肖智 胡筱薇 卿照前

摘要 目的：研究外敷透骨血竭散对类风湿性关节炎活动期抗环瓜氨酸多肽抗体（anti-CCP）、糖蛋白（DKK-1）的影响。方法：选取2017年3月至2018年3月长沙市第三医院收治的类风湿性关节炎患者100例作为研究对象，按照随机数字表法随机分为对照组和观察组，每组50例。对照组使用来氟米特片治疗，观察组患者使用来氟米特片联合外敷透骨血竭散治疗。比较2组患者临床指标，评价治疗前后中医证候情况，检测患者治疗前后肠球菌表面蛋白（ESP）、类风湿因子（RF）、DKK-1、Anti-CCP、白细胞介素-1（IL-1）、白细胞介素-6（IL-6）、肿瘤坏死因子（TNF-α）、超敏C反應蛋白（Hs-CRP）水平。结果：治疗后2组患者临床指标、中医证候评分、ESP、RF、DKK-1、Anti-CCP、IL-1、IL-6、TNF-α、Hs-CRP水平均低于治疗前（P<0.05）;且治疗后观察组临床指标、HAQ评分、中医证候评分、ESP、RF、DKK-1、Anti-CCP、IL-1、IL-6、TNF-α、Hs-CRP水平均低于对照组（P<0.05）。结论：运用外敷透骨血竭散对类风湿性关节炎患者治疗可直接用于病灶处，能迅速缓解关节疼痛，减轻患者痛苦，改善症状。

关键词 类风湿性关节炎;抗环瓜氨酸多肽抗体;糖蛋白;透骨血竭散;抗环瓜氨酸多肽抗体

Effect of External Application of Tougu Xuejie Powder on Anti-CCP and DKK-1 in Active Rheumatoid Arthritis

XIAO Zhi1，HU Xiaowei1，QING Zhaoqian2

（1 Department of Integrated Traditional Chinese and Western Medicine，the Third Hospital of Changsha，Changsha 410000，China; 2 Department of Internal Medicine，Changsha Hospital of Traditional Chinese Medicine，Changsha 410000，China）

Abstract Objective：To study the effect of external application of Tougu Xuejie Powder on anti-cyclic citrullinated polypeptide antibody （anti-CCP） and glycoprotein （DKK-1） in active rheumatoid arthritis.Methods：A total of 100 patients with rheumatoid arthritis admitted to the Third Hospital of Changsha from March 2017 to March 2018 were selected as the research objects and were randomly divided into an observation group and a control group，with 50 cases in each group.The control group used Leflunomide tablets and the observation group used leflunomide tablets combined with Tougu Xuejie Powder for external application.The clinical indicators of the 2 groups of patients were compared.The clinical indicators of the two groups of patients were compared.The TCM syndromes before and after treatment were evaluated.The levels of Enterococcus surface protein （ESP），rheumatoid factor （RF），DKK-1，anti CCP，interleukin-1 （IL-1），interleukin-6 （IL-6），tumor necrosis factor （TNF-α），and high-sensitivity C-reactive protein （hs CRP） were detected before and after treatment.Results：After treatment，the clinical indicators，TCM syndrome score，ESP，RF，DKK-1，Anti-CCP，IL-1，IL-6，TNF-α，Hs-CRP levels in the 2 groups were lower than those before treatment （P<0.05）; and after treatment，the clinical indicators，HAQ score，TCM syndrome score，ESP，RF，DKK-1，Anti-CCP，IL-1，IL-6，TNF-α，Hs-CRP levels in the observation group were lower than those in the control medication group （P<0.05）.Conclusion：External application of Tougu Xuejie Powder combined with leflunomide tablets in the treatment of patients with rheumatoid arthritis can be directly applied to the lesion，and can quickly relieve joint pain，relieve the patient′s pain and improve symptoms.

Keywords Rheumatoid arthritis; Anti-CCP; DKK-1; Tougu Xuejie Powder; Anti-cyclic citrulline peptide antibody

中图分类号：R593.22文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.03.022

类风湿性关节炎是一种对称性、多关节的全身性自身免疫疾病。此病症，出现在各个年龄段，会对身体造成不同程度的损伤，如关节破坏、畸形、残疾等，最终丧失劳动能力，严重威胁着患者的生命健康和日常生活[1]。目前临床治疗此病症主要是通过免疫抑制剂等抗炎药来进行治疗，这些西药普遍价格高，不良反应大，患者依赖性高，长期服用还会诱发耐药等不良反应。中医治疗历史悠久，中药膏对缓解病症具有起效快、费用低、使用便捷、患者易于接纳等优势，是良好的治疗途径。但目前临床上无特效治疗类风湿关节炎的方案，常采用抗炎药治疗以减轻症状，但效果不佳[2]。……