目的 探讨通络开痹片联合依那西普治疗类风湿关节炎的临床疗效。方法 选择2017年4月-2018年4月在天津市蓟州区人民医院治疗的类风湿关节炎患者94例，根据住院的先后顺序分为对照组（47例）和治疗组（47例）。对照组皮下注射注射用依那西普，25 mg/次，2次/周；治疗组在对照组基础上口服通络开痹片，0.3 g/次，3次/d。两组患者均治疗8周。观察两组患者临床疗效，同时比较治疗前后两组患者症状改善情况、DAS-28、WOMAC、HAQ和VAS评分，及血清C反应蛋白（CRP）、白细胞介素-17（IL-17）、IL-37、环氧化酶-2（COX-2）、类风湿因子（RF）、肿瘤坏死因子样配体1A（TL1A）水平。结果 治疗后，对照组和治疗组临床有效率分别为80.85%和97.87%，两组比较差异有统计学意义（P<0.05）。治疗后，两组患者关节疼痛指数、关节压痛指数、肿胀指数、20 m步行时间均显著减少（P<0.05），且治疗后治疗组患者症状明显好于对照组（P<0.05）。治疗后，两组DAS-28、WOMAC、HAQ和VAS评分均显著降低（P<0.05），且治疗组这些评分明显低于对照组（P<0.05）。治疗后，两组患者血清CRP、IL-17、IL-37、COX-2、RF、TL1A水平均显著下降（P<0.05），且治疗组患者这些血清学指标明显低于对照组（P<0.05）。结论 通络开痹片联合注射用依那西普治疗类风湿关节炎可有效改善患者临床症状，可缓解患者疼痛和提高患者生活质量，促进机体炎症因子水平下降。

Objective To explore the clinical efficacy of Tongluo Kaibi Tablets combined with etanercept in treatment of rheumatoid arthritis. Methods Patients (92 cases) with rheumatoid arthritis in Tianjin Jizhou District People's Hospital from April 2017 to April 2018 were divided into control (51 cases) and treatment (51 cases) groups according to hospitalization order. Patients in the control group were subcutaneous injection administered with Etanercept for injection, 25 mg/time, twice daily. Patients in the treatment group were po administered with Tongluo Kaibi Tablets on the basis of the control group, 0.3 g/time, three times daily. Patients in two groups were treated for 8 weeks. After treatment, the clinical efficacy was evaluated, and the symptoms, DAS-28, WOMAC, HAQ, and VAS scores, and serum levels of CRP, IL-17, IL-37, COX-2, RF, and TL1A in two groups before and after treatment were compared. Results After treatment, the clinical efficacy and in the control and treatment groups was 80.85% and 97.87% respectively, and there were differences between two groups (P<0.05). After treatment, the indexes of joint pain, tenderness, swelling, and the time of walking 20 m in two groups were significantly decreased (P<0.05), and these indexes in the treatment group were significantly lower than those in the control group (P<0.05). After treatment, the DAS-28, WOMAC, HAQ, and VAS scores in two groups were significantly decreased (P<0.05), and these scores in the treatment group were significantly lower than those in the control group (P<0.05). After treatment, the serum CRP, IL-17, IL-37, COX-2, RF, and TL1A levels in two groups were significantly decreased (P<0.05), and these serological indicators in the treatment group were significantly lower than those in the control group (P<0.05). Conclusion Tongluo Kaibi Tablets combined with etanercept in treatment of rheumatoid arthritis can effectively improve the clinical symptoms, can relieve pain and improve the quality of life, and promote the decline of inflammatory factors.