目的 觀察火把花根片聯(lián)合來氟米特治療類風(fēng)濕性關(guān)節(jié)炎的臨床效果。方法 選取2019年8月—2021年8月天津市第五中心醫(yī)院收治的104例類風(fēng)濕性關(guān)節(jié)炎患者，按隨機數(shù)字表法將104例患者分成對照組和治療組，每組各52例。對照組口服來氟米特片，2片/次，1次/d。治療組在對照組基礎(chǔ)上口服火把花根片，4片/次，3次/d。所有患者均連續(xù)治療12周。觀察兩組療效，比較治療前后兩組癥狀、體征[晨僵時間、關(guān)節(jié)疼痛視覺模擬量表（VAS）評分、關(guān)節(jié)腫脹數(shù)和壓痛數(shù)]，28個關(guān)節(jié)疾病活動度（DAS28）評分、健康評估問卷殘疾指數(shù)（HAQ-DI）評分和血沉（ESR），血清C反應(yīng)蛋白（CRP）、白細胞介素（IL）-18、可溶性細胞間黏附分子-1（sICAM-1）、基質(zhì)金屬蛋白酶-13（MMP-13）水平，外周血CD4⁺、CD8⁺水平及其比值（CD4⁺/CD8⁺）。結(jié)果 治療后，治療組總有效率為88.5%，顯著高于對照組的73.1%（P＜0.05）。治療后，兩組晨僵時間均顯著縮短，關(guān)節(jié)疼痛VAS評分均顯著降低，關(guān)節(jié)腫脹數(shù)和壓痛數(shù)均顯著減少（P＜0.05）；且均以治療組改善更顯著（P＜0.05）。治療后，兩組DAS28評分和HAQ-DI評分均顯著降低（P＜0.05）；且均以治療組下降更顯著（P＜0.05）。治療后，兩組ESR和血清CRP、IL-18、sICAM-1、MMP-13水平均較治療前顯著下降（P＜0.05）；且均以治療組的降低更顯著（P＜0.05）。治療后，兩組外周血CD4⁺水平、CD4⁺/CD8⁺均較治療前顯著降低，外周血CD8⁺水平均較治療前顯著增高（P＜0.05）；且均以治療組改善更顯著（P＜0.05）。結(jié)論 火把花根片聯(lián)合來氟米特治療類風(fēng)濕性關(guān)節(jié)炎的整體療效確切，能有效改善患者臨床表現(xiàn)，降低疾病活動度，減輕關(guān)節(jié)損害，抑制體內(nèi)炎癥反應(yīng)，改善免疫功能。

Objective To observe the clinical effect of Huobahuagen Tablets combined with leflunomide in treatment of rheumatoid arthritis.Methods A total of 104 patients with rheumatoid arthritis admitted to Tianjin Fifth Central Hospital from August 2019 to August 2021 were selected and divided into control (n=52) and treatment group (n=52) according to the random number table method.Patients in the control group were po administered with Leflunomide Tablets,2 tablets/time,once daily.Patients in the treatment group were po administered with Huobahuagen Tablets on the basis of the control group,4 tablets/time,three times daily.All patients were treated for 12 weeks.The efficacy of the two groups were observed.The symptoms and signs[morning stiffness time,joint pain visual analog scale (VAS) score,joint swelling number and tenderness number],28 joint disease activity (DAS28) scores,health assessment questionnaire disability index (HAQ-ID) were compared between the two groups before and after treatment.The erythrocyte sedimentation rate (ESR),serum C-reactive protein (CRP),interleukin (IL)-18,soluble intercellular adhesion molecule 1(SICAM-1),matrix metalloproteinase-13(MMP-13) levels,peripheral blood CD4⁺,CD8⁺ levels and their ratio (CD4⁺/CD8⁺) were compared.Results After treatment,the total effective rate of the treatment group was 88.5%,which was significantly higher than that of the control group (73.1%,P<0.05).After treatment,the morning stiffness time was significantly shortened,the VAS score of joint pain was significantly decreased,and the number of joint swelling and tenderness were significantly decreased in both groups (P<0.05).The improvement was more significant in the treatment group (P <0.05).After treatment,the DAS28 score and HAQ-DI score of the two groups were significantly decreased (P<0.05).The decrease was more significant in the treatment group (P<0.05).After treatment,ESR and serum levels of CRP,IL-18,SICAM-1 and MMP-13 in two groups were significantly decreased compared with those before treatment (P<0.05).The reduction in treatment group was more significant (P <0.05).After treatment,the levels of peripheral blood CD4⁺ and CD4⁺/CD8⁺ in the two groups were significantly lower than those before treatment,and the levels of peripheral blood CD8⁺ were significantly higher than those before treatment (P<0.05).The improvement was more significant in the treatment group (P<0.05).Conclusion Huobahuagen Tablets combined with leflunomide has a definite overall curative effect in the treatment of rheumatoid arthritis,and can effectively improve the clinical manifestations of patients,reduce disease activity and joint damage,inhibit the inflammatory response in the body,which can improve immune function.

R977

天津市第五中心醫(yī)院院內(nèi)科研項目(WZX201918)