张广辉 张超 郭占非

【摘 要】目的：观察顽痹形羸饮联合来氟米特治疗痰瘀痹阻型类风湿关节炎的临床疗效。方法：将99例痰瘀痹阻型类风湿关节炎患者随机分为治疗组50例和对照组49例。对照组口服来氟米特治疗，治疗组在对照组治疗基础上加服顽痹形羸饮。2组均以12周为1个疗程。观察2组临床疗效，以及治疗前后晨僵时间、视觉模拟评分法（VAS）评分、健康评价（HAQ指数）、关节肿胀数、关节压痛数，并观察2组不良反应发生率。结果：治疗组治愈25例，显效15例，有效8例，无效2例，总有效率为96.00%;对照组治愈16例，显效10例，有效13例，无效10例，总有效率为83.05%。2组比较，差异有统计学意义（P < 0.05）。治疗后，2组患者晨僵时间、VAS评分、HAQ指数、关节肿胀数、关节压痛数较治疗前均有改善（P < 0.05），且治疗组明显优于对照组（P < 0.05）。治疗组不良反应发生率为6.00%，对照组为26.53%，2组比较，差异有统计学意义（P < 0.05）。结论：顽痹形羸饮联合来氟米特治疗痰瘀痹阻型类风湿关节炎疗效较好，安全性较高，相关指标改善良好。

【关键词】 关节炎，类风湿;痰瘀痹阻型;顽痹形羸饮;临床疗效

【ABSTRACT】Objective：To observe the clinical effect of the treatment of rheumatoid arthritis of phlegm-stasis-obstruction type by the combination of Wanbi Xinglei Yin（顽痹形羸饮）and leflunomide.Methods：Ninety-nine patients with rheumatoid arthritis were randomly divided into a treatment group（50 cases）and a control group（49 cases）.The control group was treated with leflunomide，and the treatment group was treated with Wanbi Xinglei Yin based on the treatment for the control group.Both groups were treated for twelve weeks as a course of treatment.The clinical effect，morning stiffness time，VAS score，HAQ index，joint swelling and joint tenderness were observed before and after treatment，and the incidence of adverse reactions was also observed.Results：In the treatment group，25 cases were recovered，15 cases were markedly effective，8 cases were effective，2 cases were ineffective，and the total effective rate was 96.00%;while in the control group，16 cases were recovered，10 cases were markedly effective，13 cases were effective，10 cases were ineffective，and the total effective rate was 83.05%.There was no significant difference between the two groups（P < 0.05）.After the treatment，the morning stiffness time，VAS score，HAQ index，joint swelling and joint tenderness of the two groups were improved（P < 0.05），and the treatment group was significantly better than the control group（P < 0.05）.The incidence of adverse reactions was 6.00% in the treatment group and 26.53% in the control group.There was a statistical significance between both groups（P < 0.05）.Conclusion：The combination of Wanbi Xinglei Yin and leflunomide has a better curative effect in the treatment of rheumatoid arthritis of phlegm-stasis-obstruction type，with higher safety and better improved index.

【Keywords】 arthritis，rheumatoid;phlegm-stasis-obstruction type;Wanbi Xinglei Yin（頑痹形羸饮）;clinical efficacy

类风湿关节炎（rheumatoid arthritis，RA）为常见的风湿病，反复发作，缠绵不愈，病情较为复杂，易造成关节畸形及致残[1]。顽痹形羸饮为全国名老中医娄多峰治痹“虚邪瘀”理论的验证名方，主治邪结痰瘀证[2]。本文观察顽痹形羸饮对痰瘀痹阻型RA的临床疗效，现总结报告如下。

1 临床资料

1.1 一般资料 选取2017年1月至2019年8月在新乡市中心医院风湿免疫科就诊的痰瘀痹阻型RA患者99例，按照随机数字表法分为治疗组50例和对照组49例。治疗组男25例，女25例;年龄25～75岁，平均（40.82±6.23）岁;病程0.5～11年，平均（3.44±0.82）年;体质量60～80 kg，平均（70.41±1.65）kg。对照组男26例，女23例;年龄24～72岁，平均（41.12±6.37）岁;病程1～12年，平均（3.24±0.53）年;体质量60～80 kg，平均（70.40±1.62）kg。2组患者在性别、年龄、病程、体质量等方面比较，差异无统计学意义（P > 0.05），具有可比性。

1.2 诊断标准

1.2.1 西医诊断标准 按照中华医学会风湿病学分会《类风湿关节炎诊断及治疗指南》[3]标准。