目的 探討七味通痹口服液聯(lián)合甲氨蝶呤治療類風(fēng)濕關(guān)節(jié)炎的療效觀察及其對(duì)血清疼痛介質(zhì)和炎癥因子的影響。方法 選取2019年5月—2020年11月海南省中醫(yī)院收治的84例類風(fēng)濕關(guān)節(jié)炎患者作為研究對(duì)象，按照治療方法將84例患者分為對(duì)照組和觀察組，每組各42例。對(duì)照組口服甲氨蝶呤片，10 mg/次，1次/周。觀察組在對(duì)照組基礎(chǔ)上口服七味通痹口服液，10 mL/次，3次/d。兩組連續(xù)治療3個(gè)月。觀察兩組患者的臨床療效，比較兩組治療前后的關(guān)節(jié)壓痛數(shù)、腫脹數(shù)、晨僵持續(xù)時(shí)間，同時(shí)比較兩組視覺(jué)模擬評(píng)分法（VAS）、血清前列腺素E₂（PGE₂）、血漿P物質(zhì)（SP）、白細(xì)胞介素-17（IL-17）、抗鏈球菌溶血素O（ASO）、類風(fēng)濕因子（RF）、C反應(yīng)蛋白（CRP）和血沉（ESR）水平。結(jié)果 治療后，觀察組總有效率為85.71%，顯著高于對(duì)照組的66.67%，兩組間對(duì)比差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。兩組治療后的壓痛數(shù)、腫脹數(shù)、晨僵持續(xù)時(shí)間、疼痛程度評(píng)分顯著降低（P<0.05）；治療后，觀察組的壓痛數(shù)、腫脹數(shù)、晨僵持續(xù)時(shí)間、疼痛程度評(píng)分顯著低于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。兩組治療后的PGE₂、SP、IL-17水平顯著降低（P<0.05）；治療后，觀察組的PGE₂、SP、IL-17水平顯著低于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。兩組治療后的ASO、RF、CRP、ESR水平顯著降低（P<0.05）；治療后，觀察組的ASO、RF、CRP、ESR水平顯著低于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 七味通痹口服液聯(lián)合甲氨蝶呤可提高類風(fēng)濕關(guān)節(jié)炎的療效，降低患者血清疼痛介質(zhì)和炎癥因子的水平，進(jìn)一步減輕臨床癥狀體征，具有一定臨床研究?jī)r(jià)值。

Objective To investigate the efficacy of Qiwei Tongbi Oral Liquid combined with methotrexate in treatment of rheumatoid arthritis, and its effect on serum pain mediators and inflammatory factors. Methods A total of 84 patients with rheumatoid arthritis admitted to Hainan Hospital of Traditional Chinese Medicine from May 2019 to November 2020 were selected as the research subjects. According to the treatment methods, 84 patients were divided into control group and observation group, with 42 cases in each group. Patients in the control group were po administered with Methotrexate Tablets, 10 mg/time, once a week. Patients in the observation group were po administered with Qiwei Tongbi Oral Liquid, 10 mL/time, three times daily. The two groups were treated for 3 months. The clinical efficacy of two groups was observed. The number of joint tenderness, swelling, and duration of morning stiffness before and after treatment were compared between two groups. The levels of VAS score, serum levels of PGE 2, SP, IL-17, ASO, RF, CRP, and ESR were compared between two groups. Results After treatment, the total effective rate of the observation group was 85.71%, significantly higher than 66.67% of the control group, and the difference between the two groups was statistically significant (P < 0.05). After treatment, the number of tenderness, swelling, the duration of morning stiffness, and the degree of pain in two groups were significantly decreased (P < 0.05). After treatment, the number of tenderness, swelling, the duration of morning stiffness, and the degree of pain in the observation group were significantly lower than those in the control group, with statistical significance (P < 0.05). After treatment, the levels of PGE₂, SP, and IL-17 in two groups were significantly decreased (P < 0.05). After treatment, the levels of PGE₂, SP, and IL-17 in the observation group were significantly lower than those in the control group, with statistical significance (P < 0.05). After treatment, the levels of ASO, RF, CRP, and ESR in two groups were significantly decreased (P < 0.05). After treatment, the levels of ASO, RF, CRP, and ESR in the observation group were significantly lower than those in the control group, with statistical significance (P < 0.05). Conclusion Qiwei Tongbi Oral Liquid combined with methotrexate can improve the efficacy of rheumatoid arthritis, reduce the level of serum pain mediators and inflammatory factors, and further reduce clinical symptoms and signs, which has certain clinical research value.

河南省醫(yī)學(xué)科技公關(guān)計(jì)劃項(xiàng)目（LHGJ20190363）