谭锦辉 李博 黄海 佘若男 吴系美

[摘要] 目的 分析風湿清合剂联合甲氨蝶呤治疗活动期类风湿关节炎（ARA）的效果。 方法 选择广东省深圳市龙华区人民医院风湿科2015年1月～2018年6月收治的60例ARA患者，根据随机数字表法分为对照组（n = 30）和观察组（n = 30）。对照组采用甲氨蝶呤治疗，观察组采用风湿清合剂联合甲氨蝶呤治疗，3个月后比较两组主要症状疗效、疼痛视觉模拟（VAS）评分、骨密度、白细胞介素-17（IL-17）、肿瘤坏死因子-α（TNF-α）水平及不良反应发生率。 结果 观察组治疗前晨僵时间、关节压痛数、关节肿胀数、疼痛VAS评分与对照组比较，差异无统计学意义（P > 0.05）;观察组治疗后的晨僵时间、关节压痛数、关节肿胀数、疼痛VAS评分均明显少于对照组，差异有统计学意义（P < 0.05）。观察组治疗前骨密度、IL-17、TNF-α与对照组比较，差异无统计学意义（P > 0.05）;观察组治疗后骨密度高于对照组，IL-17、TNF-α均低于对照组，差异有统计学意义（P < 0.05）。观察组不良反应发生率低于对照组，差异有统计学意义（P < 0.05）。 结论 与单纯甲氨蝶呤治疗比较，风湿清合剂联合甲氨蝶呤治疗的效果更加显著，可有效改善患者临床症状，提高骨密度，降低炎性因子水平，且不良反应发生率低。

[关键词] 风湿清合剂;甲氨蝶呤;类风湿关节炎;作用机制

[中图分类号] R593.2          [文献标识码] A          [文章编号] 1673-7210（2019）03（c）-0158-04

[Abstract] Objective To analyze the effect of Fengshiqing Mixture combined with Methotrexate on the treatment of active rheumatoid arthritis （ARA）. Methods From January 2015 to June 2018， 60 ARA patients admitted to the Department of Rheumatology in Shenzhen Longhua District People′s Hospital of Cuangdong Province were selected. According to the random number table method， the patients were divided into control group （n = 30） and observation group （n = 30）. The control group was treated with Methotrexate， while the observation group was treated with Fengshiqing Mixture combined with Methotrexate. After 3 months， the efficacy of main symptoms， pain visual analogue scale （VAS） score， bone mineral density， interleukin-17 （IL-17）， tumor necrosis factor-α（TNF-α） and adverse reaction rate were compared between the two groups. Results The time of morning stiffness， number of joint tenderness， number of joint swelling and VAS pain score in the observation group were not significantly different from those in the control group （P > 0.05）. The time of morning stiffness， number of joint tenderness， number of joint swelling and VAS pain score in the observation group after treatment were significantly less than those in the control group， with statistically significant differences （P < 0.05）. There was no significant difference in bone mineral density， IL-17， TNF-α between the observation group and the control group before treatment （P > 0.05）， after treatment， bone mineral density in the observation group was higher than that in the control group， and IL-17 and TNF-α were lower than those in the control group， with statistically significant differences （P < 0.05）. The adverse reaction rate in the observation group was lower than that in the control group， and the difference was statistically significant （P < 0.05）. Conclusion Compared with single Methotrexate treatment， Fengshiqing Mixture combined with Methotrexate treatment has a more significant effect， which can effectively improve the clinical symptoms of patients， improve bone density， reduce the level of inflammatory factors， and have a low adverse reaction rate.

[Key words] Fengshiqing Mixture; Methotrexate; Rheumatoid arthritis; Mechanism of action

类风湿关节炎（RA）属于人体自身免疫性疾病，临床症状表现为患病关节及周围组织的进行性破坏、关节肿胀、疼痛、畸形，受損关节发生功能障碍等[1]。RA处于活动期时若得不到及时有效的治疗，极易致残。西医治疗该病主要采用抗风湿药及非甾体类抗炎药，经积极治疗后虽能在一定程度上缓解病情，但并不能完全阻止其病情的进展[2]。近年来，人们对中医的认识不断深入，对RA的中医药治疗也更加关注。中医治疗RA，注重辨病施治、辨证论治，可有效延缓病情的进展，提升患者生活质量[3]。本研……