三痹汤加减联合甲氨蝶呤治疗肝肾亏虚型类风湿关节炎的临床研究

摘要/Abstract

摘要： 目的观察中药方剂三痹汤加减联合甲氨蝶呤治疗类风湿关节炎（RA）的临床疗效。方法选取2021年9月—2023年9月厦门大学附属翔安医院收治的63例类风湿关节炎患者作为研究对象,按照随机数表法分为两组,其中对照组31例予甲氨蝶呤片口服治疗,治疗组32例在三痹汤加减联合甲氨蝶呤口服进行干预。治疗组和对照组均以4周为1个疗程。比较两组治疗前后晨僵、关节疼痛、肿胀及握力水平,检测红细胞沉降率（ESR）、类风湿因子（RF）和C反应蛋白（CRP）水平,同时对T淋巴细胞辅助因子（OKT4）、T淋巴细胞抑制因子（OKT8）、OKT4/OKT8等安全性指标进行比较,评估两组治疗前后病情活动度。结果与治疗前比较,两组治疗后晨僵时间均缩短,关节疼痛评分及关节肿胀评分均降低（P<0.05）,握力水平均升高（P<0.05）,ESR、RF及CRP水平均降低（P<0.05）,OKT4、OKT8均升高、OKT4/OKT8水平均降低（P<0.05）;与对照组相比,治疗组晨僵时间、关节疼痛、关节肿胀及握力水平改善（P<0.05）,ESR、RF及CRP水平更低（P<0.05）,OKT4、OKT8更高、OKT4/OKT8水平更低（P<0.05）。结论三痹汤加减+甲氨蝶呤组治疗RA疗效确切,能够有效改善患者临床症状,抑制病情活动度,缓解病情,调节免疫系统的活性和平衡。

关键词: 类风湿性关节炎, 临床研究, 三痹汤, 甲氨蝶呤

Abstract: Objective To observe the clinical efficacy of modified Sanbi decoction combined with methotrexate in the treatment of rheumatoid arthritis (RA). Methods A total of 63 patients with RA admitted between September 2021 and September 2023 were selected as the study subjects. They were randomly divided into two groups: the control group (n=31) received oral methotrexate tablets, and the treatment group (n=32) received modified Sanbi decoction in addition to oral methotrexate tablets. Both groups were treated for 4 weeks. Compare the levels of morning stiffness, joint pain, swelling, and grip strength before and after treatment between the two groups. Detect the erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), and C-reactive protein (CRP) levels. Additionally, compare the safety indicators such as T lymphocyte helper factor (OKT4), T lymphocyte suppressor factor (OKT8), and OKT4/OKT8 ratios to assess the disease activity before and after treatment in both groups. Results Compared with before treatment, both groups showed a significant reduction in morning stiffness duration, joint pain and swelling scores (P<0.05), and an increase in grip strength (P<0.05) after treatment. ESR, RF, and CRP levels were significantly decreased (P<0.05), while OKT4 levels , OKT8 levels increased, and OKT4/OKT8 ratio decreased significantly (P<0.05). Compared with the control group, the treatment group showed improvements in morning stiffness duration, joint pain, joint swelling, and grip strength levels (P<0.05). The levels of ESR, RF, and CRP were all lower (P<0.05). Additionally, the levels of OKT4 and OKT8 were higher, and the OKT4/OKT8 ratio was lower (P<0.05). Conclusion Modified Sanbi decoction combined with methotrexate is effective in treating RA, improving clinical symptoms, reducing inflammation, inhibiting disease activity, and preventing bone destruction.

Key words: rheumatoid arthritis, clinical studies, Sanbi decoction, methotrexate

中图分类号:

R259

杨婉晴, 张春芳, 师健, 覃家超, 张辰龙, 王玉洁, 郭凯航, 李鹏飞. 三痹汤加减联合甲氨蝶呤治疗肝肾亏虚型类风湿关节炎的临床研究[J]. 中华养生保健, 2025, 43(5): 34-38.

YANG Wan-qing, ZHANG Chun-fang, SHI Jian, QIN Jia-chao, ZHANG Chen-long, WANG Yu-jie, GUO Kai-hang, LI Peng-fei. Clinical Efficacy of Modified Sanbi Decoction Combined with Methotrexate in the Treatment of Liver-Kidney Deficiency Type Rheumatoid Arthritis: A Randomized Controlled Trial[J]. ZHONGHUA YANGSHENG BAOJIAN, 2025, 43(5): 34-38.

参考文献

[1] 高超,陈立红,黄晓玮,等.全程护理干预对类风湿关节炎患者生活质量的影响[J].中国护理管理,2014,14(S1):90-91.
[2] LANGE E, KUCHARSKI D, SVEDLUND S, et al.Effects of Aerobic and Resistance Exercise in Older Adults With Rheumatoid Arthritis: A Randomized Controlled Trial[J].Arthritis Care Res(Hoboken),2019,71(1):61-70.
[3] SPARKS J A. Rheumatoid arthritis[J].Ann Intern Med,2019,170(1):ITC1-ITC16.
[4] 杨天宁,王海东,张旭明.中医“痛”论从肝防治RA临床研究进展[J].甘肃科技纵横,2022,51(10):84-86,8.
[5] 顾向浩,陈鹏,朱琳,等.蠲痹汤辅助治疗类风湿关节炎活动期的疗效观察[J].中国中西医结合杂志,2021,41(7):812-816.
[6] WANG M Y, LI K, NIE Y X, et al.Antirheumatoid Arthritis Activities and Chemical Compositions of Phenolic Compounds-Rich Fraction from Urtica atrichocaulis, an Endemic Plant to China[J].Evidence-Based Complementary And Alternative Medicine,2012:818230.
[7] 纪德凤,张春芳,祁永校.三痹汤对佐剂性关节炎大鼠血清IL-8及IL-17的影响[J].辽宁中医药大学学报,2016,18(8):30-32.
[8] 祁永校,张春芳,纪德凤.三痹汤对佐剂性关节炎大鼠血清IL-16、IL-10及MCP-1的影响[J].中医药学报,2016,44(3):47-49.
[9] 张春芳,纪德凤,祁永校,等.三痹汤对佐剂性关节炎大鼠膝关节滑膜病理改变影响及机制研究[J].江苏中医药,2014,48(9):75-77.
[10] 郭德强,张春芳,周亚滨,等.补肝益肾通络法对佐剂型关节炎大鼠Th17/Treg平衡的影响[J].中国中医急症,2019,28(6):1029-1032.
[11] 张春芳. 基于TLR4/MAPKs/NF-κB炎症于信号通路探讨三痹颗粒对Ⅱ型胶原性关节炎大鼠的治疗作用及机制研究[J].中国药学杂志,2020(7):519-526.
[12] 刘红旗,刘月梅.风湿、类风湿性关节炎[M].北京:中国医药科技出版社,2016:542-543.
[13] 中华医学会风湿病学分会.类风湿关节炎诊断及治疗指南[J].中华风湿病学杂志,2016,14(4):265-270.
[14] 赵新秀,寇永锋.类风湿性关节炎证候诊断标准的研究[J].中华中医药学刊,2016,28(3):500-502.
[15] VANDER C B, VAN LOOY S, WYNS B, et al.DAS28 best re-flects the physician's clinical judgment of response to infliximab therapy in rheumatoid arthritis patients: validation of the DAS28 score in patients under infliximab treatment[J].Arthritis Res Ther,2005,7(5):1063-1071.
[16] 陈利民,陆一兰.中药痹通汤加减联合甲氨蝶呤治疗类风湿关节炎32例临床观察[J].风湿病与关节炎,2020,9(9):29-32.
[17] FELSON D T, ADERSON J J, BOERs M, et al.American college of rheumatology.Preliminary definition of improvement in rheumatoid rthritis[Jl.Arthritis Rheum,1995,38(6):727-735.
[18] 郑惠之,达南,黄梅.当归拈痛汤加减治疗类风湿性关节炎30例临床观察[J].四川中医,2015,33(3):102-103.
[19] 王春芳,刘娟云.尪痹胶囊联合小剂量甲氨蝶呤治疗类风湿关节炎临床研究[J].光明中医,2019,34(18):2876-2878.
[20] 姚晓玲,宁乔怡,王秋燚,等.类风湿关节炎中医病因病机研究进展[J].风湿病与关节炎,2018,7(5):68-72.
[21] 张春芳,纪德凤,祁永校,等.三痹汤对佐剂性关节炎大鼠膝关节滑膜病理改变的影响及其机制研究[J].江苏中医药,2016,48(9):75-78.
[22] 朱天碧,张钊,罗飘,等.党参药理学作用的相关研究进展[J].神经药理学报,2018,8(6):46.
[23] 许茂玉,盛炎炎,方祥,等.基于网络药理学研究“杜仲-续断”药对治疗膝关节炎的作用机制[J].安徽中医药大学学报,2022,41(4):69-75.
[24] 李泽宇,郝二伟,李卉,等.甘草配伍应用的药理作用及机制分析[J].中国实验方剂学杂志,2022,28(14):270-282.
[25] 樊梅,唐芳,马武开,等.川乌、白芍治疗类风湿关节炎的网络药理学研究[J].风湿病与关节炎,2021,10(3):28-32.
[26] 魏海华,王玲.基于网络药理学探讨杜仲治疗类风湿关节炎的作用机制[J].中医临床研究,2022,14(35):124-128.
[27] 费可,胡瑕瑜,邹璐,等.细辛临床应用与药理作用研究进展[J].上海中医药大学学报,2010,24(6):87-90.