临床误诊误治

目的 探究补肾祛湿汤联合甲氨蝶呤在老年类风湿关节炎(RA)痰瘀痹阻证患者中的疗效及不良反应发生情况。方法 选取2021年8月至2023年9月收治的老年RA痰瘀痹阻证患者93例，根据随机数字表法分为观察组47例和对照组46例。对照组采用泼尼松片联合甲氨蝶呤治疗，观察组在对照组基础上联合补肾祛湿汤治疗，均治疗6个月。比较两组临床疗效、中医证候积分、生活质量、自我效能感量表-8(ASES-8)、改良类风湿活动指数(DAS28)评分、关节功能、血清因子水平、不良反应发生率。结果 观察组退出2例，对照组退出1例。观察组总有效率[95.56%(43/45)]较对照组[80.00%(36/45)]升高(P<0.05)；观察组治疗后中医各证候积分、健康评估问卷调查表、 DAS28评分、关节功能指标较对照组降低，ASES-8评分较对照组升高(P<0.01)；治疗后，观察组血清类风湿因子、涎液化糖链抗原-6、白细胞介素-6、白细胞介素-33水平较对照组下降(P<0.01)；两组不良反应发生率比较差异无统计学意义(P>0.05)。结论 补肾祛湿汤联合甲氨蝶呤治疗老年RA痰瘀痹阻证患者效果显著，能提高生活质量，且安全性较高。

Objective To investigate the effect and adverse reactions of Bushen Qushi decoction combined with Methotrexate in the treatment of elderly patients experiencing rheumatoid arthritis(RA) with phlegm and blood stasis obstruction syndrome. Methods A total of 93 elderly RA patients with phlegm and blood stasis obstruction syndrome admitted from August 2021 to September 2023 were selected and divided into the observation group(n=47) and the control group(n=46) according to the random number table method. The control group was treated with Prednisone tablets combined with Methotrexate, and the observation group was treated with Bushen Qushi decoction on the basis of the control group. Both groups were treated for 6 months. The clinical effect, TCM syndrome score, quality of life, Athletic Shoulder Evaluation Scale-8(ASES-8),modified disease activity score(DAS28) in RA, joint function, serum factor levels, and incidence of adverse reactions were compared between the two groups. Results Two patients dropped out of the observation group and 1 patient dropped out of the control group. The total effective rate was [95.56%(43/45)] in the observation group, which was higher than that in the control group [80.00%(36/45)](P<0.05). After treatment, the TCM syndrome score, Health assessment questionnaire, DAS28 score and joint function index in the observation group were lower than those in the control group, and the ASES-8 score was higher than that in the control group(P<0.01). After treatment, the levels of rheumatoid factor, Krebs Von den Lungen-6(KL-6), interleukin(IL)-6 and IL-33 in the observation group were lower than those in the control group(P<0.01). There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Bushen Qudami decoction combined with Methotrexate is effective in the treatment of elderly RA patients with phlegm and blood stasis obstruction syndrome, which can improve the quality of life of patients, and has good safety.