来源：风湿病与关节炎,2020,9（5）:22-25.

通痹汤治疗老年类风湿关节炎患者临床疗效及对血清骨保护素和关节液中炎症因子的影响（临床研究）

张广辉，张　超，郭占非

　　【摘　要】目的：观察通痹汤治疗老年类风湿关节炎的临床疗效及对实验室指标的影响。方法：将84例活动期类风湿关节炎患者按照随机数字法分为治疗组和对照组，每组42例。对照组给予艾瑞昔布片联合甲氨蝶呤片治疗，治疗组在对照组用药基础上给予通痹汤治疗。2组均以12周为1个疗程。观察2组临床疗效以及治疗前后血清骨保护素（OPG）、类风湿因子（RF）和关节液中肿瘤坏死因子-α（TNF-α）、白细胞介素-17（IL-17）变化。结果：治疗组治愈8例，显效21例，有效11例，无效2例，总有效率为95.24%；对照组治愈1例，显效18例，有效13例，无效10例，总有效率为76.19%。2组比较，差异有统计学意义（P < 0.05）。治疗后，2组OPG水平均升高，RF、TNF-α、IL-17水平均降低（P < 0.05），且治疗组较对照组明显（P < 0.05）。2组不良反应比较，差异无统计学意义（P > 0.05）。结论：通痹汤可显著提高老年类风湿关节炎患者血清OPG水平，降低RF、TNF-α、IL-17等炎性因子的表达，临床疗效显著，安全性高，值得推广和应用。

　　【关键词】　关节炎，类风湿；通痹汤；骨保护素；类风湿因子；肿瘤坏死因子-α；白细胞介素-17；临床疗效

Effects of Tongbi Tang（通痹汤）on the Clinical Efficacy,Serum Osteoprotegerin and Inflammatory Factors in Joint Fluid of Senile Rheumatoid Arthritis

ZHANG Guang-hui,ZHANG Chao,GUO Zhan-fei

　　【ABSTRACT】Objective:To explore the effect of Tongbi Tang（通痹汤）on the clinical efficacy and laboratory indexes of senile rheumatoid arthritis.Methods:Eighty-four patients with active rheumatoid arthritis were randomly divided into a treatment group and a control group,42 cases in each group.The control group was treated with iricoxib and methotrexate,and the treatment group was treated with Tongbi Tang based on the treatment for the control group.Both groups were treated for 12 weeks as a course.The clinical effect,as well as the changes of OPG,RF,TNF-α and IL-17 of the two groups before and after treatment were observed.Results:In the treatment group,8 cases were recovered,21 cases were markedly effective,11 cases were effective,2 cases were ineffective,and the total effective rate was 95.24%.In the control group,1 case was recovered,18 cases were markedly effective,13 cases were effective,10 cases were ineffective,and the total effective rate was 76.19%.The difference between the two groups was statistically significant（P < 0.05）.After treatment,the level of OPG increased and the levels of RF,TNF-α and IL-17 decreased in both groups（P < 0.05）,and the treatment group was significantly higher than the control group（P < 0.05）.There was no significant difference between the two groups（P > 0.05）.Conclusion:Tongbi Tang can significantly improve the serum OPG level of elderly patients with rheumatoid arthritis,and reduce the expression of RF,TNF-α,IL-17 and other inflammatory factors.It has a significant clinical effect and high safety,and is worthy of promotion and application.

　　【Keywords】 arthritis,rheumatoid;Tongbi Tang（通痹汤）;osteoprotegerin;rheumatoid factor;TNF-α;IL-17;clinical efficacy