[1]刘志宇,朱 琳.基于血清生化指标及DAS28、HAQ评分变化探究桂枝芍药知母汤联合西药在老年类风湿关节炎急性期治疗中的应用效果[J].陕西中医,2024,(5):638-641.[doi:DOI:10.3969/j.issn.1000-7369.2024.05.014]
 LIU Zhiyu,ZHU Lin.Application effect of Guizhi Shaoyao Zhimu decoction combined with western medicine on elderly patients with acute stage of rheumatoid arthritis based on changes in serum biochemical indicators,DAS28 score and HAQ score[J].,2024,(5):638-641.[doi:DOI:10.3969/j.issn.1000-7369.2024.05.014]
点击复制

基于血清生化指标及DAS28、HAQ评分变化探究桂枝芍药知母汤联合西药在老年类风湿关节炎急性期治疗中的应用效果
分享到:

《陕西中医》[ISSN:1000-7369/CN:61-1281/TN]

卷:
期数:
2024年5期
页码:
638-641
栏目:
临床研究
出版日期:
2024-05-05

文章信息/Info

Title:
Application effect of Guizhi Shaoyao Zhimu decoction combined with western medicine on elderly patients with acute stage of rheumatoid arthritis based on changes in serum biochemical indicators,DAS28 score and HAQ score
作者:
刘志宇1朱 琳2
(1.安徽中医药大学附属太和中医院中医风湿科,安徽 阜阳 236600; 2.安徽中医药大学,安徽 合肥 230031)
Author(s):
LIU ZhiyuZHU Lin
(Department of Chinese Medicine and Rheumatology,Taihe Hospital of Traditional Chinese Medicine,Anhui University of Traditional Chinese Medicine,Fuyang 236600,China)
关键词:
类风湿关节炎 急性期 桂枝芍药知母汤 来氟米特 关节功能 免疫功能 老年人
Keywords:
Rheumatoid arthritis Acute stage Guizhi Shaoyao Zhimu decoction Leflunomide Joint function Immune function Elderly
分类号:
R 593.22
DOI:
DOI:10.3969/j.issn.1000-7369.2024.05.014
文献标志码:
A
摘要:
目的:探究桂枝芍药知母汤联合西药治疗对风寒湿痹型老年类风湿关节炎(RA)急性期患者血清生化指标及DAS28、HAQ评分的影响。方法:选取风寒湿痹型老年RA急性期患者86例为研究对象,采用抽签法随机分为观察组(桂枝芍药知母汤联合来氟米特)及对照组(来氟米特)各43例,比较治疗前及治疗3个月后两组患者中医证候积分、血清生化指标[血沉(ESR)、C-反应蛋白(CRP)、类风湿因子(RF)水平、抗环瓜氨酸肽抗体(CCP)]、免疫功能指标[外周血CD4+T淋巴细胞水平(CD4+)、CD8+T淋巴细胞(CD8+)水平及其比值(CD4+/CD8+)]、关节功能恢复情况[28个关节病情活动指数(DAS28)、健康评价问卷得分(HAQ)],观察并记录两组患者治疗过程中不良反应情况。结果:与治疗前相比,观察组患者治疗3个月后血清生化指标、免疫功能指标(CD4+、CD4+/CD8+)、关节功能恢复情况均呈下降趋势,且观察组明显低于同期对照组(P<0.05); 观察组CD8+水平明显高于同期对照组(P<0.05); 两组患者不良反应发生比较均无统计学差异(P>0.05)。结论:桂枝芍药知母汤联合西药治疗可有效平衡患者免疫功能,降低其机体炎症水平,促进关节功能恢复,具有较好临床疗效。
Abstract:
Objective:To explore the influence of Guizhi Shaoyao Zhimu decoction combined with western medicine on serum biochemical indicators,DAS28 score and HAQ score in elderly patients with acute stage of rheumatoid arthritis(RA)of wind-cold-dampness arthralgia.Methods:86 elderly patients with RA of wind-cold-dampness arthralgia were randomly classified into observation group(Guizhi Shaoyao Zhimu decoction combined with leflunomide,43 cases)and control group(leflunomide,43 cases)by means of lottery method.The TCM syndromes scores,serum biochemical indicators [erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),rheumatoid factor(RF),cyclic citrullinated peptide(CCP)],immune function indicators [peripheral blood CD4+T lymphocyte(CD4+),CD8+T lymphocyte(CD8+)and CD4+/CD8+] and joint function recovery [Disease Activity Score 28-joint(DAS28),Health Assessment Questionnaire(HAQ)] were compared between both groups of patients before treatment and after 3 months of treatment.The adverse reactions in the two groups during treatment were observed and recorded.Results:Compared with before treatment,serum biochemical indicators,immune function indicators(CD4+,CD4+/CD8+)and joint function recovery in observation group showed downward trends after 3 months of treatment,and the observation group had significantly lower indicators than those in control group(P<0.05).The level of CD8+ in observation group was obviously higher(P<0.05).There were no significant differences in the adverse reactions between groups(P>0.05).Conclusion:The combination of Guizhi Shaoyao Zhimu decoction and western medicine can effectively balance the immune function of patients,reduce the body' s inflammation,and promote the recovery of joint function,and it has good clinical efficacy.

参考文献/References:

[1] 王灵锐,丛珊,王钰铭,等.天山雪莲口服液对类风湿关节炎的治疗作用及其机制研究[J].中国免疫学杂志,2022,38(15):1829-1832,1837.
[2] 安新,冯超,高利常.类风湿关节炎患者血清白细胞介素-32、白细胞介素-17和白细胞介素-10表达水平及临床意义[J].陕西医学杂志,2021,50(12):1585-1588.
[3] 郑戈,袁一孟,申利平.血清正五聚素蛋白3和Wnt-3α及Survivin对类风湿关节炎治疗反应性的预测价值[J].中华实用诊断与治疗杂志,2021,35(12):1270-1274.
[4] 冯贺龙,张福利.分消走泄方作用于NLRP3炎症小体改善类风湿性关节炎的机制研究[J].川北医学院学报,2023,38(3):294-298.
[5] 顾向浩,陈鹏,朱琳,等.蠲痹汤辅助治疗类风湿关节炎活动期的疗效观察[J].中国中西医结合杂志,2021,41(7):812-816.
[6] 李顺,莫南文,李勤勇.羌活秦艽方对风寒湿痹型类风湿关节炎临床疗效、炎症因子及MMPs水平影响[J].中华中医药学刊,2023,41(1):39-42.
[7] 张国英,吉福玲,赵小强,等.桂枝芍药知母汤治疗风寒湿痹型膝骨性关节炎发作期急性炎症[J].辽宁中医杂志,2022,49(5):135-138.
[8] 中华医学会风湿病学分会.2018中国类风湿关节炎诊疗指南[J].中华内科杂志,2018,57(4):242-251.
[9] 中华中医药医学会.痹证诊疗指南[J].中国中医药现代远程教育,2011,9(11):148-149.
[10] 中华人民共和国卫生部.中药新药临床研究指导原则试行[M].北京:中国医药科技出版社,2002:361-390.
[11] 李健,赵雪峰,桂凤娇,等.火把花根片联合来氟米特治疗类风湿性关节炎的临床研究[J].现代药物与临床,2022,37(10):2333-2338.
[12] 惠晓艳,张芳,王晨,等.黄芪五藤汤联合甲氨蝶呤治疗类风湿关节炎气虚络阻证的临床疗效[J].中华中医药杂志,2022,37(8):4877-4880.
[13] 吕建敏,刘广宇,赵海河,等.温针灸配合独活寄生汤治疗类风湿性关节炎临床研究[J].陕西中医,2022,43(11):1613-1616,1620.
[14] 曹玉举.娄多峰“虚、邪、瘀”理论论治类风湿关节炎[J].中华中医药杂志,2018,33(2):569-571.
[15] 马威,孙海超,毕荣修.桂枝芍药知母汤加减对风寒湿痹型膝骨关节炎患者疗效及炎性细胞因子的影响[J].广州中医药大学学报,2021,38(2):284-288.
[16] 李进,史载祥.《金匮要略?中风历节病脉证并治》中风病范畴探析[J].中医杂志,2020,61(12):1033-1036.
[17] 吴凤嘉.桂枝芍药知母汤联合西药对寒热错杂型类风湿关节炎患者C反应蛋白、类风湿因子水平的影响[J].辽宁中医杂志,2021,48(3):134-136.
[18] 段怡帆,邢月蒙,康良琦,等.雷火灸联合中药熏洗在前交叉韧带重建术后早期康复中的效果观察[J].广州中医药大学学报,2022,39(10):2326-2334.
[19] 李嘉旗,卲轶群,许玲,等.知母皂苷AⅢ通过JAK-2/STAT3/PD-L1信号通路增加A549/DDP对顺铂的敏感性[J].中国药理学通报,2023,39(4):658-664.
[20] 宋仙芝,王治斌,颉敏琴.颉敏琴运用桂枝芍药知母汤治疗寒热错杂型类风湿性关节炎经验[J].湖南中医杂志,2018,34(8):35-36.
[21] 王蝶,尹思思,张宝成,等.基于“主客交”探讨桂枝芍药知母汤治疗类风湿性关节炎的理论机制[J].四川中医,2022,40(6):16-19.
[22] 王英辉,邹太艳,苏瑞,等.肿节风药渣绿色制备纳米银及体外抗癌作用研究[J].中草药,2022,53(7):1964-1972.
[23] 刘志队,史丽璞.加味桂枝芍药知母汤对活动期寒热错杂型类风湿关节炎患者ESR、CRP和RF调控作用分析[J].陕西中医,2019,40(1):82-84.
[24] 吕魁,孙俊峰,杨健鹰.血清C反应蛋白、降钙素原、D-二聚体在急性胰腺炎患者中的表达及与严重程度床边指数和肺损伤的相关性[J].陕西医学杂志,2023,52(10):1375-1378.
[25] 管咏梅,万鑫浩,吴文婷,等.经典名方桂枝加葛根汤标准汤剂HPLC指纹图谱研究[J].中草药,2021,52(18):5535-5542.
[26] 贾淑媛,李萍.淋巴细胞亚群在类风湿关节炎患者外周血中的表达及意义[J].中国实验诊断学,2019,23(11):1943-1946.
[27] 马永梅,樊荣.传染性单核细胞增多症患儿血清Toll样受体2、Toll样受体9与外周血T淋巴细胞亚群变化及临床意义[J].陕西医学杂志,2022,51(11):1416-1419.
[28] 张猛,曹国璠,李金玲,等.土壤改良剂对连作白术的品质、发病率及根部土壤酶活性的影响[J].中药材,2021,44(4):793-797.

相似文献/References:

[1]刘志队,史丽璞.加味桂枝芍药知母汤对活动期寒热错杂型类风湿关节炎患者ESR、CRP和RF调控作用分析*[J].陕西中医,2019,(1):82.
[2]倪丹红,刘 丹,吕琴琴,等.秦息痛片联合传统抗风湿药治疗早期活动性 类风湿关节炎临床研究*[J].陕西中医,2019,(4):484.
[3]刘志队,史丽璞,张铁峰.加味桂枝芍药知母汤治疗寒热错杂型类风湿关节炎临床研究*[J].陕西中医,2019,(7):906.
 LIU Zhidui,SHI Lipu,ZHANG Tiefeng..Clinical analysis of modified Guizhi Fuyao Zhimu decoction in treating cold and hot miscellaneous rheumatoid arthritis[J].,2019,(5):906.
[4]李 锐,叶冰玉△,刘佳钰,等.活血通络汤辨治类风湿关节炎合并肺间质纤维化临床研究*[J].陕西中医,2019,(8):1041.
 LI Rui,YE Bingyu,LIU Jiayu,et al.Brief analysis of Huoxue Tongluo decoction on differentiation and treatment of rheumatoid arthritis with pulmonary interstitial fibrosis[J].,2019,(5):1041.
[5]李 良,孙银娣,李亚峰,等.四妙二藤汤联合双氯芬酸钠对类风湿关节炎患者关节情况、炎症指标和复发率的影响[J].陕西中医,2019,(10):1397.
 LI Liang,SUN Yindi,LI Yafeng,et al.Effect of Simiao Erteng decoction combined with diclofenac sodium on joint condition,inflammation index and recurrence rate in patients with rheumatoid arthritis[J].,2019,(5):1397.
[6]尚 磊,刘 茜△.断藤益母汤甲氨喋呤联合对类风湿性关节炎患者DAS28评分和炎症指标的影响*[J].陕西中医,2019,(10):1400.
 SHANG Lei,LIU Qian..Effect of Duanteng Yimu decoction and methotrexate on DAS28 Score and inflammatory indicators in rheumatoid arthritis patients[J].,2019,(5):1400.
[7]刘 茜,樊亚红△,陈爱林,等.秦息痛药液外敷治疗类风湿关节炎疗效评价*[J].陕西中医,2019,(10):1403.
 LIU Qian,FAN Yahong,CHEN Ailin,et al.Evaluation of the therapeutic effect of external application of Qinxitong liquid onrheumatoid arthritis[J].,2019,(5):1403.
[8]尚磊,李映雪△.补肾通痹汤联合雷公藤多苷治疗老年类风湿关节炎疗效研究*[J].陕西中医,2019,(11):1552.
 SHANG Lei,LI Yingxue..Effect of Bushen Tongbi decoction combined with tripterygium wilfordii polyglycosides in the treatment of eldery rheumatoid arthritis[J].,2019,(5):1552.
[9]杨庆万,安 阳△,项飞燕,等.引火汤对类风湿关节炎患者骨代谢的影响*[J].陕西中医,2020,(1):73.
 YANG Qingwan,AN Yang,XIANG Feiyan,et al.Effect of Yinhuo decoction on bone metabolism in patients with rheumatoid arthritis[J].,2020,(5):73.
[10]田杰祥,王 钢,王 佳,等.中医外治法治疗类风湿关节炎滑膜炎研究进展*[J].陕西中医,2020,(1):131.
 TIAN Jiexiang,WANG Gang,WANG Jia,et al.Research progress of external treatment in the 〖JZ〗treatment of rheumatoid arthritis synovitis[J].,2020,(5):131.

备注/Memo

备注/Memo:
基金项目:安徽省抗癌协会临床肿瘤协作专业委员会重点研究课题(ACC0-2021-01-01); 安徽省阜阳市卫生健康委员会科研项目(FY2021-098); 安徽中医药大学临床科研项目(2023LCTH36)
更新日期/Last Update: 2024-05-09