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赵悦, 张霞, 冯娅娆, 任占芬.清肺化瘀汤联合托法替布治疗类风湿关节炎合并间质性肺炎的疗效及安全性分析[J].湖南中医药大学学报英文版,2025,45(9):1764-1770.[Click to copy
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| 清肺化瘀汤联合托法替布治疗类风湿关节炎合并间质性肺炎的疗效及安全性分析 |
| 赵悦,张霞,冯娅娆,任占芬 |
| (河北北方学院附属第一医院风湿免疫科, 河北 张家口 075000) |
| 摘要: |
| 目的 基于临床疗效、血清白细胞介素-32（IL-32）、纤维凝胶蛋白-3（ficolin-3）、涎液化糖链抗原（KL-6）探究清肺化瘀汤辅助治疗类风湿关节炎合并间质性肺炎（RA-ILD）的临床疗效及安全性。方法 选取2022年5月至2023年5月河北北方学院附属第一医院160例RA-ILD患者，根据随机数字表法分为对照组（n=80）、研究组（n=80）。对照组在常规治疗的基础上服用托法替布，研究组在对照组基础上采用清肺化瘀汤治疗，研究组患者中药治疗均与中医证型相符，符合中医辨证论治基本原则。比较两组临床疗效、不良反应及治疗前后中医证候积分、疼痛评分（VAS）、病情活动度（DAS28）、呼吸困难指数、肺功能[呼气峰值流速（PEFR）、肺总容量（TLC）、第1秒用力呼气容积（FEV1）/用力肺活量（FVC）、一氧化碳弥散量（DLCO）]、血清因子[类风湿因子（RF）、IL-32、ficolin-3、KL-6]水平。结果 研究组临床总有效率高于对照组（P<0.05）；研究组治疗后中医证候积分、VAS、DAS28评分、呼吸困难指数低于对照组（P<0.05）；研究组治疗后PEFR、TLC、FEV1/FVC、DLCO高于对照组（P<0.05）；研究组治疗后血清RF、IL-32、KL-6水平低于对照组，ficolin-3水平高于对照组（P<0.05）；两组不良反应发生率对比差异无统计学意义（P>0.05）。结论 清肺化瘀汤联合托法替布治疗RA-ILD患者，可提高临床疗效，改善临床症状、呼吸困难程度，降低病情活动度，减轻疼痛程度，并可促进肺功能恢复，抑制炎症反应，延缓病情进展，且具有一定安全性。 |
| 关键词: 类风湿关节炎 间质性肺炎 托法替布 清肺化瘀汤 疗效 肺功能 |
| DOI：10.3969/j.issn.1674-070X.2025.09.025 |
| Received:March 28, 2025 |
| 基金项目:张家口市重点研发计划项目(2221091D)。 |
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| Efficacy and safety analysis of Qingfei Huayu Decoction combined with tofacitinib in treating rheumatoid arthritis-associated interstitial lung disease |
| ZHAO Yue, ZHANG Xia, FENG Yarao, REN Zhanfen |
| (Department of Rheumatology and Immunology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei 075000, China) |
| Abstract: |
| Objective To investigate the clinical efficacy and safety of Qingfei Huayu Decoction（QFHYD） as an adjuvant therapy for rheumatoid arthritis-associated interstitial lung disease（RA-ILD）, based on assessment of clinical efficacy and measurement of serum interleukin-32（IL-32）, ficolin-3, and Krebs von den Lungen-6（KL-6） levels. Methods A total of 160 patients with RA-ILD admitted to the First Affiliated Hospital of Hebei North University from May 2022 to May 2023 were selected and assigned into a control group（n=80） and a study group（n=80） using a random number table method. The control group received tofacitinib in addition to conventional therapy, while the study group was treated with QFHYD based on the control group’s regimen. The herbal treatments administered to the patients in the study group were tailored to each patient’s Chinese medicine（CM） pattern, adhering to the fundamental principles of CM pattern identification and treatment. Clinical efficacy, adverse reactions,and pre-and post-treatment CM pattern scores, visual analogue scale（VAS） scores, disease activity score based on 28 joints（DAS28）,dyspnea index, pulmonary function parameters [including peak expiratory flow rate（PEFR）, total lung capacity（TLC）, forced expiratory volume in 1 second（FEV1）/forced vital capacity（FVC） ratio, and diffusing capacity of the lungs for carbon monoxide（DLCO）], as well as serum factor levels [including rheumatoid factor（RF）, IL-32, ficolin-3, and KL-6] were compared between the two groups. Results The total clinical effective rate in the study group was higher than that in the control group（P＜0.05）. After treatment, the study group exhibited lower CM pattern scores, VAS scores, DAS28 scores, and dyspnea index compared to the control group（P＜0.05）.Additionally, the study group demonstrated higher values in PEFR, TLC, FEV1/FVC, and DLCO than the control group after treatment（P＜0.05）. Serum levels of RF, IL-32, and KL-6 were lower, while the level of ficolin-3 was higher in the study group after treatment compared to the control group（P＜0.05）. No significant difference was observed in the incidence of adverse reactions between the two groups（P＞0.05）. Conclusion The combination of QFHYD and tofacitinib in the treatment of patients with RA-ILD can enhance clinical efficacy, alleviated clinical symptoms and severity of dyspnea, reduce disease activity, mitigate pain intensity,promote recovery of pulmonary function, suppress inflammatory responses, and delay disease progression, demonstrating a favorable safety profile. |
| Key words: rheumatoid arthritis interstitial lung disease tofacitinib Qingfei Huayu Decoction efficacy pulmonary function |
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