膝关节骨性关节炎中医证型与炎性因子的相关性研究

发布时间：2018-02-14 07:25

本文关键词： 膝关节骨性关节炎炎性因子中医辨证分型　出处：《北京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：近年来,膝关节骨性关节炎在人群的发病率逐年增高,对患者日常生活带来不便,防治膝关节骨性关节炎,提高患者生活质量具有重大意义,而利用现代医学与传统中医理论相结合对膝关节骨性关节炎做进一步研究,提供更多的临床实验证据,对膝关节骨性关节炎的早期诊断与治疗尤为重要。目的:观察膝关节骨性关节炎(Knee osteoarthritis KOA)患者中医证型的分布特点,以及KOA与年龄、性别等因素的相关性,并探索KOA不同中医证型之间与血清炎性指标的相关性。方法:采用前瞻、随机、对照的研究方法,以膝关节骨性关节炎患者为研究对象。对在2012年10月至2015年12月期间就诊于北京中医药大学东直门医院和北京市房山区大安山乡社区卫生服务中心的膝关节骨性关节炎患者进行筛选,筛选出符合入组条件的患者122例,参考《中药新药临床研究指导原则》(2002年)划分患者证候类型,根据中医辨证,将患者分为三型,这三型分别为:肝肾阴亏、筋脉瘀滞证,脾肾两虚、湿注骨节证,肾阳虚衰、痰瘀交阻证。在此期间,选取就诊于东直门医院门诊年龄在54-63岁之间的22例健康体检者作为正常对照组。留取患者晨起静脉血,检测炎性因子(IL-6、TNF-α、sVCAM-1、sICAM-1)。在此次临床实验中统计观察KOA中医证型的分布情况,KOA与年龄、性别等因素的相关性,以及各中医证型与炎性因子(IL-6、TNF-α、sVCAM-1、sICAM-1)之间的相关性。结果:在本临床实验中,膝关节骨性关节炎中医的证型以肝肾阴亏、筋脉瘀滞证最为常见。肾阳虚衰、痰瘀交阻证与脾肾两虚、湿注骨节证所占比例相近,后者略高于前者4.92%。本病多见于56-65岁之间的中老年人群,且随着年龄的增长,肝肾阴亏、筋脉瘀滞证的患者数量逐渐增加。本病男女发病率的差异较大,在本临床研究中,本病多发于女性,但膝关节骨性关节炎的三种中医证型在男女分布方面无明显差异。经实验室检查,IL-6、TNF-α、sICAM-1单位指标值方面,正常组显著低于其他三组中医证型,而三组中医证型之间则没有显著差异。在sVCAM-1单位指标值方面,肾阳虚衰、痰瘀交阻组与正常组没有显著差异,肝肾阴亏、筋脉瘀滞组与脾肾两虚、湿注骨节组也没有显著差异,但是肝肾阴亏、筋脉瘀滞组与脾肾两虚、湿注骨节组显著低于肾阳虚衰、痰瘀交阻组与正常组。结论:1膝关节骨性关节炎中医证型以肝肾阴亏、筋脉瘀滞型最常见,且与年龄正相关。2在膝关节骨性关节炎患者中,女性患者数量多于男性患者。3肝肾阴亏、筋脉瘀滞组,脾肾两虚、湿注骨节组,肾阳虚衰、痰瘀交阻组三组中医证型在炎性因子IL-6、TNF-α、sICAM-1指标值之间无差异,但显著高于正常组。表明膝关节骨性关节炎与炎性因子IL-6、TNF-α、sICAM-1有相关性,为膝关节骨性关节炎的早期诊断和治疗提供新的思路,为临床应用中医药治疗KOA提供理论依据。4在炎性因子sVCAM-1的单位指标值方面,肾阳虚衰、痰瘀交阻组与正常组没有显著差异,肝肾阴亏、筋脉瘀滞组与脾肾两虚、湿注骨节组没有显著差异,但是肝肾阴亏、筋脉瘀滞组与脾肾两虚、湿注骨节组显著低于肾阳虚衰、痰瘀交阻组与正常组。
[Abstract]:In recent years, osteoarthritis of the knee in the crowd incidence increased year by year, bring inconvenience to the daily life of patients, prevention and treatment of knee osteoarthritis, is of great significance to improve the quality of life of patients, and the use of modern medicine and traditional Chinese medicine theory to do further research on knee osteoarthritis, provide more evidence of clinical trials, early diagnosis and treatment of knee osteoarthritis is particularly important. Objective: To observe the effect of knee osteoarthritis (Knee osteoarthritis KOA) the distribution characteristic of TCM syndrome in patients with KOA, and the correlation with age, gender and other factors, and to explore the relationship between KOA in different TCM syndromes and serum inflammatory indexes.: a prospective, randomized, controlled study method, with knee osteoarthritis patients as the research object. In the period from October 2012 to December 2015 in Beijing Hospital of traditional Chinese Medicine Knee osteoarthritis patients in Dongzhimen hospital and Beijing city Fangshan District Daan Township Community Health Service Center were screened, 122 patients were eligible, with reference to "Chinese medicine clinical research guiding principles > (2002) of patients with syndrome type according to TCM, the patients were divided into three types. These three types were: liver and kidney Yin deficiency, blood stasis syndrome, spleen and kidney two empty, wet condyle syndrome, kidney yang deficiency, phlegm. In the meantime, recruited from outpatient age Dongzhimen hospital health examination in 22 patients between the ages of 54-63 volunteers as normal control group. The patients were taken the morning from the venous blood, detection of inflammatory factors (IL-6, TNF- alpha, sVCAM-1, sICAM-1). In the clinical experiment statistics to observe the distribution of TCM syndrome type of KOA, KOA and age, gender related factors, and the TCM syndrome type and inflammatory factors (IL-6, TNF- alpha, sVCAM-1, sI The correlation between CAM-1). Results: in the clinical trials, syndrome type of knee osteoarthritis in TCM of liver and kidney yin deficiency, blood stasis syndrome is the most common. Kidney yang deficiency, phlegm and spleen kidney two empty, wet condyle permit a proportion similar to that of the latter is slightly higher than the former 4.92% 56-65. The disease is more common in aged people, and with the increase of age, the number of patients with liver and kidney yin deficiency, stasis of the channels gradually increased. The difference between the incidence rate of disease, in this clinical study, the disease is more common in women, but three kinds of TCM Syndrome type of knee osteoarthritis arthritis in gender distribution is not obvious. By laboratory tests, IL-6, TNF- alpha, sICAM-1 unit index value, the normal group was significantly lower than the other three groups of TCM syndrome, but there was no significant difference between the three groups of TCM syndrome type. The sVCAM-1 value in the unit index, kidney yang deficiency, phlegm and blood stasis There was no significant difference with the normal group, liver and kidney yin deficiency, blood stasis group and the spleen kidney two empty, wet condyle group was no significant difference, but the liver and kidney yin deficiency, blood stasis group and the spleen kidney two empty, wet condyle group was significantly lower than that of kidney yang deficiency, phlegm blood stasis group and normal group 1. Conclusion: knee joint bone arthritis with TCM syndrome type of liver and kidney yin deficiency, the most common blood stasis type, and was positively correlated with age of.2 in knee osteoarthritis patients, female patients were more than the number of male patients with.3 liver and kidney yin deficiency, blood stasis group, spleen and kidney two empty, wet condyle group, kidney yang deficiency, phlegm blood stasis group, three groups of TCM in inflammatory cytokines IL-6, TNF- alpha, sICAM-1 index had no difference, but was significantly higher than the normal group. The knee osteoarthritis and inflammatory factor IL-6, TNF- alpha, sICAM-1 correlation, provide new thinking for the early diagnosis and the treatment of knee osteoarthritis The way, provide a theoretical basis for the.4 value in the unit index of inflammatory factor sVCAM-1 for the clinical application of Chinese medicine for the treatment of KOA, kidney yang deficiency, phlegm and blood stasis group had no significant difference with the normal group, liver and kidney yin deficiency, blood stasis group and the spleen kidney two empty, there is no significant difference between the wet condyle group, but the liver and kidney yin, vein stasis group and spleen kidney two empty, wet condyle group was significantly lower than that of kidney yang deficiency, phlegm blood stasis group and normal group.

【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R274.9

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