基于关节超声评价断藤益母汤联合来氟米特治疗类风湿关节炎的临床疗效

发布时间：2018-05-22 14:46

本文选题：类风湿关节炎 + 断藤益母汤　；参考：《广州中医药大学》2017年硕士论文

【摘要】：目的:1.探讨断藤益母汤联合来氟米特治疗类风湿关节炎的临床疗效及安全性。2.评价多普勒超声在类风湿关节炎患者的诊断及疗效监测中的价值。方法:在广州中医药大学第一附属医院风湿病科的住院病人中收集符合入组标准的类风湿关节炎患者60例,随机分为治疗组及对照组各30例,治疗组予断藤益母汤水煎剂(昆明山海棠45g、益母草30g、续断15g,每日1剂)及来氟米特(20mg每日1次)治疗,对照组则予甲氨蝶呤(10mg每周1次)及来氟米特(20mg每日1次)治疗。两组均治疗12周,观察治疗前后患者的临床症状、DAS28、HAQ评分及血沉(ESR)、C反应蛋白(CRP);并在治疗前后进行双手掌指关节、近端指间关节、双腕关节共22个关节的彩色多普勒超声检查,观察病理性滑膜增生的厚度及血流信号、骨侵蚀情况,采用半定量方法计算患者的关节病变积分;以ACR20、DAS28评分作为疗效评价标准,并监测治疗过程中的不良反应,评定两组疗效及安全性。结果:治疗前两组在性别、年龄、病程、RA病情活动度、关节功能分级等一般临床资料上无显著性差异,具有可比性(P0.05)。治疗前超声检查下发现的滑膜炎关节数多于临床检查发现的滑膜炎关节数,差异有统计学意义(P0.05)。治疗前超声下关节的滑膜厚度评分、血流信号评分分别与DAS28、ESR、CRP呈正相关(r0.4,P0.05)。治疗12周后,两组患者的临床指标(压痛关节数、肿胀关节数、病人对疼痛和病情整体的VAS评分、医生对病情整体的VAS评分、HAQ评分)均较治疗前改善,差异有统计学意义(P0.05);两组间比较差异无统计学意义(P0.05)。治疗12周后,两组患者的实验室指标(ESR、CRP)均较治疗前改善,差异有统计学意义(P0.05);治疗组的ESR改善优于对照组,有统计学意义(P0.05)。治疗12周后,治疗组ACR20达标率86.66%,对照组为83.33%,两组差异无统计学意义;两组DAS28评分较治疗前有统计学意义(P0.05);治疗组有效率为83.330%,对照组为76.66%,两组差异无统计学意义。治疗12周后,两组患者的超声指标(滑膜厚度评分、血流信号评分)均较治疗前改善,差异有统计学意义;骨侵蚀评分与治疗前相比无统计学意义。治疗组在改善滑膜厚度评分、血流信号评分方面优于对照组,具有统计学意义(P0.05)。治疗后超声检查下发现的滑膜炎关节数多于临床检查发现的滑膜炎关节数,差异有统计学意义(P0.05)。治疗后超声下关节的滑膜厚度评分、血流信号评分分别与DAS28、ESR、CRP呈正相关(r0.4,P0.05)。结论:1.RA患者使用断藤益母汤+来氟米特联合治疗,可改善关节功能、缓解临床症状、降低实验室指标及滑膜增生、血流信号评分,其疗效与甲氨蝶呤+来氟米特相当,且能更好地改善患者的ESR及超声下滑膜增生评分、血流信号评分。两组安全性相当。2.超声能够比临床检查发现更多的滑膜炎,超声检查评分与患者实验室指标、DAS28评分具有相关性,是监测和评价断藤益母汤联合来氟米特治疗RA疗效的有效手段。把临床、实验室各项检查与多普勒超声检查相结合可以为RA患者病情活动度的评估及治疗方案的选择提供重要依据。
[Abstract]:Objective: 1. to explore the clinical efficacy and safety of rattan Yi Mu decoction combined with leflunomide in the treatment of rheumatoid arthritis (.2.) evaluation of the value of Doppler ultrasound in the diagnosis and monitoring of rheumatoid arthritis. Methods: collect the standard wind like wind in the hospitalized patients of the First Affiliated Hospital of Guangzhou University of Chinese Medicine. 60 patients with wet arthritis were randomly divided into the treatment group and the control group with 30 cases. The treatment group was treated with rattan yomu Decoction (45g, 30g, 15g, 1 doses per day) and leflunomide (20mg 1 times a day), and the control group was treated with methotrexate (1 times per week 10mg) and leflunomide (1 times a day). The two groups were treated 12 weeks. The clinical symptoms, DAS28, HAQ scores and erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) were observed before and after treatment. Color Doppler ultrasound examination was performed on the palmar and finger joints, the proximal interphalangeal joints and the double wrist joint before and after the treatment. The thickness of the pathological synovial hyperplasia and the blood flow signal and bone erosion were observed and the bone erosion was measured by semi quantitative method. The score of the patients' joint lesion was calculated. The ACR20, DAS28 score was used as the evaluation criterion, and the adverse reaction in the treatment process was monitored, and the two groups of curative effects and safety were evaluated. Results: there was no significant difference between the two groups in the clinical data of sex, age, course of disease, activity of RA, joint function classification and so on. It was comparable (P0.05). The number of synovitis joints found under pre therapy ultrasound was more than the number of synovitis joints found in clinical examination. The difference was statistically significant (P0.05). The score of synovial thickness and the blood flow signal score were positively correlated with DAS28, ESR, CRP before treatment (r0.4, P0.05). After 12 weeks of treatment, the clinical indexes of the two groups of patients (the number of pain joint, swelling) The number of swelling joints, the patient's VAS score on pain and the overall condition of the disease, the doctor's VAS score and HAQ score were better than before the treatment, the difference was statistically significant (P0.05); the difference between the two groups was not statistically significant (P0.05). After 12 weeks of treatment, the laboratory indexes (ESR, CRP) of the two groups were all better than those before the treatment, the difference was statistically significant The ESR improvement in the treatment group was better than the control group (P0.05). After 12 weeks of treatment, the standard rate of ACR20 in the treatment group was 86.66%, the control group was 83.33%, the two groups had no statistical significance; the two group DAS28 score was statistically significant (P0.05), the effective rate of treatment group was 83.330%, the control group was 76.66%, and there was no statistical difference in the two groups. After 12 weeks of treatment, the ultrasonic index (synovium thickness score, blood flow signal score) of the two groups were all better than before the treatment. The difference was statistically significant compared with that before the treatment. The treatment group was better than the control group in improving the synovial thickness score and the blood flow signal score (P0.05). After treatment, the treatment group had statistical significance. The number of synovitis joints found under ultrasonic examination was more than the number of synovitis joints found in clinical examination. The difference was statistically significant (P0.05). The score of synovial thickness and blood flow signal score were positively correlated with DAS28, ESR, CRP (r0.4, P0.05) after treatment. Conclusion: 1.RA patients were treated by combination of rattan Yi Mu Tang and leflunomide. Improvement of joint function, relieving clinical symptoms, reducing laboratory indicators and synovial hyperplasia, blood flow signal score, the effect is equivalent to methotrexate + leflunomide, and can better improve the patient's ESR and ultrasound synovial hyperplasia score, blood flow signal score. Two groups of safety equivalent.2. ultrasound can find more synovitis than clinical examination. It is an effective means to monitor and evaluate the efficacy of leflunomide combined with leflunomide in the treatment of RA. The combination of clinical and laboratory tests and Doppler ultrasonography can provide an important basis for the evaluation of the degree of activity of the patients and the choice of the treatment scheme for the patients with RA.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R593.22

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