活血化瘀法联合抗风湿药治疗类风湿关节炎的临床研究
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摘要
目的：
类风湿关节炎(Rheumatoid arthritis, RA)是一种慢性炎性、系统性的自身免疫疾病,分布范围极为广泛,以对称性、进行性、和破坏性关节病变为主要特征,表现为外周关节持续性和进行性的滑膜炎,继而引起软骨破坏和骨侵蚀,造成关节畸形,导致不同程度的残废。致残率很高,较严重的威胁着人们的身体健康。现代医学认为,类风湿关节炎的病因尚不明确,与发病有关的有感染因素、遗传因素、细胞因子因素和内分泌因素。在治疗上,无特效治疗方法,临床证实西医治疗部分有效,但容易发生各种不良反应,患者不易坚持,中医药治疗RA历史悠久,大量的临床研究已表明中医药治疗RA有抗炎镇痛、免疫抑制、免疫调节三重效应,且大多数中药具有不良反应小、易于坚持服用等特点,故临床应用有很多优势。近年来,许多中医医家在传统中医对痹证认识的基础上,借鉴当代先进技术手段,不断丰富痹证的内容,采用微观的定性、定量研究方法,探讨类风湿关节炎与机体免疫指标、细胞因子等变化的相关性,研究中药的作用机理,已取得一定的突破。
拟通过本课题研究,对类风湿关节炎实验室指标及血液流变学相关指标的改变的现象与中西药治疗疗效进行分析,以期为中、西药的治疗方案优化提供依据,找出有效患者的临床特征性数据,根据相关临床症状,针对性地制定提高临床疗效的科学方案。在探讨中医药的作用机理和治疗新方法上做了些基础工作,为临床早期干预治疗提供新思路、并为治疗效果评价提供科学依据。方法：(1)对照组：来氟米特片(商品名：爱若华,10mg／片,苏州长征-欣凯制药有限公司生产,国家准字号：H20000550)20mg／天,每日1次口服。美洛昔康分散片(扬子江药业集团有限公司生产,国家准字号：H20010108)7.5mg／次,2次／天,饭后服。(2)治疗组：在对照组用药基础上,加用活血化瘀中药合剂水煎每次200ml,一日两次,口服。疗程：1个月1疗程,观察一个疗程。治疗前后及每周对观察病例进行全面体格检查1次,观察关节疼痛程度、晨僵时间、肿胀指数、平均握力、HAQ指数、及实验室指标包括血液流变学指标、ESR、RF、CRP等,治疗前后各检查1次,均于观察结束后进行疗效评定。
结果：
1.总有效率的比较：治疗后,患者临床症状及体征明显减轻,实验室指标明显改善。其中,治疗组总有效率为87.5%,显著高于对照组(P<0.05)。
2.临床症状及体征的比较：活血化瘀中药合剂联合来氟米特片、美洛昔康分散片明显改善类风湿关节炎患者的临床症状及体征,其中关节疼痛指数、肿胀指数、HAQ指数、功能障碍指数明显下降,晨僵时间明显缩短,双手平均握力明显增加,与对照组比较改善程度更明显。
3.实验室指标的改善：对异常实验室指标有明显改善,ESR、RF、CRP、IgA、IgG、补体C3指标、血液流变学检测指标血沉、全血黏度、血浆粘度、红细胞压积、血小板黏附率以及红细胞电泳,较对照组改善程度更明显。
4.安全性：治疗组4例患者服药4周后出现恶心,3例患者服药2周后出现腹痛,未作特殊处理,停药后症状消失,未发现明显肝肾功能损害及其他毒副反应。
结论：
活血化瘀中药合剂联合来氟米特片、美洛昔康分散片对类风湿关节炎患者的关节疼痛、关节肿胀、关节压痛症状均有明显改善,能明显提高双手握力,改善功能障碍,降低ESR、RF、CRP、IgA、IgG、补体C3指标、血液流变学检测指标血沉、全血黏度、血浆粘度、红细胞压积、血小板黏附率以及红细胞电泳。其中,关节疼痛指数、晨僵时间、血沉、全血黏度、血浆粘度、红细胞压积、血小板黏附率以及红细胞电泳指标,治疗组较对照组改善更显著。以上研究表明活血化瘀中药合剂联合来氟米特片、美洛昔康分散片对类风湿关节炎血液流变学具有肯定的治疗效果,且口服使用安全、质量稳定、使用方便,值得临床大力推广应用,以期造福患者。
Purpose:
Rheumatoid arthritis (Rheumatoid arthritis, RA) is a chronic inflammatory, systemic autoimmune diseases, extremely broad distribution, with symmetry, sexual, and destructive joint disease as the main features of peripheral joints showed sustained and progressive synovitis in turn cause cartilage destruction and bone erosion, resulting in joint deformities, resulting in varying degrees of disability. Morbidity is high, the more serious threat to people's health. Modern medicine, the cause of rheumatoid arthritis is not clear, and the incidence of infection-related factors, genetic factors, cytokines factors and endocrine factors. In the treatment, no specific treatment methods, clinical treatment of part of western medicine proved effective, but prone to a variety of adverse reactions in patients with difficult to uphold a long history of Chinese medicine treatment of RA, a large number of clinical studies have shown that Chinese medicine treatment of RA with anti-inflammatory analgesic, immune suppression, immune regulation triple effect, and most of the traditional Chinese medicine has few side effects, easy to insist on taking the characteristics of clinical application and therefore has many advantages. In recent years, many Chinese physicians of traditional Chinese medicine on the basis of knowledge of Bi Syndrome, learn contemporary advanced technological means to continuously enrich the content of Bi Syndrome, using micro-qualitative and quantitative research methods to explore indicators of rheumatoid arthritis and immune, cytokines such as changes in correlation to study the mechanism of Chinese medicine, has made some breakthroughs.
Proposed by this research, and laboratory parameters of rheumatoid arthritis and hemorheology indexes related to the phenomenon and analyze the effects of western medicine, the western medicine treatment programs optimized to provide a basis to identify effective clinical characteristics of patients with data, in accordance with relevant clinical symptoms, improve clinical efficacy of targeting the development of scientific programs. To investigate the mechanism of Chinese medicine and treatment of new ways to do some groundwork for the clinical treatment of early intervention to provide new ideas, and to provide the scientific basis for evaluation of treatment.
Method:
(1) control group:leflunomide tablets (trade name:Arava, 10mg/film, Suzhou Changzheng-Xin Kai Pharmaceutical Co., Ltd. production, batch number:H20000550) 20mg/day orally for 1 day. Meloxicam tablet (Yangtze River Pharmaceutical Group Co., Ltd. Production) 7.5mg/times,2 times/day, meal service. (2) treatment groups:control group, medication, based on traditional Chinese medicine blood stasis mixture was added decoction per 200ml, twice a day, oral. Course of treatment:3 months of a course of treatment, observation of a course of treatment. Before and after treatment and weekly to conduct a comprehensive physical examination of the observed cases of a second to observe the degree of joint pain, morning stiffness time, swelling index, the average grip strength, HAQ index, and laboratory indicators such as blood rheology, ESR, RF, CRP, etc. treatment before and after a time of the inspection, are in the observation after the conclusion of efficacy evaluation.
Results:
1 comparison of total effective:After treatment, patients with significantly reduced clinical symptoms and signs, laboratory parameters improved significantly. Among them, the treatment group, the total effective rate was 87.5%, significantly higher (P<0.05).
2 Comparison of clinical symptoms and signs:blood circulation mixture of Chinese medicine combined leflunomide tablets, dispersible tablets of meloxicam significant improvement in rheumatoid arthritis patients with clinical symptoms and signs, including joint pain index, swelling index, HAQ index, dysfunction index was significantly decreased time of morning stiffness was significantly shorter with both hands an average grip strength increased significantly compared with the control group the degree of improvement is more obvious.
3 Laboratory of indicators improved:the abnormal laboratory indicators improved significantly, ESR, RF, CRP, IgA, IgG, complement C3 indicators, hemorheology index ESR, whole blood viscosity, plasma viscosity, hematocrit, platelet adhesion rate and erythrocyte electrophoresis, compared with the control group the degree of improvement is more obvious.
4 Security:treatment group,4 patients after 4 weeks of medication, nausea,3 patients suffer from abdominal pain after 2 weeks of medication, the absence of special treatment, symptoms disappeared after treatment, no obvious damage to liver and kidney function, and other adverse reactions.
Conclusion:
Mixture of Chinese medicine blood stasis combined lef lunomide tablets, meloxicam tablet in patients with rheumatoid arthritis, joint pain, joint swelling, joint tenderness symptoms were significantly improved, can significantly improve the double-grip strength, improve dysfunction, reduced ESR, RF, CRP, IgA, IgG, complement C3 indicators, hemorheology index ESR, whole blood viscosity, plasma viscosity, hematocrit, platelet adhesion rate and erythrocyte electrophoresis. Among them, joint pain index, time of morning stiffness, ESR, whole blood viscosity, plasma viscosity, hematocrit, platelet adhesion rate and erythrocyte electrophoresis indicators, the treatment group improved more significantly than the control group. Studies have shown that blood circulation above mixture of Chinese medicine combined leflunomide tablets, meloxicam tablet rheology of rheumatoid arthritis with a positive therapeutic effect, and the oral use of safe, stable quality, it is worth strong clinical popularization and application, with a view to the patient.
类风湿关节炎(Rheumatoid arthritis, RA)是一种慢性炎性、系统性的自身免疫疾病,分布范围极为广泛,以对称性、进行性、和破坏性关节病变为主要特征,表现为外周关节持续性和进行性的滑膜炎,继而引起软骨破坏和骨侵蚀,造成关节畸形,导致不同程度的残废。致残率很高,较严重的威胁着人们的身体健康。现代医学认为,类风湿关节炎的病因尚不明确,与发病有关的有感染因素、遗传因素、细胞因子因素和内分泌因素。在治疗上,无特效治疗方法,临床证实西医治疗部分有效,但容易发生各种不良反应,患者不易坚持,中医药治疗RA历史悠久,大量的临床研究已表明中医药治疗RA有抗炎镇痛、免疫抑制、免疫调节三重效应,且大多数中药具有不良反应小、易于坚持服用等特点,故临床应用有很多优势。近年来,许多中医医家在传统中医对痹证认识的基础上,借鉴当代先进技术手段,不断丰富痹证的内容,采用微观的定性、定量研究方法,探讨类风湿关节炎与机体免疫指标、细胞因子等变化的相关性,研究中药的作用机理,已取得一定的突破。
拟通过本课题研究,对类风湿关节炎实验室指标及血液流变学相关指标的改变的现象与中西药治疗疗效进行分析,以期为中、西药的治疗方案优化提供依据,找出有效患者的临床特征性数据,根据相关临床症状,针对性地制定提高临床疗效的科学方案。在探讨中医药的作用机理和治疗新方法上做了些基础工作,为临床早期干预治疗提供新思路、并为治疗效果评价提供科学依据。方法：(1)对照组：来氟米特片(商品名：爱若华,10mg／片,苏州长征-欣凯制药有限公司生产,国家准字号：H20000550)20mg／天,每日1次口服。美洛昔康分散片(扬子江药业集团有限公司生产,国家准字号：H20010108)7.5mg／次,2次／天,饭后服。(2)治疗组：在对照组用药基础上,加用活血化瘀中药合剂水煎每次200ml,一日两次,口服。疗程：1个月1疗程,观察一个疗程。治疗前后及每周对观察病例进行全面体格检查1次,观察关节疼痛程度、晨僵时间、肿胀指数、平均握力、HAQ指数、及实验室指标包括血液流变学指标、ESR、RF、CRP等,治疗前后各检查1次,均于观察结束后进行疗效评定。
结果：
1.总有效率的比较：治疗后,患者临床症状及体征明显减轻,实验室指标明显改善。其中,治疗组总有效率为87.5%,显著高于对照组(P<0.05)。
2.临床症状及体征的比较：活血化瘀中药合剂联合来氟米特片、美洛昔康分散片明显改善类风湿关节炎患者的临床症状及体征,其中关节疼痛指数、肿胀指数、HAQ指数、功能障碍指数明显下降,晨僵时间明显缩短,双手平均握力明显增加,与对照组比较改善程度更明显。
3.实验室指标的改善：对异常实验室指标有明显改善,ESR、RF、CRP、IgA、IgG、补体C3指标、血液流变学检测指标血沉、全血黏度、血浆粘度、红细胞压积、血小板黏附率以及红细胞电泳,较对照组改善程度更明显。
4.安全性：治疗组4例患者服药4周后出现恶心,3例患者服药2周后出现腹痛,未作特殊处理,停药后症状消失,未发现明显肝肾功能损害及其他毒副反应。
结论：
活血化瘀中药合剂联合来氟米特片、美洛昔康分散片对类风湿关节炎患者的关节疼痛、关节肿胀、关节压痛症状均有明显改善,能明显提高双手握力,改善功能障碍,降低ESR、RF、CRP、IgA、IgG、补体C3指标、血液流变学检测指标血沉、全血黏度、血浆粘度、红细胞压积、血小板黏附率以及红细胞电泳。其中,关节疼痛指数、晨僵时间、血沉、全血黏度、血浆粘度、红细胞压积、血小板黏附率以及红细胞电泳指标,治疗组较对照组改善更显著。以上研究表明活血化瘀中药合剂联合来氟米特片、美洛昔康分散片对类风湿关节炎血液流变学具有肯定的治疗效果,且口服使用安全、质量稳定、使用方便,值得临床大力推广应用,以期造福患者。
Purpose:
Rheumatoid arthritis (Rheumatoid arthritis, RA) is a chronic inflammatory, systemic autoimmune diseases, extremely broad distribution, with symmetry, sexual, and destructive joint disease as the main features of peripheral joints showed sustained and progressive synovitis in turn cause cartilage destruction and bone erosion, resulting in joint deformities, resulting in varying degrees of disability. Morbidity is high, the more serious threat to people's health. Modern medicine, the cause of rheumatoid arthritis is not clear, and the incidence of infection-related factors, genetic factors, cytokines factors and endocrine factors. In the treatment, no specific treatment methods, clinical treatment of part of western medicine proved effective, but prone to a variety of adverse reactions in patients with difficult to uphold a long history of Chinese medicine treatment of RA, a large number of clinical studies have shown that Chinese medicine treatment of RA with anti-inflammatory analgesic, immune suppression, immune regulation triple effect, and most of the traditional Chinese medicine has few side effects, easy to insist on taking the characteristics of clinical application and therefore has many advantages. In recent years, many Chinese physicians of traditional Chinese medicine on the basis of knowledge of Bi Syndrome, learn contemporary advanced technological means to continuously enrich the content of Bi Syndrome, using micro-qualitative and quantitative research methods to explore indicators of rheumatoid arthritis and immune, cytokines such as changes in correlation to study the mechanism of Chinese medicine, has made some breakthroughs.
Proposed by this research, and laboratory parameters of rheumatoid arthritis and hemorheology indexes related to the phenomenon and analyze the effects of western medicine, the western medicine treatment programs optimized to provide a basis to identify effective clinical characteristics of patients with data, in accordance with relevant clinical symptoms, improve clinical efficacy of targeting the development of scientific programs. To investigate the mechanism of Chinese medicine and treatment of new ways to do some groundwork for the clinical treatment of early intervention to provide new ideas, and to provide the scientific basis for evaluation of treatment.
Method:
(1) control group:leflunomide tablets (trade name:Arava, 10mg/film, Suzhou Changzheng-Xin Kai Pharmaceutical Co., Ltd. production, batch number:H20000550) 20mg/day orally for 1 day. Meloxicam tablet (Yangtze River Pharmaceutical Group Co., Ltd. Production) 7.5mg/times,2 times/day, meal service. (2) treatment groups:control group, medication, based on traditional Chinese medicine blood stasis mixture was added decoction per 200ml, twice a day, oral. Course of treatment:3 months of a course of treatment, observation of a course of treatment. Before and after treatment and weekly to conduct a comprehensive physical examination of the observed cases of a second to observe the degree of joint pain, morning stiffness time, swelling index, the average grip strength, HAQ index, and laboratory indicators such as blood rheology, ESR, RF, CRP, etc. treatment before and after a time of the inspection, are in the observation after the conclusion of efficacy evaluation.
Results:
1 comparison of total effective:After treatment, patients with significantly reduced clinical symptoms and signs, laboratory parameters improved significantly. Among them, the treatment group, the total effective rate was 87.5%, significantly higher (P<0.05).
2 Comparison of clinical symptoms and signs:blood circulation mixture of Chinese medicine combined leflunomide tablets, dispersible tablets of meloxicam significant improvement in rheumatoid arthritis patients with clinical symptoms and signs, including joint pain index, swelling index, HAQ index, dysfunction index was significantly decreased time of morning stiffness was significantly shorter with both hands an average grip strength increased significantly compared with the control group the degree of improvement is more obvious.
3 Laboratory of indicators improved:the abnormal laboratory indicators improved significantly, ESR, RF, CRP, IgA, IgG, complement C3 indicators, hemorheology index ESR, whole blood viscosity, plasma viscosity, hematocrit, platelet adhesion rate and erythrocyte electrophoresis, compared with the control group the degree of improvement is more obvious.
4 Security:treatment group,4 patients after 4 weeks of medication, nausea,3 patients suffer from abdominal pain after 2 weeks of medication, the absence of special treatment, symptoms disappeared after treatment, no obvious damage to liver and kidney function, and other adverse reactions.
Conclusion:
Mixture of Chinese medicine blood stasis combined lef lunomide tablets, meloxicam tablet in patients with rheumatoid arthritis, joint pain, joint swelling, joint tenderness symptoms were significantly improved, can significantly improve the double-grip strength, improve dysfunction, reduced ESR, RF, CRP, IgA, IgG, complement C3 indicators, hemorheology index ESR, whole blood viscosity, plasma viscosity, hematocrit, platelet adhesion rate and erythrocyte electrophoresis. Among them, joint pain index, time of morning stiffness, ESR, whole blood viscosity, plasma viscosity, hematocrit, platelet adhesion rate and erythrocyte electrophoresis indicators, the treatment group improved more significantly than the control group. Studies have shown that blood circulation above mixture of Chinese medicine combined leflunomide tablets, meloxicam tablet rheology of rheumatoid arthritis with a positive therapeutic effect, and the oral use of safe, stable quality, it is worth strong clinical popularization and application, with a view to the patient.
引文
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[22]Koremen AJ,Boss JU, Rhodes G, et al. Genetic complexity and expression of human class II his to compatility antigens. Immunol Rev 1985; 85 (7):45.
[23]唐福林,黄锋,鲍春德,等.第四次全国风湿病学学术会议纪要[J].中华内科杂志1993；32(7)：513.
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[29]戴自英主编.实用内科学(上册)[M],北京：人民卫生出版社,1994,(9)：780-783.
[30]原桃介.类风湿性关节炎的汉方治疗[J].国外医学中医中药分册,1982; (4)： 14.
[31]Ostergaaard M, Hansen M, Stolrnberg M, et al. Magnetic resonance imaging-determined synovial membrane volume as a marker of disease activity and a predictor of progressive joint destruction in the wrists of patients with rheumatoid arthritis. Arthritis Rheum,1999; 42 (5):918～27.
[32]张之南,沈悌.慢性病贫血.血液病诊断及疗效标准[M],北京：科学出版社,1998,(2)：10-11,30-31.
[33]陈嘉林,李淑兰,徐闽,等.血清转铁蛋白受体对贫血患者鉴别诊断的临床意义[J].中华内科杂志,2004；43(6)：423-425.
[34]和虹,储榆林,邵宗鸿.类风湿性关节炎相关性血液学异常[J]中华血液学杂志,2000；21(10)：556-557.
[35]Voulgari PV, Kolios G, Papadopoulos GK, et al. Role of cytokines in the pathogenesis of anemia of chronic disease in rheumatoid arthritis[J]. Clin Immunol,1999; 92 (2):153-160.
[36]刘长林,金兆清,等.血清免疫球蛋白浓度与血浆粘度相关性的研究[J].中国血液流变学杂志,2000；10(1)：45～47.
[37]Elewaat D, De Keyser F, Dewever N, et al. Acomparative phen-otypical alysis of rheumatoid nodules and rheumatiod synovium with special refernce to adhesion molecules and activation markers [J].Ann RheumDis 1998; 57:480.
[38]Joosten LAB, Lubberts E. Role of IL-4 and IL-10 in murine collagen induced arthritis:protective effect of IL-4 and IL-10 treatment on cartilage destruction [J].Arthritis rheum,1997; 40:249-260.
[39]张荒生、王进军.风湿病辩治的临床思路与方法[J].中医药学刊,2006；24(4)：612-613.
[40]王昊等.配合黄芪注射液治疗类风湿性关节炎临床观察[J].中华风湿病学杂志,2003；(7)：32.
[1]何映.汪履秋教授治痹证经验[J].河北中医,2006,28(8)：32.
[2]娄高峰.中国名老中医药专家学术经验集·立虚邪癣说的治痹名家娄多峰[M].贵阳：贵州科技出版社,1995,(2)：398.
[3]周全,金实.试论肝在类风湿性关节炎发病机制中的作用[J].吉林中医药,2004,24(3)：4.
[4]朱辉军,黄胜光教授治疗类风湿性关节炎经验介绍[J].新中医,2004,36(1)：9-11.
[5]周学平,周仲瑛,金妙文,等.益肾蠲痹、消痰化瘀法治疗中、晚期类风湿性关节炎的临床研究[J].中医杂志,1998,39(10)：606-609.
[6]郜中明.中医辨证治疗类风湿性关节炎82例[J].四川中医,2006,24 (8)： 64.
[7]李广文.辨证治疗类风湿性关节炎16例[J].辽宁中医杂志,2004,31 (10)： 839.
[8]肖云松.辨证治疗类风湿性关节炎33例[J].中国民间疗法,2002,10 (4)： 53.
[9]赵和平,杨东威,王素梅,等.乌蚌煎治疗类风湿性关节炎的临床观察[J].湖北中医杂志,2005,27(1)：25.
[10]史成和,关晓旭.和血蠲痹汤治疗类风湿性关节炎90例[J].陕西中医,2004,25(7)：614-616.
[11]马彬,张奉生,乳香追风汤治疗类风湿性关节炎40例[J].山东中医杂志,2004,23(6)：337-338.
[12]毕世庆,杨全兴.中药熏蒸治疗类风湿性关节炎35例疗效观察[J].遵义医学院学报,2004,27(4)：365-366.
[13]何洋,徐红霞.中药雾化加针灸治类风湿性关节炎疗效观察[J]针灸临床杂志,2004,20(10)：11-12.
[14]李晋青.温针治疗类风湿性关节炎50例[J].四川中医,2003,21(9)： 91.
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[20]周学平,周仲瑛,金妙文,等.益肾蠲痹、消痰化瘀法治疗中、晚期类风湿性关节炎的临床研究[J].中医杂志,1998；39(10)：606-609.
[21]高生、许新晖、刘小惠.陈昆山论治类风湿性关节炎[J].江西中医药,2004；35(257)：5-6.
[22]Koremen AJ,Boss JU, Rhodes G, et al. Genetic complexity and expression of human class II his to compatility antigens. Immunol Rev 1985; 85 (7):45.
[23]唐福林,黄锋,鲍春德,等.第四次全国风湿病学学术会议纪要[J].中华内科杂志1993；32(7)：513.
[24]Rothbard JB, Gefter ML. Interactions between Immuno genetics peptides and MHC peptides.Ann Rev Immunol 1992; 10:527.
[25]孟学,王迎雪,施全胜,等.类风湿性关节炎发病机理[J].基础医学与临床,1998；18(4)：2.
[26]Tsuchiya N,Murayama T, Yoshinoya S, et al. Antibodies to human cytomegalovirus 65-kilodalton Fc binding protein in rheumatoid arthritis:idiotypic mimicry hypothesis of rheumatoid factor production. Autoimmunity,1993,15:39.
[27]Bresnihan B, Alvaro-Gracia JM, Cobby M, et al. Treatment of rheumatoid arthritis with recombinant human interleukin-1 receptor antagonist [J].Arthritis Rheum,1998; 41 (12):219 6-2204.
[28]Neeck G, Federlin K, Graef V, et al. Adrenal secretion of cortiso-1 in patients with rheumatoid arthritis.J Rheumatol 1990; 17 (1):24.
[29]戴自英主编.实用内科学(上册)[M],北京：人民卫生出版社,1994,(9)：780-783.
[30]原桃介.类风湿性关节炎的汉方治疗[J].国外医学中医中药分册,1982; (4)： 14.
[31]Ostergaaard M, Hansen M, Stolrnberg M, et al. Magnetic resonance imaging-determined synovial membrane volume as a marker of disease activity and a predictor of progressive joint destruction in the wrists of patients with rheumatoid arthritis. Arthritis Rheum,1999; 42 (5):918～27.
[32]张之南,沈悌.慢性病贫血.血液病诊断及疗效标准[M],北京：科学出版社,1998,(2)：10-11,30-31.
[33]陈嘉林,李淑兰,徐闽,等.血清转铁蛋白受体对贫血患者鉴别诊断的临床意义[J].中华内科杂志,2004；43(6)：423-425.
[34]和虹,储榆林,邵宗鸿.类风湿性关节炎相关性血液学异常[J]中华血液学杂志,2000；21(10)：556-557.
[35]Voulgari PV, Kolios G, Papadopoulos GK, et al. Role of cytokines in the pathogenesis of anemia of chronic disease in rheumatoid arthritis[J]. Clin Immunol,1999; 92 (2):153-160.
[36]刘长林,金兆清,等.血清免疫球蛋白浓度与血浆粘度相关性的研究[J].中国血液流变学杂志,2000；10(1)：45～47.
[37]Elewaat D, De Keyser F, Dewever N, et al. Acomparative phen-otypical alysis of rheumatoid nodules and rheumatiod synovium with special refernce to adhesion molecules and activation markers [J].Ann RheumDis 1998; 57:480.
[38]Joosten LAB, Lubberts E. Role of IL-4 and IL-10 in murine collagen induced arthritis:protective effect of IL-4 and IL-10 treatment on cartilage destruction [J].Arthritis rheum,1997; 40:249-260.
[39]张荒生、王进军.风湿病辩治的临床思路与方法[J].中医药学刊,2006；24(4)：612-613.
[40]王昊等.配合黄芪注射液治疗类风湿性关节炎临床观察[J].中华风湿病学杂志,2003；(7)：32.
[1]何映.汪履秋教授治痹证经验[J].河北中医,2006,28(8)：32.
[2]娄高峰.中国名老中医药专家学术经验集·立虚邪癣说的治痹名家娄多峰[M].贵阳：贵州科技出版社,1995,(2)：398.
[3]周全,金实.试论肝在类风湿性关节炎发病机制中的作用[J].吉林中医药,2004,24(3)：4.
[4]朱辉军,黄胜光教授治疗类风湿性关节炎经验介绍[J].新中医,2004,36(1)：9-11.
[5]周学平,周仲瑛,金妙文,等.益肾蠲痹、消痰化瘀法治疗中、晚期类风湿性关节炎的临床研究[J].中医杂志,1998,39(10)：606-609.
[6]郜中明.中医辨证治疗类风湿性关节炎82例[J].四川中医,2006,24 (8)： 64.
[7]李广文.辨证治疗类风湿性关节炎16例[J].辽宁中医杂志,2004,31 (10)： 839.
[8]肖云松.辨证治疗类风湿性关节炎33例[J].中国民间疗法,2002,10 (4)： 53.
[9]赵和平,杨东威,王素梅,等.乌蚌煎治疗类风湿性关节炎的临床观察[J].湖北中医杂志,2005,27(1)：25.
[10]史成和,关晓旭.和血蠲痹汤治疗类风湿性关节炎90例[J].陕西中医,2004,25(7)：614-616.
[11]马彬,张奉生,乳香追风汤治疗类风湿性关节炎40例[J].山东中医杂志,2004,23(6)：337-338.
[12]毕世庆,杨全兴.中药熏蒸治疗类风湿性关节炎35例疗效观察[J].遵义医学院学报,2004,27(4)：365-366.
[13]何洋,徐红霞.中药雾化加针灸治类风湿性关节炎疗效观察[J]针灸临床杂志,2004,20(10)：11-12.
[14]李晋青.温针治疗类风湿性关节炎50例[J].四川中医,2003,21(9)： 91.