卞小芳 杨杰 许超 徐伟 苏克雷 王志衡 林聃 华迪 曹鹏 胡春萍

【摘 要】 目的：觀察自拟搜风散结方联合西药治疗痰瘀痹阻型类风湿关节炎的临床疗效。方法：选取痰瘀痹阻型类风湿关节炎患者80例，采用简单随机分组的方法分为对照组与观察组各40例。对照组予基础治疗;观察组给予基础治疗加自拟搜风散结方，每组治疗周期均为2个月，观察两组治疗前后中医证候疗效变化，评估其有效性。结果：对照组的总有效率45%，观察组中医证侯疗效的总有效率95%，明显优于对照组，差异有统计学意义（P<0.01）。两组关节疼痛、关节压痛数、关节肿胀数、晨僵时间、双手平均握力四项均有明显改善，差异有统计学意义（P<0.05），且观察组对于上述主要症状、体征的改善优于对照组，差异有统计学意义（P<0.01）。两组疗效比较，对照组的总有效率50%，观察组总有效率97.5%，差异有统计学意义（P<0.01）。结论：自拟搜风散结方联合西药治疗痰瘀痹阻型类风湿关节炎显著有效。

【关键词】 自拟搜风散结方;类风湿关节炎;临床疗效

【中图分类号】R593.2   【文献标志码】 A    【文章编号】1007-8517（2021）19-0101-05

Clinical Observation of Soufeng Sanjie Formula in theTreatment of Middle and Late Rheumatoid Arthritis （Phlegm and Blood Stasis Syndrome

BIAN Xiaofang1 YANG Jie2 XU Chao2 XU Wei2 SU Kelei2 WANG Zhiheng2 LIN Dan2 HUA Di2 CAO Peng2 HU Chunping2*

1.Wujin Hospital of Traditional Chinese Medicine， Changzhou 213161，China; 2.Affiliated Hospital of Integrated Traditional Chinese and Western Medicine， Nanjing University of Chinese Medicine， Nanjing 210028，China

Abstract：Objective To observe the clinical efficacy of self-made Soufeng Sanjie prescription combined with western medicine in the treatment of rheumatoid arthritis of phlegm and blood stasis.Methods 80 patients with rheumatoid arthritis （phlegm and blood stasis obstruction syndrome） were randomly divided into control group （n=40） and observation group （n=40）. Methods： eighty patients with rheumatoid arthritis （phlegm and blood stasis obstruction syndrome） were randomly divided into control group （n=40） and observation group （n=40）. The control group was given basic treatment， and the observation group was given self-made Soufeng Sanjie prescription plus basic treatment. The treatment cycle of each group was 2 months. The curative effect changes of TCM syndromes in the two groups before and after treatment were observed and its effectiveness was evaluated.Results the total effective rate of the control group was 45%， and that of the observation group was 95%， which was significantly better than that of the control group （P<0.01）. The joint pain， the number of joint tenderness， the number of joint swelling， the time of morning stiffness and the average grip strength of both hands were significantly improved between the two groups （P<0.05）， and the improvement of the above main symptoms and signs in the observation group was better than that in the control group （P<0.01）. The difference was statistically significant （P<0.01）. Compared with the curative effect of the two groups， the total effective rate of the control group was 50%， and that of the observation group was 97.5%， and the difference was statistically significant （P<0.01）.Conclusion self-made Soufeng Sanjie prescription combined with western medicine is effective in the treatment of rheumatoid arthritis of phlegm and blood stasis.

Key words：Self-made Soufeng Sanjie Formula; Rheumatoid Arthritis; Clinical Effect

类风湿关节炎（Rheumatoid arthritis，RA）被称为“不死的癌症”，是以侵蚀性多关节炎为主要表现的全身性自身免疫病[1]。RA早期表现为对称性关节炎，晚期关节僵硬和畸形，是一种致残率高、危害性大的常见病、疑难病[2]。全世界范围内有0.5%～1%的成人发病，且女性发病率高于男性[3]。我国RA患病率约为0.3%～0.42%，有超过500万人口长期受到RA症状的困扰，特别是在经济欠发达地区RA流行更为严重。患者常常因为疾病失去工作能力而导致家庭经济困难和社会负担的增加[4]。

RA中晚期多为痰瘀痹阻证，顽固难愈。搜风散结方由全蝎、蜈蚣、黄芪等中药组成，虫类药具有搜剔窜透、攻毒散结、通络止痛之功效。课题组前期研究表明，以虫类药为主的搜风散结方具有双重调节作用，可有效缓解临床RA患者症状，并明显改善骨侵蚀;同时动物实验发现，搜风散结方能有效缓解CIA小鼠关节的肿胀及降低关节滑膜的损伤，明显减轻CIA小鼠的骨侵蚀，对促炎细胞因子和破骨细胞分化的关键蛋白RANKL均有抑制作用。……