目的 观察火把花根片联合来氟米特治疗类风湿性关节炎的临床效果。方法 选取2019年8月—2021年8月天津市第五中心医院收治的104例类风湿性关节炎患者，按随机数字表法将104例患者分成对照组和治疗组，每组各52例。对照组口服来氟米特片，2片/次，1次/d。治疗组在对照组基础上口服火把花根片，4片/次，3次/d。所有患者均连续治疗12周。观察两组疗效，比较治疗前后两组症状、体征[晨僵时间、关节疼痛视觉模拟量表（VAS）评分、关节肿胀数和压痛数]，28个关节疾病活动度（DAS28）评分、健康评估问卷残疾指数（HAQ-DI）评分和血沉（ESR），血清C反应蛋白（CRP）、白细胞介素（IL）-18、可溶性细胞间黏附分子-1（sICAM-1）、基质金属蛋白酶-13（MMP-13）水平，外周血CD4⁺、CD8⁺水平及其比值（CD4⁺/CD8⁺）。结果 治疗后，治疗组总有效率为88.5%，显著高于对照组的73.1%（P＜0.05）。治疗后，两组晨僵时间均显著缩短，关节疼痛VAS评分均显著降低，关节肿胀数和压痛数均显著减少（P＜0.05）；且均以治疗组改善更显著（P＜0.05）。治疗后，两组DAS28评分和HAQ-DI评分均显著降低（P＜0.05）；且均以治疗组下降更显著（P＜0.05）。治疗后，两组ESR和血清CRP、IL-18、sICAM-1、MMP-13水平均较治疗前显著下降（P＜0.05）；且均以治疗组的降低更显著（P＜0.05）。治疗后，两组外周血CD4⁺水平、CD4⁺/CD8⁺均较治疗前显著降低，外周血CD8⁺水平均较治疗前显著增高（P＜0.05）；且均以治疗组改善更显著（P＜0.05）。结论 火把花根片联合来氟米特治疗类风湿性关节炎的整体疗效确切，能有效改善患者临床表现，降低疾病活动度，减轻关节损害，抑制体内炎症反应，改善免疫功能。

Objective To observe the clinical effect of Huobahuagen Tablets combined with leflunomide in treatment of rheumatoid arthritis.Methods A total of 104 patients with rheumatoid arthritis admitted to Tianjin Fifth Central Hospital from August 2019 to August 2021 were selected and divided into control (n=52) and treatment group (n=52) according to the random number table method.Patients in the control group were po administered with Leflunomide Tablets,2 tablets/time,once daily.Patients in the treatment group were po administered with Huobahuagen Tablets on the basis of the control group,4 tablets/time,three times daily.All patients were treated for 12 weeks.The efficacy of the two groups were observed.The symptoms and signs[morning stiffness time,joint pain visual analog scale (VAS) score,joint swelling number and tenderness number],28 joint disease activity (DAS28) scores,health assessment questionnaire disability index (HAQ-ID) were compared between the two groups before and after treatment.The erythrocyte sedimentation rate (ESR),serum C-reactive protein (CRP),interleukin (IL)-18,soluble intercellular adhesion molecule 1(SICAM-1),matrix metalloproteinase-13(MMP-13) levels,peripheral blood CD4⁺,CD8⁺ levels and their ratio (CD4⁺/CD8⁺) were compared.Results After treatment,the total effective rate of the treatment group was 88.5%,which was significantly higher than that of the control group (73.1%,P<0.05).After treatment,the morning stiffness time was significantly shortened,the VAS score of joint pain was significantly decreased,and the number of joint swelling and tenderness were significantly decreased in both groups (P<0.05).The improvement was more significant in the treatment group (P <0.05).After treatment,the DAS28 score and HAQ-DI score of the two groups were significantly decreased (P<0.05).The decrease was more significant in the treatment group (P<0.05).After treatment,ESR and serum levels of CRP,IL-18,SICAM-1 and MMP-13 in two groups were significantly decreased compared with those before treatment (P<0.05).The reduction in treatment group was more significant (P <0.05).After treatment,the levels of peripheral blood CD4⁺ and CD4⁺/CD8⁺ in the two groups were significantly lower than those before treatment,and the levels of peripheral blood CD8⁺ were significantly higher than those before treatment (P<0.05).The improvement was more significant in the treatment group (P<0.05).Conclusion Huobahuagen Tablets combined with leflunomide has a definite overall curative effect in the treatment of rheumatoid arthritis,and can effectively improve the clinical manifestations of patients,reduce disease activity and joint damage,inhibit the inflammatory response in the body,which can improve immune function.

R977

天津市第五中心医院院内科研项目(WZX201918)