清热利湿方治疗急性痛风性关节炎湿热痹阻证的临床研究

发布时间：2018-04-09 19:54

本文选题：清热利湿方　切入点：急性痛风性关节炎　出处：《南京中医药大学》2017年硕士论文

【摘要】：目的:通过文献研究,探讨中医学对急性痛风性关节炎的认识;通过临床研究观察清热利湿方治疗急性痛风性关节炎的湿热痹阻证患者在中医临床症状、证候积分、血沉(ESR)、C反应蛋白(CRP)、血尿酸(UA)等指标的影响,为急性痛风性关节炎的中医药治疗提供有效方药。方法:本研究采用随机对照的原则,将符合急性痛风性关节炎湿热痹阻证诊断标准的60例患者,随机分为对照组和治疗组各30例。其中,对照组给予基础治疗(生活方式干预、低嘌呤饮食、适当运动)加扶他林治疗。扶他林剂量每次75mg,每日2次,疼痛缓解后每日1次。治疗组在对照组基础上加清热利湿方干预,每日1剂。1周为一疗程,观察2个疗程。分别评价两组治疗前后临床症状、血尿酸、血沉、C反应蛋白、中医证候疗效评分、关节症状相关评价等指标,以及安全性。结果:经过SPSS19.0软件对两组患者数据进行统计学分析:①总有效率:治疗组30例,总有效率96.7%。对照组30例,总有效率70.00%,两组的比较差异有统计学意义(P0.05)。②在中医临床表现方面,治疗组患者治疗后与治疗前相比都有一定的改善(P0.05或P0.01),说明差异具有统计学意义。组间比较,治疗组对中医证候的改善显著优于对照组(P0.05)。③对于关节症状相关评价(关节疼痛VAS评分、关节肿胀程度评价、关节活动能力评价、关节压痛评分),治疗后两组对关节症状的改善较治疗前有显著差异(P0.05);组间比较,治疗组的改善显著优于对照组(P0.05)。④对血尿酸、血沉、C反应蛋白的监测,治疗后两组患者血尿酸、血沉、C反应蛋白均明显降低(P0.05);组间比较,治疗组的控制效果明显优于对照组(P0.05)。⑤安全性方面,治疗组在研究期间,通过对血尿粪常规,肝肾功能的统计分析,无统计学差异(P0.05),并在治疗期间未出现恶心、呕吐等胃肠道反应,以及皮疹等不良反应。结论:经过本次临床研究提示清热利湿方联合西药常规治疗治疗急性痛风性关节炎湿热痹阻证患者的效果优于单纯西药治疗,既可改善急性痛风性关节炎的湿热痹阻证患者的中医临床症状,又可改善关节相关症状,降低了血尿酸、血沉,具有安全,可靠的特点,值得我们临床中广泛推广,并进行下一步深入研究。
[Abstract]:Objective: to explore the understanding of acute gouty arthritis in traditional Chinese medicine (TCM) through literature study, and to observe the clinical symptoms and syndromes of the patients with damp-heat arthralgia syndrome of acute gouty arthritis treated by Qingre Li-shen recipe in traditional Chinese medicine.The effect of erythrocyte sedimentation rate (ESR) C-reactive protein (CRP) and hematuria (UAA) on the treatment of acute gouty arthritis by traditional Chinese medicine (TCM) provides an effective prescription for the treatment of acute gouty arthritis.Methods: 60 patients with acute gouty arthritis were randomly divided into control group (n = 30) and treatment group (n = 30).The control group was treated with basic therapy (lifestyle intervention, low purine diet, appropriate exercise) and Fentalin.The dosage was 75 mg, twice a day, once a day after pain relief.The treatment group in the control group on the basis of Qingre and dampness prescription intervention, 1 dose per day for a course of treatment, observation of two courses.The clinical symptoms, serum uric acid, erythrocyte sedimentation rate C reactive protein (ESR C reactive protein), curative effect score of TCM syndromes, related evaluation of joint symptoms, and safety were evaluated before and after treatment.Results: the total effective rate of the two groups was statistically analyzed by SPSS19.0 software: 30 cases in the treatment group and 96. 7% in the treatment group.There were 30 cases in the control group, the total effective rate was 70.00g. The difference between the two groups was statistically significant in the clinical manifestation of traditional Chinese medicine (TCM). After treatment, the patients in the treatment group improved to a certain extent compared with before treatment (P0.05 or P0.01), which indicated that the difference was statistically significant.There was no significant difference (P 0.05) and no gastrointestinal reactions, such as nausea, vomiting, and rash, were observed during the treatment.Conclusion: after this clinical study, the effect of Qingre Li-li Fang combined with western medicine in the treatment of acute gouty arthritis with damp-heat obstruction syndrome is better than that of western medicine alone.It can not only improve the clinical symptoms of the patients with damp-heat arthralgia and obstruction syndrome of acute gouty arthritis, but also improve the symptoms related to joints, reduce the blood uric acid and erythrocyte sedimentation rate, and have the characteristics of safety and reliability, so it is worth widely popularizing in our clinical practice.And carries on the next step thorough research.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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