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期 刊 ：中国中药杂志 2007年 32卷 13期 页码：1306.

关键词：解毒通络利湿方；拆方研究；类风湿性关节炎；抗炎；镇痛；调节免疫；

Keywords:Jiedu Tongluo Lishi decoction, MTX, rheumatoid arthritis, clinical effect, safety,

摘 要 ：目的：比较观察解毒通络利湿方及拆方对类风湿性关节炎(RA)的抗炎镇痛及调节免疫作用,并探讨其可能的组方原理和作用机制。方法：Freund’s完全佐剂诱导法建立RA大鼠模型,以甲氨喋呤(MTX)为西药对照组,分组观察解毒通络利湿方及拆方对关节炎症肿胀的抑制作用,对血清IL-1β,TNF-α和PGE₂水平的影响,以及对胸腺和脾指数的影响。比较观察对冰醋酸性疼痛所致小鼠扭体反应的抑制率和对热刺激性反应的痛阈提高率。结果：解毒通络利湿方对佐剂性关节炎症肿胀有显著抑制作用,其效果在早期(14～23 d)优于MTX,后期(26～29 d)与MTX相当；在抑制冰醋酸性疼痛反应或提高热刺激痛阈方面效果显著,优于MTX组；能显著降低血清中IL-1,TNF-α和PGE₂的水平。解毒通络利湿方及其拆方比较,在抑制佐剂性关节炎症肿胀方面,早期解毒、利湿药优于通络药,后期效果相当；在抑制冰醋酸性疼痛反应方面,利湿组优于解毒组和通络组；在抑制热刺激反应方面,通络组优于解毒组和利湿组；在致胸腺、脾脏萎缩的副作用方面,通络药最为明显,与MTX接近,其次是解毒药,而健脾利湿药有一定保护作用。结论：解毒、通络、利湿药对RA抗炎、镇痛和调节免疫方面具有协同效应,其配伍组方能增强疗效和减轻毒副作用,值得临床推广应用。

Abstract:Objective: To explore the clinical curative effect and safety of Jiedu Tongluo Lishi decoction on treating active rheumatoid arthritis (RA). Method: 106 cases of RA in active period were randomly divided into the integrated Chinese and western medicine group (n=54) and western medicine contrast group (n=52). The former group were treated by Jiedu Tongluo Lishi decoction combined with SASP, the latter by MTX combined with SASP. The arthritis morning stiffness time, ache indexes, tumidness indexes, function indexes, hands grip, 20-m walking time and experimental indexes including ESR, RF, CRP, C₃, immune globin of both groups were observed and compared. Result: The obviously clinical effective ratio and the total clinical effective ratio in the former group were 77.78% and 90.74% respectively, which are better than those in the latter group (59.62％ and 71.15% respectively) (P<0.01). The arthritis morning stiffness time, ache indexes, tumidness indexes, function indexes, hands grip and 20-m walking time in both groups were obviously released after treatment (P<0.01). The clinical release in the former group was better than that in the latter group (P<0.05). ESR, RF and CRP in both groups were markedly improved (P<0.05). The improvement of ESR, RF, CRP, C3 and IgA in the former group were better than those in the latter group (P<0.05). The side effect includes gastroenteric tract reaction, decrease of leucocyte, abnormity of liver function, tetter and catamenia maladjustment. The occurent ratio in the former group was 7.41％, which was obviously lower than that in the latter group (15.38％) (P<0.01). Conclusion: The compositively clinical curative effect of Jiedu Tongluo Lishi decoction combined with MTX on treating RA is obviously better than that of western medicine only such as MTX and SASP, with less side effect and higher safety, which is worth applying in clinics extensively.

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