目的 觀察白芍總苷膠囊聯(lián)合依那西普治療幼年特發(fā)性關(guān)節(jié)炎的臨床療效。方法 將2013年7月—2016年6月鄭州兒童醫(yī)院收治的56例患兒隨機分為對照組和治療組，每組各28例。兩組患兒均給予常規(guī)治療，對照組皮下注射注射用依那西普，每次0.4 mg/kg，2次/周；治療組在對照組的基礎(chǔ)上口服白芍總苷膠囊，30 mg/（kg·d），3次/d。兩組患兒均治療12周。治療后，觀察兩組患者臨床療效，同時比較治療前后兩組患者臨床癥狀、血液指標、炎癥因子水平及不良反應(yīng)情況。結(jié)果 治療后，對照組和治療組的總有效率分別為71.43%、85.71%，兩組比較差異具有統(tǒng)計學意義（P< 0.05）。治療后，兩組患者晨僵時間、關(guān)節(jié)壓痛數(shù)、關(guān)節(jié)壓痛指數(shù)、關(guān)節(jié)腫脹數(shù)和關(guān)節(jié)腫脹指數(shù)均顯著降低，同組治療前后比較差異具有統(tǒng)計學意義（P< 0.05）；且治療組患者臨床癥狀改善情況顯著優(yōu)于對照組，兩組比較差異具有統(tǒng)計學意義（P< 0.05）。兩組患者血沉、C反應(yīng)蛋白、類風濕因子水平均顯著降低，同組治療前后比較差異具有統(tǒng)計學意義（P< 0.05）；且治療組患者上述血液指標明顯優(yōu)于對照組，兩組比較差異具有統(tǒng)計學意義（P< 0.05）。治療后，兩組TNF-α、IL-1和IL-17水平均顯著下降，同組比較差異具有統(tǒng)計學意義（P< 0.05）；且治療組患兒TNF-α、IL-1和IL-17水平改善情況明顯優(yōu)于對照組，兩組比較差異具有統(tǒng)計學意義（P< 0.05）。兩組均無明顯不良反應(yīng)發(fā)生。結(jié)論 白芍總苷膠囊聯(lián)合依那西普治療幼年特發(fā)性關(guān)節(jié)炎療效確切，臨床癥狀改善明顯，血液指標及炎癥因子降低明顯，不良反應(yīng)較輕，具有一定的臨床推廣應(yīng)用價值。

Objective To observe the clinical effect of Total Glucosides of Paeony Capsules combined with etanercept in treatment of juvenile idiopathic arthritis. Methods Patients (56 cases) with juvenile idiopathic arthritis in Children's Hospital of Zhengzhou from July 2013 to June 2016 were randomly divided into control group and treatment group, and each group had 28 cases. Patients in two groups were given conventional therapy. Patients in the control group were ih administered with Etanercept for injection, 0.4 mg/kg per time, twice weekly. Patients in the treatment group were po administered with Total Glucosides of Paeony Capsules on the basis of the control group, 30 mg/(kg·d), three times daily. Patients in two groups were treated for 12 weeks. After treatment, the clinical efficacy was evaluated, and clinical symptoms, blood indexes, inflammatory factor levels, and adverse reactions in two groups before and after treatment were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 71.43% and 85.71% respectively, and there was difference between two groups (P < 0.05). After treatment, morning stiffness time, tender joint count, tender articular index, swollen joint count, and swollen joint count index significantly decreased, the difference was statistically significant in the same group (P < 0.05). And the improvement of clinical symptoms in the treatment group was significantly better than that in the control group, with significant difference between two groups (P < 0.05). Erythrocyte sedimentation rate, C-reactive protein, and rheumatoid factor levels in two groups significantly decreased, the difference was statistically significant in the same group (P < 0.05). And the blood indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P < 0.05). After treatment, TNF-α, IL-1, and IL-17 levels in two groups significantly decreased, the difference was statistically significant in the same group (P < 0.05). And the improvement of those indexes in the treatment group was significantly better than that in the control group, with significant difference between two groups (P < 0.05). There were no adverse reactions in two groups. Conclusion Total Glucosides of Paeony Capsules combined with etanercept has curative effect in treatment of juvenile idiopathic arthritis, can significantly improve clinical symptoms, and can significantly decrease blood index and inflammatory factors with mild adverse reactions, which has a certain clinical application value.