白细胞介素（IL）-1、IL-6、B淋巴细胞刺激因子（BlyS）占據很重要的地位。湿热痹阻型RA在临床中很常见，银苓消肿丸具有清热利湿、活血祛瘀、消肿止痛的作用，在临床上适用于湿热痹阻型痹病的治疗，是本院治疗湿热痹阻型痹病的验方。笔者采用慢作用抗风湿药联合银苓消肿丸治疗RA患者50例，现总结报告如下。

1 临床资料

1.1 一般资料 选取2016年2月至2016年9月在本院就诊的住院RA患者100例，采用随机数字表及对照的试验设计方法分为治疗组和对照组，每组50例。……