蠲痹汤加减联合甲氨喋呤及来氟米特治疗活动期类风湿性关节炎寒湿痹阻证临床观察

目的:观察蠲痹汤加减内服外洗治疗活动期类风湿性关节炎(RA)寒湿痹阻证的疗效以及对血清和关节液中基质金属蛋白酶-3(MMP-3)和金属蛋白酶抑制剂-1(TIMP-1)水平的影响。方法:选择RA患者共120例,参照数字表法随机分为治疗组和对照组,每组均60例;两组均依据《类风湿关节炎诊断及治疗指南》给予非药物治疗;对照组给予甲氨喋呤片(10 mg/次,1次/周),来氟米特片(10 mg/次,1次/d);治疗组在对照组用药基础上给予蠲痹汤加减内服(1剂/d,早晚煎煮口服)和外洗(药渣熏洗病变部位2次/d,30 min/次)治疗,治疗12周。比较两组中医临床症状评分以及血沉(ESR),类风湿因子(RF)和C反应蛋白(CRP)水平;检测两组血清和关节液中MMP-3和TIMP-1水平。结果:治疗组总有效率为96.67%,明显高于对照组的83.33%(P0.05);治疗组治疗12周后患者中医症状各指标评分均显著低于对照组(P0.01);治疗组治疗后ESR,RF,CRP,血清和关节液中MMP-3水平均明显低于对照组,而TIMP-1水平明显高于对照组,比较差异有统计学意义(P0.01)。结论:在常规西医用药基础上,蠲痹汤加减内服外洗治疗活动期RA寒湿痹阻证可明显改善临床症状,降低ESR,RF,CRP水平,提高临床疗效,下调血清和关节液中MMP-3水平而上调TIMP-1水平是其可能机制。

Effect of Juanbi Decoction Combied with Methotrexate and Leflunomide Tablets on Active Stage Rheumatoid Arthritis with Cold Dampness Syndrome

Objective: To observe the effect of oral and fumigation-washing administration of Juanbi decoction on active stage rheumatoid arthritis (RA) with cold dampness syndrome and investigate its effect on levels of matrix metalloproteinase-3(MMP-3) and tissue inhibitor of metalloproteinase-1(TIMP-1) in serum and synovial fluid. Method: One hundred and twenty RA patients were randomly divided into control group and treatment group by random number table, n=60 in each group. Patients in both groups were treated with non-drug therapy referring to Guidelines on Diagnosis and Treatment of RA. Patients in control group were also treated with methotrexate tablets (10 mg/time, 1 time/week) and leflunomide tablets (10 mg/time and 1 time/day). Based on the treatment of control group, patients in treatment group were also given with oral and fumigation-washing administration of Juanbi decoction,1dose/d and tid for oral, plus fumigation-washing, 2 times/d and 30 min/time. Both groups were treated for 12 weeks. Scores of Chinese medicine clinical symptoms and levels of erythrocyte sedimentation rate (ESR), rheumatoid factors (RF) and C reactive protein (CRP) levels were compared between two groups. Levels of MMP-3 and TIMP-1 levels in serum and synovial fluid were detected. Result: The total rate was 96.67% in treatment group, significantly higher than 83.33% in control group (P<0.05). After 12 weeks' treatment, scores of Chinese medicine clinical symptoms in treatment group were significantly lower than those in control group (P<0.01). After treatment, ESR, RF, and CRP levels as well as MMP-3 level in serum and synovial fluid in treatment group were significantly lower than those in the control group, while TIMP-1 level was significantly higher than that in control group, with statistical difference (P<0.01). Conclusion: Based on routine western medicine treatment, oral and fumigation-washing administration of Juanbi decoction for active stage RA with cold dampness syndrome could obviously improve clinical symptoms, decrease ESR, RF, and CRP levels, and elevate clinical efficacy. Its action mechanism may be associated with down-regulation of MMP-3 and up-regulation of TIMP-1 in serum and synovial fluid.