Liu Xi-De, Zhang Jin-Lu, Ye Li-Hong
Department of Athropathy, Zhejiang Provincial Hospital of Integrated Traditional and Western Medicine, Hangzhou.
Zhongguo Zhong Xi Yi Jie He Za Zhi. 2009 Sep;29(9):787-90.
To observe the clinical effect of Wenhua Juanbi Recipe (WJR) in treating rheumatoid arthritis (RA), its effects in reducing the dosage of Western medicine used and stabilizing condition of disease, as well as its influences on peripheral blood levels of tumor necrosis factor alpha (TNF-alpha), interleukin 1beta (IL-1beta) and anti-cyclic citrullinated peptide antibody (anti-CCP), for the sake of exploring its preliminary acting mechanism.
One hundred patients with RA were randomly assigned to 2 groups, the control group and the treated group, 50 in each group. All were treated with oral administration of methotrexate (MTX,7.5 mg per week), sulfasalazine (0.5 g, tid) and meloxicam (Mobic, 7.5 mg, bid), but to the treated group WJR was given additionally. The therapeutic course for both groups was 3 months. Clinical effect, changes of symptoms and physical signs, dosages of western medicines used, and laboratory indices in 2 groups after treatment were observed, and cases of relapse 3 months after treatment were figured out.
The total effective rate in the treated group was higher than that in the control group (88.0% vs 76.0%, P<0.05). The improvements in scores of symptoms and signs [joint pain (0.61 +/- 0.59), swelling (1.49 +/- 1.20), tenderness (0.90 +/- 0.69), movement (0.68 +/- 0.62), griping strength (68.56 +/- 6.50) mm Hg, morning stiff time (23.26 +/- 9.26) min], and in levels of laboratory indices (TNF-alpha, IL-1beta, anti-CCP, RF, ESR, CRP, PLT and Ig) in the treated group after treatment were significantly superior to those in the control group (P<0.05 or P<0.01). The dosages of MTX [(82.11 +/- 11.35) mg vs (94.75 +/- 10.23) mg] and meloxicam [(108.85 +/- 16.13) mg vs (189.63 +/- 18.44) mg] used, and the relapse rate in the treated group were lower significantly (P<0.05, P<0.01) than those in the control group respectively.
Effect of combined therapy of WJR and Western medicines is superior to that of using Western medicines alone in treating RA; WJR can reduce the dosages of Western medicines used and the relapse rate, as well as stabilize the condition of illness. It has the effects of immune regulating and anti-inflammatory reaction. Its mechanism for treating RA is possibly the inhibition on cytokines of TNF-alpha and IL-1beta.
观察文化蠲痹方(WJR)治疗类风湿关节炎(RA)的临床疗效,及其在减少西药用量和稳定病情方面的作用,以及对肿瘤坏死因子α(TNF-α)、白细胞介素1β(IL-1β)和抗环瓜氨酸肽抗体(抗CCP)外周血水平的影响,以探讨其初步作用机制。
将100例RA患者随机分为对照组和治疗组,每组50例。两组均口服甲氨蝶呤(MTX,每周7.5mg)、柳氮磺胺吡啶(0.5g,每日3次)和美洛昔康(莫比可,7.5mg,每日2次),但治疗组加用WJR。两组疗程均为3个月。观察两组治疗后的临床疗效、症状和体征变化、西药用量及实验室指标,并统计治疗后3个月的复发情况。
治疗组总有效率高于对照组(88.0%对76.0%,P<0.05)。治疗组治疗后症状和体征评分[关节疼痛(0.61±0.59)、肿胀(1.49±1.20)、压痛(0.90±0.69)、活动度(0.68±0.62)、握力(68.56±6.50)mmHg、晨僵时间(23.26±9.26)min]及实验室指标水平(TNF-α、IL-1β、抗CCP、类风湿因子、血沉(ESR)、C反应蛋白(CRP)、血小板(PLT)和免疫球蛋白(Ig))的改善情况均显著优于对照组(P<0.05或P<0.01)。治疗组MTX用量[(82.11±11.35)mg对(94.75±10.23)mg]和美洛昔康用量[(108.85±16.13)mg对(189.63±18.44)mg]以及复发率均显著低于对照组(P<0.05,P<0.01)。
WJR联合西药治疗RA的疗效优于单纯使用西药;WJR可减少西药用量和复发率,稳定病情,具有免疫调节和抗炎作用,其治疗RA的机制可能是抑制TNF-α和IL-1β细胞因子。