类风湿性关节炎症状与疗效关系的回归分析

目的:运用回归分析方法,探讨类风湿性关节炎(rheumatoid arthritis, RA)症状与中、西药治疗疗效之间的关系.方法:413例确诊为活动期RA的病例来自9个临床中心,随机分成中药治疗组209例和西药治疗组204例.西药治疗方案包括非甾体抗炎药和慢作用药,中药治疗方案包括基础治疗和辨证用药.治疗前后收集患者的18项常见症状.疗效评价采用美国风湿病学会20%改善标准(the American college of rheumatology 20, ACR20)进行判断.数据分析主要采用Logistic回归和卡方检验.结果:中药治疗组中,关节疼痛、关节压痛和夜尿增多症状与治疗12周的疗效相关,其中关节疼痛和关节压痛症状与疗效呈正相关,夜尿增多则呈负相关;关节压痛、发热和小便黄浊症状与治疗24周的疗效相关,其中关节压痛、发热与疗效呈正相关,小便黄浊则呈负相关.西药治疗组中,关节压痛、口渴和眩晕症状与治疗12周的疗效相关,其中关节压痛、口渴与疗效呈正相关,眩晕则呈负相关;关节压痛、肢体困重症状与治疗24周的疗效相关,其中关节压痛与疗效呈正相关,肢体困重则呈负相关.将回归分析结果中显示的相关性症状列入治疗的适应证,分析后的结果表明:中、西药治疗组的疗效均有所提高.结论:中、西药治疗RA的疗效与一些症状之间存在一定的相关性,应加强症状对疗效影响的研究,将症状纳入药物治疗的适应证.

Correlations of clinical symptoms and treatment efficacy in patients with rheumatoid arthritis treated with Chinese herbal drugs or Western medicine

Objective: To evaluate the correlations between clinical symptoms and treatment efficacy in patients with rheumatoid arthritis RA.Methods: Four hundred and thirteen patients were included in the clinical trial from 9 clinical centers.They were randomly divided into Western medicine-treated group with 204 cases and Chinese herbal drug-treated group with 209 cases.Eighteen clinical symptoms were evaluated before and after treatment.The Western medicine therapy included voltaren extended release tablets, methotrexate and sulfasalazine.The Chinese herbal drug therapy included glucosidorum Tripterygii totorum tablets and Yishen Juanbi Tablets combined with treatment based on syndrome differentiation.The American college of rheumatology 20 ACR20 was used as efficacy evaluation criteria.Results: In the Chinese herbal drug-treated group,clinical symptoms such as arthralgia and tenderness of joints were positively correlated with the efficacy after 12-week treatment,while frequent urination at night was negatively correlated.In the same group,tenderness of joints and fever were positively correlated with the efficacy after 24-week treatment,while deep-colored and turbid urine was negatively correlated.In the Western medicine-treated group,tenderness of joints and thirst were positively correlated with the efficacy after 12-week treatment,while vertigo was negatively correlated.And in the same group,tenderness of joints was positively correlated with the efficacy after 24-week treatment,while heaviness of limbs was negatively correlated to the efficacy.The statistical results showed that the treatment efficacy was improved when the correlated symptoms were included in the indications.Conclusion: The treatment efficacy of RA is correlated with some symptoms,so further studies should proceed on these correlations in order to achieve better treatment outcome.