目的 探討?zhàn)鲅阅z囊聯(lián)合托法替布治療類風(fēng)濕關(guān)節(jié)炎的臨床療效。方法 選取2021年1月—2022年12月衡水市人民醫(yī)院收治的112例類風(fēng)濕關(guān)節(jié)炎患者，按隨機(jī)數(shù)字表法分為對(duì)照組和治療組，每組各56例。對(duì)照組口服枸櫞酸托法替布片，5 mg/次，2次/d。治療組在對(duì)照組基礎(chǔ)上口服瘀血痹膠囊，6粒/次，3次/d。兩組療程均為12周。觀察兩組的臨床療效，比較治療前后兩組主要癥狀和體征情況、以C反應(yīng)蛋白（CRP）計(jì)算的28個(gè)關(guān)節(jié)疾病活動(dòng)度（DAS28-CRP）、多維健康評(píng)估問(wèn)卷（MDHAQ）評(píng)分、影像學(xué)Sharp評(píng)分，以及全血紅細(xì)胞沉降率（ESR）、血小板與淋巴細(xì)胞比值（PLR）和血清CRP、白細(xì)胞介素-8（IL-8）、血管生成素樣蛋白4（ANGPTL4）水平。結(jié)果 治療組ACR20、ACR50達(dá)標(biāo)率分別為82.14%、48.21%，較對(duì)照組的64.26%、28.57%均顯著提高（P＜0.05）；治療組ACR70達(dá)標(biāo)率為19.64%，高于對(duì)照組的12.5%，但差異無(wú)統(tǒng)計(jì)學(xué)意義。治療后，兩組關(guān)節(jié)疼痛VAS評(píng)分、壓痛和腫脹關(guān)節(jié)個(gè)數(shù)均較治療前顯著降低，晨僵時(shí)間顯著縮短（P＜0.05）；且均以治療組改善更顯著（P＜0.05）。治療后，兩組DAS28-CRP評(píng)分、MDHAQ評(píng)分均顯著降低，而Sharp評(píng)分顯著升高（P＜0.05）；治療后，治療組DAS28-CRP評(píng)分、MDHAQ評(píng)分、Sharp評(píng)分低于對(duì)照組（P＜0.05）。治療后，兩組全血ESR、PLR和血清CRP、IL-8、ANGPTL4水平均顯著下降（P＜0.05）；且治療后，治療組全血ESR、PLR和血清CRP、IL-8、ANGPTL4水平均顯著低于對(duì)照組（P＜0.05）。結(jié)論 瘀血痹膠囊聯(lián)合托法替布治療類風(fēng)濕關(guān)節(jié)炎具有較好的臨床療效，能有效促進(jìn)主要癥狀、體征好轉(zhuǎn)及病情緩解，減輕機(jī)體炎性反應(yīng)，延緩骨破壞和關(guān)節(jié)功能損害，改善整體功能狀態(tài)，值得臨床推廣應(yīng)用。

Objective To explore the clinical efficacy of Yuxuebi Capsules combined with tofacitinib in treatment of rheumatoid arthritis. Methods A total of 112 patients with rheumatoid arthritis treated in Hengshui People’s Hospital from January 2021 to December 2022 were selected and divided into control group and treatment group according to random number table method, with 56 cases in each group. Patients in the control group were po administered with Tofacitinib Citrate Tablets, 5 mg/time, twice daily. Patients in the treatment group were po administered with Yuxuebi Capsules on the basis of the control group, 6 grains/time, three times daily. Patients in two groups were treated for 12 weeks. After treatment, the clinical efficacy was evaluated, main symptoms and signs, 28 joint disease activity (DAS28-CRP) calculated by C-reactive protein (CRP), multi-dimensional health assessment questionnaire (MDHAQ) score, imaging Sharp score, and whole blood Erythrocyte sedimentation rate (ESR), platelet to lymphocyte ratio (PLR) and serum CRP, Interleukin 8 (IL-8), angiopoietin like protein 4 (ANGPTL4) levels in two groups before and after treatment were compared. Results After treatment, the compliance rates of ACR20 and ACR50 in the treatment group were 82.14% and 48.21%, respectively, compared with 64.26% and 28.57% in the control group (P < 0.05). The ACR70 compliance rate in the treatment group was 19.64%, higher than 12.5% in the control group, but the difference was not statistically significant. After treatment, the joint pain VAS score, the number of tender and swollen joints were significantly decreased in both groups compared with before treatment, and the morning stiffness time was significantly shortened (P < 0.05). The improvement was more significant in the treatment group (P < 0.05). After treatment, DAS28-CRP score and MDHAQ score were significantly decreased in both groups, while Sharp score was significantly increased (P< 0.05). After treatment, DAS28-CRP score, MDHAQ score and Sharp score in the treatment group were lower than those in the control group (P < 0.05). After treatment, whole blood ESR, PLR and serum CRP, IL-8, and ANGPTL4 levels in both groups were significantly decreased (P < 0.05). After treatment, whole blood ESR, PLR and serum CRP, IL-8, and ANGPTL4 levels in the treatment group were significantly lower than those in the control group (P< 0.05). Conclusion Yuxuebi Capsules combined with tofacitinib has a good clinical effect in treatment of rheumatoid arthritis, and can effectively promote the improvement of the main symptoms and signs and the remission of the disease, reduce the inflammatory reaction of the body, delay the bone destruction and joint function damage, and can improve the overall function state, which is worthy of clinical promotion and application.

R977

衡水市科技計(jì)劃項(xiàng)目(2020014069Z)