梅莎莎　宋恩峰　项琼

摘要 目的：探讨健脾生血颗粒治疗类风湿关节炎并发缺铁性贫血的临床疗效及作用机制。方法：选取2017年1月至2018年12月武汉大学人民医院中医科收治的类风湿关节炎并发缺铁性贫血的患者87例作为研究对象，随机分为观察组（n=47）和对照组（n=40）。2组患者均口服来氟米特和甲氨蝶呤片。对照组给予福乃得口服治疗。观察组给予健脾生血颗粒口服。2组连续治疗8周后观察患者的中医证候积分变化、血生化及铁蛋白指标指标变化、类风湿因子（RF）、红细胞沉降率（ESR）、C-反应蛋白（CRP）水平、基础药物治疗效果、不良反应发生情况。结果：治疗后观察组的中医证候积、RF、ESR、CRP、总铁结合力水平均明显低于对照组（P<0.05），而RBC、Hb、MCV、MCH、MCHC、血清铁水平均明显高于对照组（P<0.05），2组药物不良反应及基础药物疗效比较差异均无统计学意义（P>0.05）。结论：健脾生血颗粒治疗类风湿关节炎并发缺铁性贫血有显著疗效。

关键词 健脾生血颗粒;类风湿关节炎;缺铁性贫血

Clinical Observation on Jianpi Shengxue Granules in the Treatment of Iron-deficiency Anemia in Patients with Rheumatoid Arthritis

MEI Shasha，SONG Enfeng，XIANG Qiong

（Department of Traditional Chinese Medicine，Renmin Hospital of Wuhan University，Wuhan 430060，China）

Abstract Objective：To investigate the clinical effects and the action mechanism of Jianpi Shengxue Granules on iron-deficiency anemia in the patients with rheumatoid arthritis.Methods：A total of 87 cases of iron-deficiency anemia with rheumatoid arthritis admitted to Department of Traditional Chinese Medicine of Renmin Hospital of Wuhan University were randomly into a treatment group（n=47）and a control group（n=40）.All patients were treated with methotrexate and leflunomide tablets.The control group was given Funaide oral liquid and the treatment group was treated with Jianpi Shengxue Granules.After 8 weeks of continuous treatment，the changes of TCM syndrome scores，blood biochemical and ferritin index，rheumatoid factor（RF），erythrocyte sedimentation rate（ESR），C-reactive protein（CRP）level，and the effect of basic drug treatment and adverse reactions were observed.Results：After treatment，the TCM syndrome score，RF，ESR，CRP，total iron binding level in the treatment group were significantly lower than those in the control group（P<0.05），while the RBC，Hb，MCV，MCH，MCHC，serum iron were significantly higher the control group（P<0.05）.There was no significant difference in the adverse reactions and curative effects of basic drugs between the 2 groups（P>0.05）.Conclusion：Jianpi Shengxue Granules have good curative effects on iron-deficiency anemia in patients with rheumatoid arthritis.

Keywords Jianpi Shengxue Granules; Rheumatoid arthritis; Iron-deficiency anemia

中圖分类号：R242文献标识码：Adoi：10.3969/j.issn.1673-7202.2020.15.014

类风湿关节炎（Rheumatoid Arthritis，RA）是一种以关节滑膜炎和关节外病变为主要表现的慢性自身免疫性疾病，其临床表现为多发对称性小关节肿胀、疼痛、僵硬、变形及活动受限[1]，临床上常采用非甾体类抗炎药进行抗炎治疗。但若长期服用此类药物可造成消化道慢性出血，因此RA患者的贫血发生率较高，其中以缺铁性贫血（IDA）最为常见，其发病机制为铁代谢异常导致的铁吸收减少。其中，贫血的严重程度与疾病的活动呈正相关，贫血越严重，导致病情预后越差[3]，因此有效改善贫血症状对控制RA患者的病情具有重要意义。健脾生血颗粒作为临床治疗缺铁性贫血的常用中成药补铁制剂，具有健脾和胃，养血补血、理气安神等功效[4]，在临床上治疗RA合并缺铁性贫血（气血两虚型）疗效显著。……