杞菊地黄汤加减联合甲氨蝶呤治疗类风湿关节炎的临床疗效

doi:10.3760/cma.j.cn441417-20240802-13024

摘要/Abstract

摘要：

目的　分析杞菊地黄汤加减联合甲氨蝶呤治疗类风湿关节炎（RA）肝肾亏虚证的效果。方法　回顾性分析2019年4月至2024年4月汉中市中医医院收治的118例肝肾亏虚证RA患者，按照不同治疗方法分为两组。对照组57例中男32例、女25例，年龄（56.50±4.85）岁，病程（2.45±0.41）年。观察组61例中男36例、女25例，年龄（55.81±4.93）岁，病程（2.64±0.43）年。两组均给予非甾体抗炎药、抗风湿药、糖皮质激素、生物制剂等治疗。对照组采取甲氨蝶呤治疗，口服，每周1次，4片/次。观察组在对照组基础上加用杞菊地黄汤加减治疗，取药汁200 ml，早、晚分别温服。两组均持续治疗4周。对比两组疗效、中医证候评分（主症、次症评分）、炎症指标（C反应蛋白、红细胞沉降率、类风湿因子）、疾病活动性指标［28处关节疾病活动性评分（DAS28）、临床疾病活动指数（CDAI）］、骨代谢指标［碱性磷酸酶（ALP）、Ⅰ型胶原羟基端肽β降解产物（β-CTX）、骨钙素］和不良反应。采用χ²检验、t检验进行统计分析。结果　观察组总有效率高于对照组［96.72%（59/61）比80.70%（46/57）］，差异有统计学意义（χ²=7.714，P=0.005）。治疗4周后，观察组的主症、次症、DAS28、CDAI评分分别为（2.56±0.38、8.26±1.74、2.32±0.58、8.26±1.04）分，均低于对照组的（4.08±0.41、10.25±1.86、3.74±0.69、11.74±1.68）分；观察组的C反应蛋白、红细胞沉降率、类风湿因子、ALP、β-CTX水平分别为（18.63±2.84）mg/L、（21.52±3.74）mm/h、（93.52±12.84）U/ml、（70.26±4.26）U/L、（0.72±0.08）µg/L，对照组分别为（32.89±3.01）mg/L、（36.05±4.08）mm/h、（137.45±15.96）U/ml、（79.18±4.24）U/L、（0.79±0.09）µg/L；观察组的骨钙素水平高于对照组［（39.84±4.85）µg/L比（34.05±4.38）µg/L］；上述指标比较，差异均有统计学意义（均P<0.05）。两组不良反应总发生率差异无统计学意义（P>0.05）。结论　杞菊地黄汤加减联合甲氨蝶呤治疗肝肾亏虚证RA患者疗效显著，可改善骨代谢指标，减轻机体炎症状态，降低疾病活动度，临床用药安全性尚可。

关键词: 类风湿关节炎, 杞菊地黄汤, 甲氨蝶呤, 肝肾亏虚证, 疗效

Abstract:

Objective　To analyze the effect of Qiju Dihuang decoction combined with methotrexate in the treatment of liver and kidney deficiency syndrome of rheumatoid arthritis (RA). Methods　A retrospective analysis was conducted on 118 RA patients with liver and kidney deficiency syndrome admitted to Hanzhong Traditional Chinese Medicine Hospital from April 2019 to April 2024. Patients were divided into two groups based on different treatment methods. The control group consisted of 57 patients, including 32 males and 25 females, aged (56.50±4.85) years and a disease duration of (2.45±0.41) years. The observation group included 61 patients, comprising 36 males and 25 females, aged (55.81±4.93) years and a disease duration of (2.64±0.43) years. Both groups received treatment with non-steroidal anti-inflammatory drugs, anti-rheumatic drugs, glucocorticoids, and biological agents. The control group was treated with methotrexate, oral, once a week, 4 tablets/time. On the basis of the control group, the observation group was treated with Qiju Dihuang decoction, 200 ml of medicine juice was taken, and warmed in the morning and evening respectively. Both groups were treated for 4 weeks. The curative effect, Traditional Chinese Medicine (TCM) syndrome scores (main and secondary symptom scores), inflammatory indicators (C-reactive protein, erythrocyte sedimentation rate, rheumatoid factor), disease activity indicators [Disease Activity Score in 28 joints (DAS28), Clinical Disease Activity Index (CDAI)], bone metabolism index [alkaline phosphatase (ALP), type I collagen hydroxyl terminal peptide beta degradation products (β-CTX), osteocalcin], and adverse reactions were compared between the two groups. Statistical analysis was performed using χ² tests and t tests. Results　The total effective rate in the observation group was higher than that in the control group [96.72% (59/61) vs. 80.70% (46/57)], with a statistically significant difference (χ²=7.714, P=0.005). After 4 weeks of treatment, the main symptom scores, secondary symptom scores, DAS28, and CDAI in the observation group were (2.56±0.38, 8.26±1.74, 2.32±0.58, 8.26±1.04) points, all lower than those in the control group (4.08±0.41, 10.25±1.86, 3.74±0.69, 11.74±1.68) points. The levels of C-reactive protein, erythrocyte sedimentation rate, rheumatoid factor, ALP, and β-CTX in the observation group were (18.63±2.84) mg/L, (21.52±3.74) mm/h, (93.52±12.84) U/ml, (70.26±4.26) U/L, and (0.72±0.08) µg/L, respectively, while in the control group they were (32.89±3.01) mg/L, (36.05±4.08) mm/h, (137.45±15.96) U/ml, (79.18±4.24) U/L, and (0.79±0.09) µg/L. The osteocalcin level in the observation group was higher than that in the control group [(39.84±4.85) µg/L vs. (34.05±4.38) µg/L]. Comparisons of the above indicators showed statistically significant differences (all P<0.05). The overall incidence of adverse reactions did not differ significantly between the two groups (P>0.05). Conclusion　Qiju Dihuang decoction combined with methotrexate shows significant efficacy in treating RA patients with liver and kidney deficiency syndrome, improving bone metabolism indicators, reducing the inflammatory state of the body, and lowering disease activity, with acceptable clinical safety.

Key words: Rheumatoid arthritis, , Qiju Dihuang , decoction, , Methotrexate, , Liver and kidney deficiency syndrome, , Curative effect

张敏张靖琨杨健伟宋雪红.

杞菊地黄汤加减联合甲氨蝶呤治疗类风湿关节炎的临床疗效 [J]. 国际医药卫生导报, 2025, 31(13): 2231-2236.

Zhang Min, Zhang Jingkun, Yang Jianwei, Song Xuehong.

Clinical efficacy of Qiju Dihuang decoction combined with methotrexate in treatment of rheumatoid arthritis [J]. International Medicine and Health Guidance News, 2025, 31(13): 2231-2236.

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