目的 探討通痹膠囊聯(lián)合酮洛芬治療類風(fēng)濕性關(guān)節(jié)炎的臨床療效。方法 選取2019年10月—2022年7月東營市東營區(qū)人民醫(yī)院收治的128例類風(fēng)濕性關(guān)節(jié)炎患者，按隨機(jī)數(shù)字表法將所有患者分為對照組和治療組，每組各64例。對照組口服酮洛芬腸溶片，50 mg/次，3次/d，飯后整片吞服。治療組在對照組基礎(chǔ)上口服通痹膠囊，1粒/次，3次/d，飯后口服。兩組治療療程均為12周。觀察兩組的臨床療效，比較治療前后兩組主要臨床表現(xiàn)、中醫(yī)癥狀積分、28個(gè)關(guān)節(jié)疾病活動度（DAS28）-C反應(yīng)蛋白（CRP）、關(guān)節(jié)炎生活質(zhì)量量表2-短卷（AIMS2-SF）總分以及血漿D-二聚體（D-D）、纖維蛋白原（FIB）水平和血清CRP、Nod樣受體蛋白3（NLRP3）、白細(xì)胞介素（IL）-1β、基質(zhì)金屬蛋白酶-3（MMP-3）水平。并統(tǒng)計(jì)兩組不良反應(yīng)情況。結(jié)果 治療后，治療組總有效率是93.75%，較對照組的81.25%顯著提高（P<0.05）。治療后，兩組關(guān)節(jié)壓痛數(shù)、腫脹數(shù)、關(guān)節(jié)疼痛VAS評分均顯著降低，晨僵時(shí)間顯著縮短（P<0.05）；治療后，治療組主要臨床表現(xiàn)改善優(yōu)于對照組（P<0.05）。治療后，兩組中醫(yī)癥狀積分、DAS28-CRP均顯著下降，而AIMS2-SF總分均顯著升高（P<0.05）；以治療組改善更顯著（P<0.05）。治療后，兩組血漿D-D、FIB水平均顯著下降（P<0.05）；治療后治療組D-D、FIB顯著低于對照組（P<0.05）。治療后，兩組血清CRP、NLRP3、IL-1β、MMP-3水平均顯著下降（P<0.05）；且治療后，治療組血清CRP、NLRP3、IL-1β、MMP-3水平均顯著低于對照組（P<0.05）。治療組和對照組不良反應(yīng)發(fā)生率分別是6.25%、4.69%，兩組不良反應(yīng)發(fā)生率比較差異無統(tǒng)計(jì)學(xué)意義。結(jié)論 通痹膠囊聯(lián)合酮洛芬治療類風(fēng)濕性關(guān)節(jié)炎有確切療效，在改善患者主要臨床表現(xiàn)、降低疾病活動度以及提高生活質(zhì)量方面的效果滿意，并可進(jìn)一步糾正機(jī)體凝血功能障礙、減輕炎癥損傷，且具有較好的安全性。

Objective To investigate the clinical efficacy of Tongbi Capsules combined with ketoprofen in treatment of rheumatoid arthritis. Methods A total of 128 patients with rheumatoid arthritis admitted to Dongying District People's Hospital of Dongying from October 2019 to July 2022 were selected and divided into control group and treatment group according to random number table method, with 64 cases in each group. Patients in the control group were po administered with Ketoprofen Enteric-coated Tablets, and swallowed tablets whole after meals, 50 mg/time, three times daily. Patients in the treatment group were po administered with Tongbi Capsules on the basis of the control group, 1 capsule/time, 3 times daily, orally after meals. After treatment, the clinical efficacy was evaluated, the main clinical manifestations, TCM symptom scores, 28 joint disease activity (DAS28)-C-reactive protein (CRP), total score of Arthritis Life Quality Scale 2-Short Scale (AIMS2-SF) and plasma dimer (D-D), fibrinogen (FIB) levels and serum CRP, Nod-like receptor protein 3 (NLRP3), interleukin (IL)-1β, matrix metalloproteinase-3 (MMP-3) levels in two groups before and after treatment were compared. The adverse reactions of the two groups were analyzed. Results After treatment, the total effective rate of the treatment group was 93.75%, which was significantly higher than that of the control group (81.25%) (P < 0.05). After treatment, the number of joint tenderness, swelling and joint pain VAS score were significantly decreased in both groups, and the time of morning stiffness was significantly shortened (P < 0.05). After treatment, the improvement of main clinical manifestations in the treatment group was better than that in the control group (P < 0.05). After treatment, TCM symptom scores and DAS28-CRP were significantly decreased in both groups, while AIMS2-SF total scores were significantly increased (P < 0.05). The improvement was more significant in the treatment group (P < 0.05). After treatment, plasma D-D and FIB levels in two groups were significantly decreased (P < 0.05). After treatment, D-D and FIB in the treatment group were significantly lower than those in the control group (P < 0.05). After treatment, serum CRP, NLRP3, IL-1β and MMP-3 levels in two groups were significantly decreased (P < 0.05). After treatment, serum CRP, NLRP3, IL-1β and MMP-3 levels in the treatment group were significantly lower than those in the control group (P < 0.05). The incidence of adverse reactions in the treatment group and the control group were 6.25% and 4.69%, respectively, and there was no statistical significance in the incidence of adverse reactions between the two groups. Conclusion Tongbi Capsules combined with ketoprofen has definite curative effect in treatment of rheumatoid arthritis, and the effect is satisfactory in improving the main clinical manifestations, reducing the disease activity and improving the quality of life, and can further correct the coagulation dysfunction and reduce the inflammatory injury, which has better security.

R982

山東省東營市衛(wèi)生和計(jì)劃生育委員會基金項(xiàng)目（2017HW252）