目的 探討附桂骨痛膠囊聯(lián)合來氟米特治療類風(fēng)濕關(guān)節(jié)炎的臨床療效。方法 選取2017年8月—2019年12月上海交通大學(xué)醫(yī)學(xué)院附屬第九人民醫(yī)院北部90例類風(fēng)濕關(guān)節(jié)炎患者作為研究對象，按照治療方法分為對照組和觀察組，每組各45例。對照組口服來氟米特片，10 mg/次，1次/d。觀察組在對照組治療的基礎(chǔ)上口服附桂骨痛膠囊，4粒/次，3次/d。兩組連續(xù)治療3個月。對比兩組的臨床總有效率，比較兩組關(guān)節(jié)腫脹數(shù)、壓痛數(shù)、晨僵時間的變化。檢測患者治療前后血清C反應(yīng)蛋白（CRP）、白細胞介素-32（IL-32）、類風(fēng)濕因子（RF）、血沉的水平及血液流變學(xué)指標(biāo)。記錄藥物不良反應(yīng)的發(fā)生情況。結(jié)果 治療后，觀察組患者總有效率為95.56%，對照組為82.22%，兩組間比較差異有統(tǒng)計學(xué)意義（P<0.05）。治療后，兩組關(guān)節(jié)腫脹數(shù)、壓痛數(shù)、晨僵時間顯著降低（P<0.05），以觀察組降低更明顯（P<0.05）。治療后，兩組的CRP、IL-32、RF、血沉水平均顯著降低（P<0.05）；治療后，觀察組的CRP、IL-32、RF、血沉水平顯著低于對照組，差異有統(tǒng)計學(xué)意義（P<0.05）。治療后，兩組的全血黏度、血漿比黏度、紅細胞壓積、血小板聚集率均顯著降低（P<0.05）；治療后，觀察組的全血黏度、血漿比黏度、紅細胞壓積、血小板聚集率顯著低于對照組，差異有統(tǒng)計學(xué)意義（P<0.05）。兩組藥物不良反應(yīng)的發(fā)生率無明顯差異。結(jié)論 附桂骨痛膠囊聯(lián)合來氟米特片治療類風(fēng)濕關(guān)節(jié)炎的療效確切，可降低炎癥反應(yīng)，改善血液流變學(xué)水平，顯著改善臨床癥狀。

Objective To investigate the clinical efficacy of Fugui Gutong Capsules combined with leflunomide in treatment of rheumatoid arthritis. Methods Ninety patients with rheumatoid arthritis from August 2017 to December 2019 in the Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine were selected as the research subjects, and were divided into control group and observation group according to treatment methods, with 45 cases in each group. Patients in the control group were po administered with Leflunomide Tablets, 10 mg/time, once daily. Patients in the observation group were po administered with Fugui Gutong Capsules on the basis of control group, 4 capsules/time, three times daily. The two groups were treated for 3 months. The clinical total effective rate of two groups was compared, and the changes of joint swelling number, tenderness number, and morning stiffness time were compared. Serum levels of C-reactive protein (CRP), interleukin-32 (IL-32), rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), and hemorheology were detected before and after treatment. Record the occurrence of adverse drug reactions. Results After treatment, the total effective rate was 95.56% in the observation group and 82.22% in the control group, and the difference between two groups was statistically significant (P < 0.05). After treatment, joint swelling number, tenderness number, and morning stiff time in two groups were significantly decreased (P < 0.05), and the decrease was more obvious in the observation group (P < 0.05). After treatment, the levels of CRP, IL-32, RF, and erythrocyte sedimentation rate in two groups were significantly decreased (P < 0.05). After treatment, the levels of CRP, IL-32, RF, and erythrocyte sedimentation rate in the observation group were significantly lower than those in the control group, with statistical significance (P < 0.05). After treatment, the whole blood viscosity, plasma specific viscosity, hematocrit, and platelet aggregation rate in two groups were significantly decreased (P < 0.05). After treatment, the whole blood viscosity, plasma specific viscosity, hematocrit, and platelet aggregation rate in the observation group were significantly lower than those in the control group, with statistical significance (P < 0.05). There was no significant difference in the incidence of adverse drug reactions between two groups. Conclusion Fugui Gutong Capsules combined with Leflunomide Tablets has definite curative effect in treatment of rheumatoid arthritis, which can reduce inflammatory response, improve hemorheology level and significantly improve clinical symptoms.

R979.5

上海市科研計劃項目（19ZR1429200）