余海燕　彭剑虹　叶雪英

【摘要】 目的：觀察探讨来氟米特和白芍总苷联合甲氨蝶呤治疗类风湿关节炎的治疗效果及安全性，总结临床用药经验。方法：选择2015年8月-2017年8月本院收治的80例类风湿关节炎患者，按照随机数字表法将其均分为两组，各40例，对照组采取常规来氟米特联合甲氨蝶呤治疗，观察组在其基础上加用白芍总苷治疗，治疗后观察对比两组临床疗效与治疗期间药物不良反应。结果：观察组患者在治疗后第36周的ACR20、ACR50、ACR70缓解率均显著高于对照组（P<0.05）；两组患者治疗后第12、36周的晨僵时间、压痛指数、关节肿胀指数、DAS评分、CRP、RF、ESR、IL-1β、IL-6与治疗前相比，均有明显下降（P<0.05），而观察组下降程度更为显著（P<0.05）；观察组不良反应发生率为15.0%，对照组为22.5%，两组比较差异无统计学意义（P>0.05）。结论：来氟米特和白芍总苷联合甲氨蝶呤治疗类风湿关节炎的近远期疗效明显，能调节免疫和改善炎性状态，值得临床合理推广使用。

【关键词】 来氟米特； 白芍总苷； 甲氨蝶呤； 类风湿关节炎； 不良反应

Efficacy and Safety of Leflunomide and Total Glucosides of Paeony Combined with Methotrexate in the Treatment of Rheumatoid Arthritis/YU Haiyan，PENG Jianhong，YE Xueying.//Medical Innovation of China，2018，15（27）：00-012

【Abstract】 Objective：To observe the therapeutic effect and safety of Leflunomide and Total Glucosides of Paeony combined with Methotrexate in the treatment of rheumatoid arthritis（RA），and summarizing the experience of clinical use.Method：A total of 80 patients with RA admitted in our hospital from August 2015 to August 2017 were divided into two groups according to the random number table group，40 cases in each group.The control group was treated with conventional Leflunomide combined with Methotrexate，while the observation group was treated with Total Glucosides of Paeony on the basis of the control group.After treatment，the effect and the adverse drug reaction of two groups were observed and compared.Result：The remission rates of ACR20，ACR50 and ACR70 in the thirty-sixth weeks after treatment in the observation group were significantly higher than those in the control group（P<0.05）.After the twelfth，thirty-sixth weeks of treatment，the morning stiffness，pressure index，joint swelling index，DAS score，CRP，RF，ESR，IL-1βand IL-6 of two groups were significantly lower than those of before treatment（P<0.05），but the decline degree of the observation group was significantly lower than that in the observation group（P<0.05）.The incidence of adverse reactions in the observation group was 15.0%，the control group was 22.5%，and the adverse reaction rates of two groups was not significantly different（P>0.05）.Conclusion：The short-term and long-term effects of Leflunomide and Total Glucosides of Paeony combined with Methotrexate in the treatment of rheumatoid arthritis are obvious.It can regulate immunity and improve the inflammatory state.It is worth of popularizing in clinical practice.

【Key words】 Leflunomide； Total Glucosides of Paeony； Methotrexate； Rheumatoid arthritis； Adverse reactions.

First-authors address：Dongguan Hospital of Traditional Chinese Medicine，Dongguan 523000，China

doi：10.3969/j.issn.1674-4985.2018.27.003

类风湿关节炎（RA）是一种以慢性侵袭性关节滑膜炎为主要表现的全身性自身免疫疾病，致畸率高，病情具有持续性和反复发作的特点，若不能得到及时和有效的治疗，患者可发生不可逆的骨关节侵蚀性破坏，对患者日后的生活质量造成严重的影响[1]。目前临床以长期服用抗风湿药物联合非甾体类消炎止痛药或激素治疗为主[2]。本研究通过观察探讨来氟米特和白芍总苷联合甲氨蝶呤治疗类风湿关节炎的治疗效果及安全性，总结临床用药经验。现报道如下。

1 资料与方法

1.1 一般资料 选择2015年8月-2017年8月本院收治的80例类风湿关节炎患者，按照随机数字表法将其均分为两组，每组40例。纳入标准：（1）符合以下美国风湿病协会RA修订标准（1987）活动期的RA诊断标准至少3条：类风湿因子检测为阳性；……