目的 探讨瘀血痹胶囊联合托法替布治疗类风湿关节炎的临床疗效。方法 选取2021年1月—2022年12月衡水市人民医院收治的112例类风湿关节炎患者，按随机数字表法分为对照组和治疗组，每组各56例。对照组口服枸橼酸托法替布片，5 mg/次，2次/d。治疗组在对照组基础上口服瘀血痹胶囊，6粒/次，3次/d。两组疗程均为12周。观察两组的临床疗效，比较治疗前后两组主要症状和体征情况、以C反应蛋白（CRP）计算的28个关节疾病活动度（DAS28-CRP）、多维健康评估问卷（MDHAQ）评分、影像学Sharp评分，以及全血红细胞沉降率（ESR）、血小板与淋巴细胞比值（PLR）和血清CRP、白细胞介素-8（IL-8）、血管生成素样蛋白4（ANGPTL4）水平。结果 治疗组ACR20、ACR50达标率分别为82.14%、48.21%，较对照组的64.26%、28.57%均显著提高（P＜0.05）；治疗组ACR70达标率为19.64%，高于对照组的12.5%，但差异无统计学意义。治疗后，两组关节疼痛VAS评分、压痛和肿胀关节个数均较治疗前显著降低，晨僵时间显著缩短（P＜0.05）；且均以治疗组改善更显著（P＜0.05）。治疗后，两组DAS28-CRP评分、MDHAQ评分均显著降低，而Sharp评分显著升高（P＜0.05）；治疗后，治疗组DAS28-CRP评分、MDHAQ评分、Sharp评分低于对照组（P＜0.05）。治疗后，两组全血ESR、PLR和血清CRP、IL-8、ANGPTL4水平均显著下降（P＜0.05）；且治疗后，治疗组全血ESR、PLR和血清CRP、IL-8、ANGPTL4水平均显著低于对照组（P＜0.05）。结论 瘀血痹胶囊联合托法替布治疗类风湿关节炎具有较好的临床疗效，能有效促进主要症状、体征好转及病情缓解，减轻机体炎性反应，延缓骨破坏和关节功能损害，改善整体功能状态，值得临床推广应用。

Objective To explore the clinical efficacy of Yuxuebi Capsules combined with tofacitinib in treatment of rheumatoid arthritis. Methods A total of 112 patients with rheumatoid arthritis treated in Hengshui People’s Hospital from January 2021 to December 2022 were selected and divided into control group and treatment group according to random number table method, with 56 cases in each group. Patients in the control group were po administered with Tofacitinib Citrate Tablets, 5 mg/time, twice daily. Patients in the treatment group were po administered with Yuxuebi Capsules on the basis of the control group, 6 grains/time, three times daily. Patients in two groups were treated for 12 weeks. After treatment, the clinical efficacy was evaluated, main symptoms and signs, 28 joint disease activity (DAS28-CRP) calculated by C-reactive protein (CRP), multi-dimensional health assessment questionnaire (MDHAQ) score, imaging Sharp score, and whole blood Erythrocyte sedimentation rate (ESR), platelet to lymphocyte ratio (PLR) and serum CRP, Interleukin 8 (IL-8), angiopoietin like protein 4 (ANGPTL4) levels in two groups before and after treatment were compared. Results After treatment, the compliance rates of ACR20 and ACR50 in the treatment group were 82.14% and 48.21%, respectively, compared with 64.26% and 28.57% in the control group (P < 0.05). The ACR70 compliance rate in the treatment group was 19.64%, higher than 12.5% in the control group, but the difference was not statistically significant. After treatment, the joint pain VAS score, the number of tender and swollen joints were significantly decreased in both groups compared with before treatment, and the morning stiffness time was significantly shortened (P < 0.05). The improvement was more significant in the treatment group (P < 0.05). After treatment, DAS28-CRP score and MDHAQ score were significantly decreased in both groups, while Sharp score was significantly increased (P< 0.05). After treatment, DAS28-CRP score, MDHAQ score and Sharp score in the treatment group were lower than those in the control group (P < 0.05). After treatment, whole blood ESR, PLR and serum CRP, IL-8, and ANGPTL4 levels in both groups were significantly decreased (P < 0.05). After treatment, whole blood ESR, PLR and serum CRP, IL-8, and ANGPTL4 levels in the treatment group were significantly lower than those in the control group (P< 0.05). Conclusion Yuxuebi Capsules combined with tofacitinib has a good clinical effect in treatment of rheumatoid arthritis, and can effectively promote the improvement of the main symptoms and signs and the remission of the disease, reduce the inflammatory reaction of the body, delay the bone destruction and joint function damage, and can improve the overall function state, which is worthy of clinical promotion and application.

R977

衡水市科技计划项目(2020014069Z)