【作者】 田飞；

【导师】 谢沛霖；

【作者基本信息】 湖北中医学院 ， 中医内科学， 2008， 硕士

【摘要】 甲氨蝶呤羟氯喹白芍总苷联合治疗类风湿关节炎的临床观察。目的:观察甲氨蝶呤、羟氯喹、白芍总苷联合治疗活动期类风湿关节炎(RA)的临床疗效及其安全性。方法:将60例活动期类风湿性关节炎患者根据随机原则分成治疗组和对照组,治疗组30例予甲氨蝶呤7.5mg口服,每周1次,羟氯喹0.2g口服,每天2次,白芍总苷(帕夫林)600mg口服,每天3次治疗,对照组30例予甲氨蝶呤7.5mg口服,每周1次,羟氯喹0.2g口服,每天2次治疗,观察治疗前,治疗3个月后患者的晨僵时间、关节压痛数、关节肿胀数、病人对疾病活动的总体评价、医生对疾病活动的总体评价等临床症状、体征,观察血沉(ESR)、类风湿因子(RF)定量、C-反应蛋白等实验室指标及不良反应的发生率,包括恶心,呕吐,腹泻等胃肠道反应、口腔溃疡、白细胞减少、肝功能异常、眼部病变等。治疗效果采用美国风湿病学会(American college of Rheumatology ACR)发布的ACR20标准判断,分别对患者初诊时的信息和治疗3个月后结果进行统计分析,分析方法在SPSS 11.5统计学软件进行。结果:①治疗3个月后两组患者的晨僵时间、关节压痛数、关节肿胀数、病人对疾病活动的总体评价、医生对疾病活动的总体评价等临床症状、体征均较治疗前明显改善(P＜0.05或P＜0.01),且治疗组在晨僵时间(49.8±15.6)、关节压痛数(7.3±1.4)、关节肿胀数(5.2±1.9)、病人对疾病活动的总体评价(3.1±1.8)、医生对疾病活动的总体评价(3.3±2.1)与对照组的在晨僵时间(65.9±15.7)、关节疼痛(压痛)数(8.6±1.8)、关节肿胀数(6.7±2.5)、病人对疾病活动的总体评价(4.3±2.7)、医生对疾病活动的总体评价(4.5±2.8)比较差异有显著意义(P＜0.05)。②治疗3个月后两组患者的血沉(ESR)、类风湿因子(RF)定量、C-反应蛋白等实验室指标都有显著下降(P＜0.05或P＜0.01),且治疗组在ESR(48.37±16.10)、类风湿因子(RF)定量(158.3±89.2)、C-反应蛋白(27.8±11.9)与对照组在ESR(64.42±21.94)、类风湿因子(RF)定量(195.1±121.9)、C-反应蛋白(38.4±14.6)相比差异显著(P＜0.05)。③两组药物引起的不良反应以胃肠道反应比较多见,主要表现为食欲减退,胃区不适,腹痛,腹泻,治疗组有4例,而对照组有5例。两组比较无显著差异(P＞0.05),治疗组出现口腔溃疡2例,而对照组是4例,两组比较无显著差异(P＞0.05)。治疗组无1例出现白细胞减少,肝肾功能损害等副反应,而对照组出现5例,两组比较有显著性的差异((P＜0.05)。治疗组总的不良反应率为20%,明显低于对照组的46.7%。结论:①甲氨蝶呤+羟氯喹+白芍总苷治疗组和甲氨蝶呤+羟氯喹对照组疗效比较,两组在治疗3个月后都能明显改善活动期类风湿性关节炎临床症状、体征及实验室指标。②甲氨蝶呤羟氯喹白芍总苷治疗组在改善患者的临床症状、体征及实验室指标等方面明显优于甲氨蝶呤羟氯喹组,且不良反应的发生明显减少。③白芍总苷具有抗炎、止痛、抑制自身免疫反应及保护肝细胞的功能,与甲氨蝶呤羟氯喹联用可以增强疗效,减少甲氨蝶呤羟氯喹的用药剂量,减少毒副作用的发生,增加患者的依从性。更多还原

【Abstract】 Objective:To observe the methotrexate,hydroxychloroquine total Glucosides of Paeony Capsulesin(TGP)in the treatment of active rheumatoid arthritis(RA)the clinical efficacy and safety.Methods:Sixty cases of active rheumatoid arthritis patients were randomly divided into treatment and control groups.Treatment group of thirty patients to oral methotrexate methotrexate 7.5 mg,one week,hydroxychloroquine 0.2 g oral,two times a day,TGP(Pa Fulin)600 mg orally,three times a day.The control group of 30 patients to oral methotrexate 7.5 mg,1 week,hydroxychloroquine 0.2 g oral,twice a day,Observation of patients before treatment,three months after the treatment of Chen Jiang,several joint tenderness,joint swelling,the patients on the overall assessment of disease activity,the doctor on the overall assessment of disease activity, Observe the ESR,Rheumatoid factor quantitative,C-reactive protein and other laboratory indicators and the incidence of adverse reactions,including gastrointestinal reaction,neutropenia,abnormal liver function,eye diseases,and so on.We use the United States Institute of Rheumatology issued by the ACR20 criteria to evaluate the efficacy,We used SPSS 11.5 statistical software for newly diagnosed patients with the information and treatment three months after the results of statistical analysis.Results:①Two groups of patients have improved significantly with Chenjiang time, several joint tenderness,joint swelling the number of patients on the overall assessment of disease activity,the doctor on the overall assessment of disease activity three months after than before treatment,The treatment group of Chenjiang time, several joint tenderness,joint swelling the number of patients on the overall assessment of disease activity,the doctor on the overall assessment of disease activity than the control group②Two groups of patients with ESR,rheumatoid factor(RF) quantitative,C-reactive protein and other targets in the laboratory for three months after 3 months treatment has dropped significantly.Treatment group was significantly better than the control group.③Drugs were caused by adverse reactions to see more gastrointestinal reaction,mainly for anorexia,stomach discomfort,abdominal pain, diarrhoea,treatment group,four cases,while the control group five cases.2 groups showed no significant difference(P＞0.05),oral ulcer treatment group in two cases, while the control group is the four cases,two groups showed no significant difference (P＞0.05).None of the treatment group there neutropenia,liver and kidney damage and other side effects,while the control group in five cases,two groups was significant difference((P＜0.05).Two groups,the rate of adverse reactions to the treatment group 20 percent,significantly lower than the control group,46.7%.Conclusion:①Methotrexate+hydroxychloroquine+TGP treatment group and methotrexate+hydroxychloroquine control group,two groups can significantly improve the activities of rheumatoid arthritis symptoms,signs and laboratory Indicators.②Methotrexate hydroxychloroquine TGP treatment group to improve the treatment of patients with clinical symptoms,signs and laboratory indicators,is superior to methotrexate hydroxychloroquine group,and significantly reduce adverse reactions.③TGP has anti-inflammatory pain and inhibit their immune response and protection of the functions of the liver cells,and methotrexate hydroxychloroquine use can enhance the efficacy compliance with the increase and reduce the occurrence of side effects.更多还原