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目的:观察蠲痹汤加减内服外洗治疗活动期类风湿性关节炎(RA)寒湿痹阻证的疗效以及对血清和关节液中基质金属蛋白酶-3(MMP-3)和金属蛋白酶抑制剂-1(TIMP-1)水平的影响。方法:选择RA患者共120例,参照数字表法随机分为治疗组和对照组,每组均60例;两组均依据《类风湿关节炎诊断及治疗指南》给予非药物治疗;对照组给予甲氨喋呤片(10 mg/次,1次/周),来氟米特片(10 mg/次,1次/d);治疗组在对照组用药基础上给予蠲痹汤加减内服(1剂/d,早晚煎煮口服)和外洗(药渣熏洗病变部位2次/d,30 min/次)治疗,治疗12周。比较两组中医临床症状评分以及血沉(ESR),类风湿因子(RF)和C反应蛋白(CRP)水平;检测两组血清和关节液中MMP-3和TIMP-1水平。结果:治疗组总有效率为96.67%,明显高于对照组的83.33%(P<0.05);治疗组治疗12周后患者中医症状各指标评分均显著低于对照组(P<0.01);治疗组治疗后ESR,RF,CRP,血清和关节液中MMP-3水平均明显低于对照组,而TIMP-1水平明显高于对照组,比较差异有统计学意义(P<0.01)。结论:在常规西医用药基础上,蠲痹汤加减内服外洗治疗活动期RA寒湿痹阻证可明显改善临床症状,降低ESR,RF,CRP水平,提高临床疗效,下调血清和关节液中MMP-3水平而上调TIMP-1水平是其可能机制。
OBJECTIVE: To observe the curative effect of Danbi decoction on cold and dampness syndrome of active rheumatoid arthritis (RA) as well as its effect on the expression of matrix metalloproteinase-3 (MMP-3) and metalloproteinase inhibitors -1 (TIMP-1) levels. Methods: A total of 120 patients with RA were selected and randomly divided into treatment group and control group according to the digital table method, and each group had 60 cases. Both groups were given non-drug treatment according to the Guideline for Diagnosis and Treatment of Rheumatoid Arthritis. Methotrexate tablets (10 mg / time, once a week), leflunomide tablets (10 mg / time, 1 time / d); the treatment group was given on the basis of the control group of Bibi Decoction (1 Dose / d, morning and evening boiling orally) and external washing (dregs fumigation lesions 2 times / d, 30 min / times) for 12 weeks. The clinical symptom score, erythrocyte sedimentation rate (ESR), rheumatoid factor (RF) and C-reactive protein (CRP) were compared between the two groups. The levels of MMP-3 and TIMP-1 in serum and synovial fluid of the two groups were detected. Results: The total effective rate in the treatment group was 96.67%, which was significantly higher than that in the control group (83.33%, P <0.05). The scores of TCM symptoms in the treatment group after 12 weeks treatment were significantly lower than those in the control group (P <0.01) The levels of ESR, RF, CRP, MMP-3 in serum and synovial fluid after treatment were significantly lower than those in control group, while the levels of TIMP-1 were significantly higher than those in control group (P <0.01). Conclusion: Based on the conventional western medicine, the treatment of RA cold-dampness and Bi-obstruction by active and passive washing with Tubi decoction can significantly improve the clinical symptoms, reduce the levels of ESR, RF and CRP, improve the clinical curative effect, and decrease the MMP in serum and synovial fluid -3 levels and up-regulate the level of TIMP-1 is its possible mechanism.