甲氨蝶呤联合枸橼酸托法替布片治疗4种中医证型类风湿关节炎临床疗效比较

刘禹全 吕新亮

【摘 要】目的：对甲氨蝶呤联合枸橼酸托法替布片治疗4种中医证型类风湿关节炎的临床疗效进行比较。方法：选取100例类风湿关节炎患者，分别为风湿痹阻证、寒湿痹阻证、湿热痹阻证、肝肾不足證各25例。均给予甲氨蝶呤片联合枸橼酸托法替布片口服治疗。4组疗程均为12周。观察4组患者中医证候疗效，以及治疗前后中医证候积分、红细胞沉降率（ESR）、超敏C反应蛋白（hs-CRP）、抗环瓜氨酸肽抗体（抗CCP抗体）以及28个关节的疾病活动度（DAS28）有效应答率。结果：治疗后，4组中医证候积分、ESR、hs-CRP、抗CCP抗体较治疗前均有改善（P < 0.05）;且风湿痹阻证组、寒湿痹阻证组、湿热痹阻证组的中医证候疗效、中医证候积分、抗CCP抗体、DAS28有效应答率均明显高于肝肾不足证组（P < 0.05）。结论：甲氨蝶呤联合枸橼酸托法替布片治疗类风湿关节炎风湿痹阻证、寒湿痹阻证、湿热痹阻证疗效优于肝肾不足证。

【关键词】 类风湿关节炎;中医分型;甲氨蝶呤;枸橼酸托法替布片;临床疗效

Comparison of Clinical Efficacy of Methotrexate Combined with Tofatib Citrate in the Treatment of Four TCM Syndrome Types of Rheumatoid Arthritis

LIU Yu-quan，LYU Xin-liang

【ABSTRACT】Objective：To compare the clinical efficacy of methotrexate combined with tofatib citrate in the treatment of four TCM syndrome types of rheumatoid arthritis.Methods：One hundred patients with rheumatoid arthritis were selected，including 25 cases of rheumatism obstruction syndrome，25 cases of cold damp obstruction syndrome，25 cases of damp heat obstruction syndrome and 25 cases of liver and kidney deficiency syndrome.All patients were treated with methotrexate tablets combined with tofatib citrate tablets.The course of treatment for the four groups was 12 weeks.Observe the curative effect of TCM syndrome of the four groups，and the effective response rates of TCM syndrome score，erythrocyte sedimentation rate（ESR），high-sensitivity C-reactive protein（hs-CRP），anti cyclic citrullinated peptide antibody（anti-CCP antibody）and disease activity of 28 joints（DAS28）before and after treatment.Results：After treatment，TCM syndrome scores，ESR，hs-CRP and anti-CCP antibody in the four groups were improved compared with those before treatment（P < 0.05）;the TCM syndrome efficacy，TCM syndrome score，anti-CCP antibody，and DAS28 effective response rate of the rheumatism syndrome group，the cold damp syndrome group and damp heat syndrome group were significantly higher than those of the liver and kidney deficiency syndrome group（P < 0.05）.Conclusion：The curative effect of methotrexate combined with tofatib citrate in the treatment of rheumatoid arthritis with rheumatism obstruction syndrome，cold dampness obstruction syndrome and damp heat obstruction syndrome is better than that with liver and kidney deficiency syndrome.

【Keywords】 rheumatoid arthritis;TCM classification;methotrexate;tofatib citrate tablets;clinical efficacy

类风湿关节炎（rheumatoid arthritis，RA）主要表现为以双手、腕、膝、距小腿和足关节等小关节受累为主的对称性、持续性多关节炎[1]。RA在各年龄中皆可发病，发病率随年龄增长而逐渐增高，其中50岁以上的女性发病率较高，我国为0.3%～0.6%[2]。早期干预对RA患者的预后有积极作用，如果没有得到有效、规范的治疗，几乎所有的患者都会有不同程度的关节功能丧失，甚至失去自理能力，带来严重的问题。因此，有学者将其描述为“5D”，即不适、抑郁、残疾、死亡和花费钱财[3]。

RA的治疗是多方面的，药物治疗的目的在于减轻症状，控制病情发展，尽可能保持受累关节的功能，减少关节破坏以达到较长时间的临床缓解。西医学治疗RA主要采用非甾体抗炎药、改善病情抗风湿药、糖皮质激素、生物制剂、血浆置换或免疫吸附等。中医治疗RA依据辨证论治的原则，通过辨病结合辨证的方法，采用中药口服联合外用，多种途径实现个体化和整体化相结合以提高临床疗效[4]。……