中药对难治性类风湿关节炎激素的增效作用

作者	单位
刘维	天津中医药大学第一附属医院天津300193
刘晓亚	天津中医药大学第一附属医院天津300193
王熠	天津中医药大学第一附属医院天津300193
张磊	天津中医药大学第一附属医院天津300193
岳敏	天津中医药大学第一附属医院天津300193
房丹	天津中医药大学第一附属医院天津300193
张宏博	天津中医药大学第一附属医院天津300193

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中文摘要:

目的探讨中药对难治性类风湿关节炎(rheumatoid arthritis,RA)患者使用激素的增效作用。方法采用随机对照方法,将120例难治性RA患者分为两组。治疗组口服清痹片,对照组肌肉注射甲氨喋呤(MTX)、口服扶他林缓释片75mg、羟基氯喹0.2g,每日1次。两组均口服泼尼松,治疗组泼尼松起始量小于对照组。每2周记录临床指标、泼尼松用量及药物不良反应情况。结果使用美国风湿病学院(ACR)发布的RA病情改善及临床缓解标准评定疗效,两组差异无显著性(P>0.05)。两组患者治疗后临床及实验室指标较治疗前差异有显著性(P<0.05)。其中治疗组的休息痛、患者评价、医生评价3项指标较对照组差异有显著性(P<0.05)。治疗组患者至第20周时使用泼尼松总量为32935mg,对照组患者为51170mg,前者全病程总用量少于后者。各观察时间点两组患者人均泼尼松用量差异有显著性(P<0.05),治疗组泼尼松总量少于对照组。结论中药对难治性RA患者具有激素增效作用,且表现出减少激素不良反应的趋势。

英文摘要:

Objective To investigate the Chinese herbal medicine in enhancing effect of prednisone for treatment of refractory rheumatoid arthritis (RA). Methods One hundred and twenty patients with refraetory RA were assigned to two groups, the treated group was orally administered with Qingbi Tablet, a patent Chinese herbal preparation formulated based on the clearing heat and removing toxic substances principle, and the control group was treated with intramuscular injection of amethopterin (MTX), oral intake of voltaren 75 mg and hydroxychloroquine 0.2 g once a day. Besides prednisone was given to all patients orally, the initiating dosage used in the treated group was lesser than that in the control group. The clinical index, dosage and adverse reaction of prednisone were recorded every 2 weeks. Results The curative effect evaluated by American College of Rheumatology (ACR) standard showed no statistical difference between the two groups (P>0.05). Either clinical or laboratory indexes were improved significantly in both groups (P<0.05), but the improvement in resting pain, patient’s self-evaluation and doctor’s evaluation in the treated group were better than those in the control group, showing statistical difference (P<0.05). The 20-week total amount of prednisone used in the treated group was less than that in the control group (32 935 mg vs 51 170 mg), while the dosage of prednisone used in various observation time points between the two groups was also significantly different respectively (P<0.05), the former was less than the latter. Conclusion Chinese herbal medicine can enhance the effect of prednisone in patients of refractory RA and alleviate the adverse reactions of prednisone.

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