李婷 郑宝林 叶美杏

[摘要] 目的 探討活络通痹丸联合甲氨蝶呤治疗类风湿关节炎（RA）的临床效果。 方法 选择2017年1月～2018年12月广东省佛山市中医院收治的RA患者85例，依照随机数字表法将其分为对照组（43例）和观察组（42例）。对照组采用甲氨蝶呤治疗，观察组采用活络通痹丸联合甲氨蝶呤治疗，两组均连续治疗12周。治疗后进行临床疗效评价。比较两组的关节肿胀个数、关节压痛个数、晨僵时间及双手握力。比较两组治疗前后的类风湿因子（RF）、红细胞沉降率（ESR）、C反应蛋白（CRP）、基质金属蛋白酶-1（MMP-1）、基质金属蛋白酶-3（MMP-3）水平及治疗过程中的不良反应。 结果 观察组的临床总有效率高于对照组，差异有统计学意义（P < 0.05）。两组治疗后关节肿胀个数、关节压痛个数均少于治疗前，晨僵时间短于治疗前，双手握力高于治疗前（P < 0.05），且观察组上述指标改善情况均优于对照组（P < 0.05）。两组治疗后RF、ESR及CRP水平均明显低于治疗前（P < 0.05），且观察组低于对照组（P < 0.05）。两组治疗后血清MMP-1、MMP-3水平均明显低于治疗前（P < 0.05），且观察组明显低于对照组（P < 0.05）。两组治疗过程中均无严重的不良反应发生。 结论 活络通痹丸联合甲氨蝶呤治疗RA的临床效果显著，能明显改善临床症状，降低血清MMP-1、MMP-3水平，且安全性较好。

[关键词] 类风湿关节炎;活络通痹丸;甲氨蝶呤;疗效

[中图分类号] R274          [文献标识码] A          [文章编号] 1673-7210（2020）07（a）-0128-05

[Abstract] Objective To explore clinical efficacy of Huoluo Tongbi Pills combined with Methotrexate in the treatment of rheumatoid arthritis （RA）. Methods Eighty-five patients with RA admitted to Foshan Hospital of Traditional Chinese Medicine from January 2017 to December 2018 were divided into control group （43 cases） and observation group （42 cases） according to the random number table method. Control group was treated with Methotrexate， while observation group was treated with Huoluo Tongbi Pills combined with Methotrexate. Two groups were treated for 12 weeks. Clinical efficacy was evaluated after treatment. The joint swelling number， joint tenderness number， morning stiffness times and hands grip strengths were compared between two groups. The levels of rheumatoid factors （RF）， erythrocyte sedimentation rate （ESR）， C-reactive protein （CRP）， matrix metalloproteinase-1 （MMP-1） and matrix metalloproteinase-3 （MMP-3） of two groups were compared before and after treatment. The adverse reactions of two groups during treatment were compared. Results Total effective rate of observation group was significantly higher than that of control group， the difference was statistically significant （P < 0.05）. After treatment， the number of joint swelling and joint tenderness in two groups were less than those before treatment， the time of morning stiffness was shorter than that before treatment， and the hand grip strength was higher than that before treatment （P < 0.05）; the improvement of the above indexes in observation group was better than that in control group （P < 0.05）. After treatment， the levels of RF， ESR and CRP in two groups were significantly lower than those before treatment （P < 0.05）， and those in observation group were lower than those in control group （P < 0.05）. The levels of MMP-1 and MMP-3 in two groups after treatment were significantly lower than those before treatment （P < 0.05）， and the level in observation group was significantly lower than that in control group （P < 0.05）. During treatment， there was no serious adverse reactions of two groups. Conclusion Huoluo Tongbi Pills combined with Methotrexate in the treatment of RA has a good efficacy， it can improve the clinical symptoms， reduce the serum levels of MMP-1 and MMP-3， and has good safety.

[Key words] Rheumatoid arthritis; Huoluo Tongbi Pills; Methotrexate; Efficacy

类风湿关节炎（RA）是一种临床常见的全身性免疫疾病，其主要特征为全身多发性小关节肿痛、关节滑膜炎，临床主要表现为对称性关节晨僵、肿痛，甚至畸形，能累及全身含有滑膜组织的所有关节，尤其好发于手和足部，具有病情易反复、致残率高的特点[1]。RA多发生在女性群体，在我国的发病率高达0.4%，且近年来的发病率越来越高，对患者及其家庭带来极大的负担[2]。目前，临床治疗RA主要采用控制风湿病情和延缓风湿病情的措施，其中甲氨蝶呤是最常用的药物，能有效改善临床症状，且有价格低廉的优势，然而对于部分患者的疗效仍然不甚理想，且病情容易反复[3]。近年来，中医药在治疗RA方面的应用受到人们的广泛关注。……