目的 探討尪痹片聯(lián)合托法替布治療類風(fēng)濕關(guān)節(jié)炎的臨床療效。方法 選取2022年9月—2023年8月聊城市第二人民醫(yī)院收治的116例類風(fēng)濕關(guān)節(jié)炎患者，使用SPSS 27.0統(tǒng)計(jì)軟件包生成隨機(jī)數(shù)字表，按照1∶1進(jìn)行隨機(jī)分組，分為對(duì)照組58例和治療組58例。對(duì)照組患者口服枸櫞酸托法替布片，5 mg/次，2次/d。治療組在對(duì)照組治療基礎(chǔ)上口服尪痹片，4片/次，3次/d。兩組療程12周。觀察兩組治療4、8、12周后的臨床療效，比較兩組治療前后各項(xiàng)臨床表現(xiàn)評(píng)分、28個(gè)關(guān)節(jié)疾病活動(dòng)度（DAS28-CRP和DAS28-ESR）評(píng)分、類風(fēng)濕關(guān)節(jié)炎自我效能量表（RASE）評(píng)分、36項(xiàng)健康調(diào)查簡(jiǎn)表（SF-36）評(píng)分及全血中性粒細(xì)胞與淋巴細(xì)胞比值（NLR）和血清C反應(yīng)蛋白（CRP）、白細(xì)胞介素（IL）-6、γ干擾素（IFN-γ）、IL-10水平變化。結(jié)果 治療組治療4、8周后的總有效率分別為72.41%、86.21%，與對(duì)照組的67.24%、75.86%比較差異無統(tǒng)計(jì)學(xué)意義；治療12周后治療組的總有效率是94.83%，顯著高于對(duì)照組的82.76%（P＜0.05）。治療后，兩組關(guān)節(jié)疼痛評(píng)分、腫脹評(píng)分、屈伸不利評(píng)分、晨僵評(píng)分、關(guān)節(jié)壓痛評(píng)分均較同組治療前顯著降低（P＜0.05）；治療后，治療組臨床表現(xiàn)評(píng)分顯著低于對(duì)照組（P＜0.05）。治療后，兩組DAS28-CRP評(píng)分、DAS28-ESR評(píng)分顯著降低，而RASE評(píng)分和SF-36評(píng)分均顯著增加（P＜0.05）；治療后，治療組DAS28評(píng)分、RASE評(píng)分和SF-36評(píng)分改善優(yōu)于對(duì)照組（P＜0.05）。治療后，兩組NLR、CRP、IL-6、IFN-γ、IL-10均顯著降低（P＜0.05）；治療后，治療組炎癥指標(biāo)低于對(duì)照組（P＜0.05）。結(jié)論 尪痹片聯(lián)合托法替布治療類風(fēng)濕關(guān)節(jié)炎的效果確切，能有效促進(jìn)臨床表現(xiàn)和疾病活動(dòng)度減輕，并能進(jìn)一步緩解機(jī)體炎癥損傷，改善患者自我效能和生活質(zhì)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

山東省中醫(yī)藥科技項(xiàng)目(M2023272)