来源：风湿病与关节炎,2019,8（2）:31-34,42.

桂枝芍药知母汤联合甲氨蝶呤治疗寒热错杂型类风湿关节炎41例临床观察（临床研究）

李杰辉¹，林焱斌²，余光书²，张寿雄¹，刘友瑛¹，许宏滨¹

　　【摘　要】目的：观察桂枝芍药知母汤联合甲氨蝶呤治疗寒热错杂型类风湿关节炎的临床疗效和安全性。方法：将82例寒热错杂型活动期类风湿关节炎患者随机分为治疗组和对照组，每组41例。对照组口服甲氨蝶呤治疗，治疗组在对照组治疗基础上加用桂枝芍药知母汤治疗，2组均根据疼痛程度酌情使用塞来昔布胶囊。2组均以12周为1个疗程。观察2组中医证候疗效、实验室指标及DAS28-ESR积分。结果：治疗组脱落1例，显效10例，有效28例，无效2例，总有效率为95.00%；对照组脱落2例，显效6例，有效18例，无效15例，总有效率为61.54%。2组比较，差异有统计学意义（P < 0.05）。治疗后，2组患者C-反应蛋白、红细胞沉降率、类风湿因子、免疫球蛋白（IgG、IgA、IgM）水平及DAS28-ESR积分较治疗前均明显降低（P < 0.05），且治疗组低于对照组（P < 0.05）。在塞来昔布胶囊使用的数量、天数及不良反应发生率方面，治疗组均明显少于对照组（P < 0.05）。结论：桂枝芍药知母汤联合甲氨蝶呤治疗寒热错杂型活动期类风湿关节炎，能进一步改善患者实验室指标及关节功能，减轻疼痛，临床疗效与安全性更优。

　　【关键词】　关节炎，类风湿；寒热错杂型；桂枝芍药知母汤；甲氨蝶呤；塞来昔布；临床疗效

Clinical Observation on Treating 41 Cases of Rheumatoid Arthritis of Mixed Heat and Cold Type with Guizhi Shaoyao Zhimu Tang（桂枝芍药知母汤）Combined with Methotrexate

LI Jie-hui,LIN Yan-bin,YU Guang-shu,ZHANG Shou-xiong,LIU You-ying,XU Hong-bin

　　【ABSTRACT】Objective:To observe the clinical efficacy and safety of Guizhi Shaoyao Zhimu Tang（桂枝芍药知母汤）combined with methotrexate in the treatment of rheumatoid arthritis of mixed cold and heat type.Methods:Eighty-two patients with rheumatoid arthritis of mixed cold-heat type in active stage were randomly divided into a treatment group and a control group,forty-one cases in each group.The control group was treated with methotrexate,while the treatment group was given Guizhi Shaoyao Zhimu Tang on the basis of the treatment for the control group.Celecoxib capsules were used in both groups in terms of the degree of pain.The two groups were treated for twelve weeks as a course.The curative effect of TCM syndromes,laboratory indexes and DAS28-ESR scores were observed in both groups.Results:In the treatment group,there were one case of abscission,10 cases of marked effect,28 cases of effective and 2 cases of ineffective,and the total effective rate was 95.00%.In the control group,there were 2 cases of abscission,6 cases of marked effect,18 cases of effective and 15 cases of ineffective,and the total effective rate was 61.54%.There was a significant difference between the two groups（P < 0.05）.After treatment,the levels of C-reactive protein,erythrocyte sedimentation rate,rheumatoid factor,immunoglobulin（IgG,IgA and IgM）and DAS28-ESR scores in the two groups were significantly lower than those before treatment（P < 0.05）,and the treatment group was lower than the control group（P < 0.05）.The number,days and incidence of adverse reactions of celecoxib capsules in the treatment group were significantly less than those in the control group（P < 0.05）.Conclusion:Guizhi Shaoyao Zhimu Tang combined with methotrexate can further improve the laboratory indicators and joint function of patients with rheumatoid arthritis of mixed cold-heat type in active stage,alleviate pain,and have better clinical efficacy and safety.

　　【Keywords】 arthritis,rheumatoid;mixed cold and heat type;Guizhi Shaoyao Zhimu Tang（桂枝芍药知母汤）;methotrexate;celecoxib;clinical efficacy