目的 觀察雙氯芬酸聯(lián)合柳氮磺吡啶治療類風(fēng)濕性關(guān)節(jié)炎的臨床療效。方法 選取2011年10月—2014年10月張家港市中醫(yī)醫(yī)院收治的類風(fēng)濕性關(guān)節(jié)炎患者114例,隨機(jī)分為對照組和治療組,每組各57例。對照組口服柳氮磺吡啶腸溶片,初始劑量4片/次,3次/d,若患者無明顯不適可漸增加劑量,6片/次,3次/d,患者癥狀好轉(zhuǎn)后可減量,2片/次,3次/d。治療組在對照組的治療基礎(chǔ)上口服雙氯芬酸鈉緩釋膠囊,1粒/次,2次/d。兩組均連續(xù)治療6個月。觀察兩組的臨床療效,同時比較兩組癥狀體征、關(guān)節(jié)功能分級和X線分級的改善程度。比較兩組治療前后血沉(ESR)、C反應(yīng)蛋白(CRP)、免疫球蛋白(IgA、IgG、IgM)的變化情況。結(jié)果 治療后,對照組和治療組的總有效率分別為75.44%、92.98%,兩組比較差異具有統(tǒng)計學(xué)意義(P< 0.05)。治療后,兩組關(guān)節(jié)疼痛評分、關(guān)節(jié)壓痛評分、關(guān)節(jié)腫脹評分、活動障礙評分均顯著降低,晨僵時間明顯縮短,同組治療前后差異有統(tǒng)計學(xué)意義(P< 0.05);且治療組的改善程度優(yōu)于對照組,兩組比較差異有統(tǒng)計學(xué)意義(P< 0.05)。治療后,兩組ESR、CRP、IgA、IgG、IgM顯著降低,同組治療前后差異有統(tǒng)計學(xué)意義(P< 0.05);且治療組的下降程度優(yōu)于對照組,兩組比較差異有統(tǒng)計學(xué)意義(P< 0.05)。治療后,兩組關(guān)節(jié)功能分級、X線分級有明顯改善,治療組的改善情況明顯優(yōu)于對照組,兩組比較差異有統(tǒng)計學(xué)意義(P< 0.05)。結(jié)論 雙氯芬酸鈉聯(lián)合柳氮磺吡啶治療類風(fēng)濕性關(guān)節(jié)炎具有較好的臨床療效,可顯著改善患者的癥狀體征,調(diào)節(jié)患者免疫力,具有一定的臨床推廣應(yīng)用價值。

Objective To explore the clinical effect of Diclofenac Sodium Sustained Release Capsules combined with Sulfasalazine in treatment of rheumatoid arthritis. Methods Patients (114 cases) with rheumatoid arthritis in Zhangjiafang Hospital of Traditional Chinese Medicine from October 2011 to in October 2014 were randomly divided into control and treatment groups, and each group had 57 cases. The patients in the control group were po administered with Sulfasalazine Enteric-coated Tablets, with initial dosage of 4 tablets/time, three times daily. If the patient had no obvious discomfort, the dosage could be gradually increased to 6 tablets/time, three times daily. If symptoms could be improved, the dosage was reduced, 2 tablets/time, three times daily. The patients in the treatment group were po administered with Diclofenac Sodium Sustained Release Capsules on the basis of the control group, 1 grain/time, twice daily. The patients in two groups were treated for 6 months. After treatment, the efficacy was evaluated, and the improvement degree of signs and symptoms, joints functional grading and X-ray classification in two groups were compared. The changes of ESR, CRP, IgA, IgG, and IgM in two groups were compared. Results After treatment, the efficacies in the control and treatment groups were 75.44% and 92.98%, respectively, and there were differences between two groups (P < 0.05). After treatment, scores of joint pain, joint tenderness, joint swelling, and activity obstacle were significantly lowered, and morning stiffness time was significantly shortened, and the difference was statistically significant in the same group (P < 0.05). These observational indexes in treatment group were better than those in control group, with significant difference between two groups (P < 0.05). After treatment, ESR, CRP, IgA, IgG, and IgM in two groups were significantly decreased, and the difference was statistically significant in the same group (P < 0.05). These observational indexes in treatment group were better than those in control group, with significant difference between two groups (P < 0.05). After treatment, joints functional grading and X-ray classification in two groups had significantly improved, and the improvement degree of the treatment group was obviously better than that in the control group, with significant difference between two groups (P < 0.05). Conclusion Diclofenac Sodium Sustained Release Capsules combined with Sulfasalazine has clinical curative effect in treatment of rheumatoid arthritis, and can significantly improve the symptoms and signs, and can adjust the immunity of patients, which has a certain clinical application value.