目的 探讨尪痹片联合托法替布治疗类风湿关节炎的临床疗效。方法 选取2022年9月—2023年8月聊城市第二人民医院收治的116例类风湿关节炎患者，使用SPSS 27.0统计软件包生成随机数字表，按照1∶1进行随机分组，分为对照组58例和治疗组58例。对照组患者口服枸橼酸托法替布片，5 mg/次，2次/d。治疗组在对照组治疗基础上口服尪痹片，4片/次，3次/d。两组疗程12周。观察两组治疗4、8、12周后的临床疗效，比较两组治疗前后各项临床表现评分、28个关节疾病活动度（DAS28-CRP和DAS28-ESR）评分、类风湿关节炎自我效能量表（RASE）评分、36项健康调查简表（SF-36）评分及全血中性粒细胞与淋巴细胞比值（NLR）和血清C反应蛋白（CRP）、白细胞介素（IL）-6、γ干扰素（IFN-γ）、IL-10水平变化。结果 治疗组治疗4、8周后的总有效率分别为72.41%、86.21%，与对照组的67.24%、75.86%比较差异无统计学意义；治疗12周后治疗组的总有效率是94.83%，显著高于对照组的82.76%（P＜0.05）。治疗后，两组关节疼痛评分、肿胀评分、屈伸不利评分、晨僵评分、关节压痛评分均较同组治疗前显著降低（P＜0.05）；治疗后，治疗组临床表现评分显著低于对照组（P＜0.05）。治疗后，两组DAS28-CRP评分、DAS28-ESR评分显著降低，而RASE评分和SF-36评分均显著增加（P＜0.05）；治疗后，治疗组DAS28评分、RASE评分和SF-36评分改善优于对照组（P＜0.05）。治疗后，两组NLR、CRP、IL-6、IFN-γ、IL-10均显著降低（P＜0.05）；治疗后，治疗组炎症指标低于对照组（P＜0.05）。结论 尪痹片联合托法替布治疗类风湿关节炎的效果确切，能有效促进临床表现和疾病活动度减轻，并能进一步缓解机体炎症损伤，改善患者自我效能和生活质量。

Objective To explore the clinical efficacy of Wangbi Tablets combined with tofacitinib in treatment of rheumatoid arthritis. Methods A total of 116 patients with rheumatoid arthritis admitted to the Second People’s Hospital of Liaocheng from September2022 to August 2023 were selected. SPSS 27.0 statistical software package was used to generate a random number table, and randomly divided into a control group (58 cases) and a treatment group (58 cases) according to 1:1. 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 Wangbi Tablets on the basis of the control group, 4 tablets/time, three times daily. Both groups were treated for 12 weeks. The clinical efficacy of the two groups was observed after 4, 8 and 12 weeks of treatment. The changes of clinical manifestations, 28 joint disease activity (DAS28-CRP and DAS28-ESR) scores, rheumatoid arthritis Self-efficacy Scale (RASE) scores, 36 health survey summary Form (SF-36) scores, whole blood neutrophil to lymphocyte ratio (NLR) and serum C-reactive protein (CRP), interleukin (IL)-6, interferon-γ (IFN-γ), and IL-10 in two groups were compared before and after treatment for changed. Results After 4 and 8 weeks of treatment, the total effective rate of the treatment group was 72.41% and 86.21%, respectively, which had no statistical significance compared with 67.24% and 75.86% of the control group. After 12 weeks of treatment, the total effective rate of treatment group was 94.83%, which was significantly higher than that of control group (82.76%) (P< 0.05). After treatment, joint pain score, swelling score, adverse flexion and extension score, morning stiffness score and joint tenderness score in 2 groups were significantly lower than before treatment (P < 0.05). After treatment, the clinical performance score of the treatment group was significantly lower than that of the control group (P < 0.05). After treatment, DAS28-CRP score and DAS28-ESR score were significantly decreased, but RASE score and SF-36 score were significantly increased in both groups (P < 0.05). After treatment, DAS28 score, RASE score and SF-36 score in the treatment group were better than those in the control group (P < 0.05). After treatment, NLR, CRP, IL-6, IFN-γ and IL-10 were significantly decreased in both groups (P< 0.05). After treatment, the inflammation index in the treatment group was lower than that in the control group (P < 0.05). Conclusion Wangbi Tablets combined with tofacitinib has a definite effect in treatment of rheumatoid arthritis, and can effectively promote the reduction of clinical manifestations and disease activity, further alleviate the inflammatory damage of the body, improve the self-efficacy and quality of life of patients.

R982

山东省中医药科技项目(M2023272)