张声生教授治疗溃疡性结肠炎经验的数据挖掘及临床疗效评价研究

发布时间：2018-06-10 19:50

本文选题：溃疡性结肠炎 + 临床疗效　；参考：《北京中医药大学》2017年硕士论文

【摘要】：背景:溃疡性结肠炎(ulcerative colitis,UC),是一种原因尚不明确的慢性非特异性炎症性肠病,其病情迁延难愈,易于复发,有一定的癌变倾向,近年来发病率呈明显的上升趋势,已逐渐成为消化内科常见的疑难病。且该病病因尚不明确,临床治疗仍以控制炎症、改善症状为主,疗效并不十分满意。中医药因其疗效确切、不良反应少、复发率低等优势逐渐受到社会的认可,体现了祖国医学在治疗UC上的优势和特色,展现了良好的临床前景。本研究主要分为数据挖掘研究和临床观察研究两个部分:一、基于数据挖掘技术探讨张声生教授治疗溃疡性结肠炎经验研究目的:运用数据挖掘技术,探讨张声生教授治疗溃疡性结肠炎的用药规律及辨治思路,以期为临床遣方用药提供客观依据。方法:通过对张声生教授治疗的溃疡性结肠炎患者的门诊病例资料进行收集、整理,并严格按照纳入标准、排除标准进行筛选,将符合条件的70例(275诊次)的病案资料利用"一体化临床病案分析系统"进行储存、分析、处理,以探讨张声生教授治疗溃疡性结肠炎的临证组方思路。结果:1、一般资料:70例研究对象中,男性共37例,女性共33例;年龄在23-79岁之间,平均年龄39.3岁。2、症状分析:排在前10位的症状频次频率依次为:大便黏液脓血,腹痛,便次增多,乏力,大便稀,睡眠欠佳,口干,形寒肢冷,性急,里急后重;3、中医证候分析:统计分析70例UC患者首次就诊时的中医证候,按频次排序依次为大肠湿热证、肝郁脾虚证、脾虚湿蕴证、寒热错杂证、脾肾阳虚证及阴血亏虚证。4、用药频次分析:张声生教授治疗溃疡性结肠炎最常用的分别为炒白术、三七、地榆炭、白扁豆、炙黄芪、木香、儿茶、白芍、黄连、山药、延胡索、血余炭、炮姜、焦神曲、仙鹤草、薏苡仁、肉豆蔻、当归、生黄芪、墨睹旱莲等。药性功效方面,以补气补血等补虚药最为多见,其次凉血止血、收敛止血、化疲止血等亦为常用,同时兼顾理气、消食、清热、收敛等;用药多偏甘、温,搭配苦、微寒,寒热并用;归经方面多从脾、胃、肝入手,兼顾肺、肾,同时本病病位在大肠,亦有所兼顾。5、关联性分析:药物与药物:地榆炭和炒白术,白扁豆和炒白术,儿茶和三七,山药和炒白术等呈强关联性,为张声生教授常用药对,并以炙黄芪、炒白术、三七、木香、儿茶、地榆炭、白芍、黄连、白扁豆、山药等为基础的药物组方。症状与药物:当患者出现性急、腹痛症状,常以延胡索;口干、脉细常以白芍、三七等。用药与疗效:应用炮姜、血余炭、黄连后便次增多可得到减轻;仙鹤草、延胡索、血余炭、三七后腹痛症状可得到减轻等。症状变化与用药变化:出现大便脓血的症状或大便脓血较前加重,则加用血余炭;当睡眠欠佳,乏力等减轻或好转则加用黄连等。6、主症疗效统计:通过统计诊次间主症疗效的症状积分变化,发现对于包括大便次数增多、大便脓血、腹痛等常见症状具有较好的临床疗效。结论:1、溃疡性结肠炎以大便黏液脓血、腹痛、便次增多、乏力、大便稀等为主要症状,根据其临床表现一般可归属于"休息痢"等病范畴,中医证型分布上以大肠湿热证最为多见,其次为肝郁脾虚证及脾虚湿蕴证。2、通过常用药物进行分析,可以发现张声生教授治疗UC多从"虚"、"疲"、"湿"、"热"、"毒"入手,注重"调和气血",临证多以补气补血药为基础,配合活血、化瘀、止血等理血药,同时不忘兼顾清热、燥湿、解毒;药物归经方面入脾、胃、肝,兼顾肺、肾,组方简而准,少而精;临证以炙黄芪、炒白术、三七、木香、儿茶、地榆炭、白芍、黄连、白扁豆、山药等药物应用最多,逐渐形成了以此为中心的基础方,并且对于本病具有良好的疗效。二、清热化湿凉血化瘀法治疗活动期溃疡性结肠炎的临床观察研究目的:观察清热化湿凉血化瘀法治疗溃疡性结肠炎活动期大肠湿热证的临床疗效,并评价其安全性。方法:将30例确诊为溃疡性结肠炎活动期及中医辨证为大肠湿热证的患者,随机分成两组;治疗组15例予清热化湿凉血化疲法中药汤剂联合美沙拉嗪口服;对照组15例单纯口服美沙拉嗪。疗程均为3个月,治疗结束后通过两组的临床疗效、中医证候疗效、安全性指标等方面评价治疗效果。结果:1、本研究中,男性患者与女性患者的参与例数比为1:1.07;在年龄分布上,以30-60岁较多,尤其以30-39年龄段内患者为多,平均年龄为42.34岁。2、比较治疗后两组的临床疗效情况,试验组的临床疗效明显优于对照组,差异具有统计学意义(P0.05)。3、分别比较两组的临床缓解率及总有效率,未发现两组差异具有统计学意义(P0.05),其中试验组的临床缓解率、总有效率分别为53.3%、93.3%,对照组的临床缓解率、总有效率分别为21.4%、71.4%。4、在两组中医症状疗效的比较中,试验组明显优于对照组,差异具有统计学意义(P0.05)。5、分别比较两组证候的缓解率、显愈率及有效率,在显愈率上试验组优于对照组(P0.05),差异具有统计学意义;在缓解率及有效率上未发现两组差异具有统计学意义(P0.05)。6、在主要症状改善情况上,试验组在腹泻的消失率上明显优于对照组(P0.05),差异具有统计学意义,认为试验组对于腹泻的疗效优于对照组;在脓血便与腹痛的消失率比较中,未发现统计学差异(P0.05)。结论:清热化湿凉血化瘀法对于活动期溃疡性结肠炎的治疗效果显著而安全,对于症状的改善情况明显优于美沙拉嗪。
[Abstract]:Background: ulcerative colitis (UC) is a kind of chronic nonspecific inflammatory bowel disease, which is still unclear. The disease is difficult to recover, is easy to relapse and has a certain tendency of canceration. In recent years, the incidence of the disease has shown an obvious upward trend, and has gradually become a common difficult disease in the medicine department. The etiology of the disease is not yet clear and clinical treatment is not clear. The curative effect is not very satisfactory. The advantages of traditional Chinese medicine are gradually accepted by the society because of its definite curative effect, less adverse reaction and low recurrence rate, which embodies the advantages and characteristics of the Chinese medicine in the treatment of UC, and shows good clinical prospect. This study is mainly divided into data mining and clinical observation. Research two parts: first, based on data mining technology to explore the experience of Professor Zhang Sheng Sheng in the treatment of ulcerative colitis: using data mining technology to explore the rule of medicine and the thinking of treating ulcerative colitis by Professor Zhang Sheng Sheng, in order to provide an objective basis for clinical medication. The data of outpatient cases of ulcerative colitis were collected, arranged and selected strictly according to the inclusion criteria and exclusion criteria. The medical records of 70 cases (275 times of diagnosis) were stored, analyzed and processed by the integrated clinical case analysis system to discuss the clinical prescription of Professor Zhang Sheng Sheng in the treatment of ulcerative colitis. Results: 1, general data: among the 70 subjects, 37 cases were male and 33 were female; the average age was 23-79 years old, and the average age was 39.3 years old.2. The frequency of symptoms of the first 10 places was: stool mucus pus and blood, abdominal pain, stool, weakness, poor sleep, dry mouth, cold limbs cold, acute, in and back weight; 3, Analysis of TCM syndrome: Statistics and analysis of 70 cases of UC patients for the first time of TCM syndrome, according to the frequency order of large intestine damp heat syndrome, liver depression and spleen deficiency syndrome, spleen deficiency syndrome, cold and heat syndrome, spleen kidney yang deficiency syndrome and Yin blood deficiency syndrome.4, frequency analysis: Zhang Sheng Sheng Professor treatment ulcers colitis is the most commonly used to stir fry, 37, SM Charcoal, white lentil, Radix Astragalus, Radix Paeoniae, Paeonia lactiflora, Rhizoma Paeoniae, Rhizoma Coptidis, Rhizoma Corydalis, Rhizoma Corydalis, Rhizoma Corydalis, blood charcoal, ginger, charcoal, Coix, coix seed, nutmeg, Radix Angelicae, Radix Astragali, ink and glimpse of dry lotus. Eliminate food, heat, converge and so on; the drug is more partial, warm, bitter, cold, cold and hot and used; the return to the spleen, stomach, liver, the lung, the kidney, and the disease position in the large intestine, also.5, related analysis: medicine and medicine: the charcoal and stir fry, white lentil and Baizhu, catechu and 37, yam and Baizhu, and so on, In order to teach Zhang Sheng's commonly used drugs, the symptoms and drugs are based on the decoction of Radix Astragali, roasting Atractylodes, Chinese wood aroma, catechu, Radix lony charcoal, Radix Paeoniae Alba, Rhizoma Coptidis, white lentil and yam. Symptoms and drugs: when the patients appear acute, abdominal pain, often with yalhu; dry mouth, pulse fine often with Paeonia lactiflora, 37, and the curative effect: the use of ginger, blood charcoal, Huang Lianhou The increase can be reduced; cranes, corydalis, blood carbon, 37 abdominal pain symptoms can be reduced. Symptoms change and use of changes in medication: symptoms of pus and blood, pus and blood more aggravated than before, plus blood carbon; when poor sleep, fatigue and other mitigation or good turn is added to the.6, the main effect statistics: through statistical diagnosis The change of the symptom integral of the main symptom, found that the common symptoms, including the increasing number of stool, the pus and blood, abdominal pain, and other common symptoms, have good clinical effect. Conclusion: 1, ulcerative colitis is the main symptom of stool mucus, abdominal pain, anathema, weakness and dilute of stool. According to its clinical manifestation, it is generally attributable to "rest dysentery" and other diseases. The distribution of TCM syndrome type is most common in the syndrome of large intestine damp heat syndrome, followed by liver depression and spleen deficiency syndrome and spleen deficiency syndrome.2. Through the analysis of commonly used drugs, Professor Zhang Sheng Sheng can be found to treat UC more from "deficiency", "fatigue", "damp", "heat" and "poison", and pay attention to "harmonizing Qi and blood", and on the basis of Supplementing Qi and enriching blood drugs, combined with blood activating, stasis removing and hemostasis. Blood drugs, at the same time do not forget heat, dampness, detoxification; drugs into the spleen, stomach, liver, both lungs, kidneys, groups are simple and accurate, few and fine; the clinical evidence of Radix Astragalus, 37, wood, catechin, Radix lony charcoal, Radix Paeoniae, Rhizoma Coptidis, white lentil, yam has been used most, and gradually formed the basis of this center, and for the disease. Good curative effect. Two, the clinical observation and Study on the treatment of active ulcerative colitis by clearing away heat and removing blood stasis and removing stasis method: observe the clinical effect of clearing heat, cooling blood and removing stasis to treat ulcerative colitis, and evaluate its safety. Methods: 30 cases were diagnosed as ulcerative colitis and TCM syndrome differentiation was large The patients with intestinal damp heat syndrome were randomly divided into two groups; 15 patients in the treatment group were given the decoction of clearing heat, cooling blood, cooling blood and exhausting the Chinese medicine decoction combined with mesalazine, and 15 cases of the control group were only oral mesalazine. The course of treatment was 3 months. After the treatment, the curative effect was evaluated through the clinical efficacy of the two groups, the curative effect of TCM syndrome and the safety index. The result: 1, Ben. In the study, the number of participants in the male patients and the female patients was 1:1.07, and the age distribution was more than 30-60 years old, especially in the 30-39 age group, and the average age was 42.34 years.2. The clinical curative effect of the two groups after the treatment was compared. The clinical effect of the test group was obviously superior to the control group, the difference was statistically significant (P0.05).3, respectively. The clinical remission rate and total effective rate of the two groups were compared, and the difference between the two groups was not found statistically significant (P0.05). The clinical remission rate of the experimental group was 53.3%, 93.3% respectively, and the clinical remission rate of the control group was 21.4%, 71.4%.4 respectively. In the comparison of the two groups of TCM symptoms, the experimental group was obviously superior to the control group. The difference was statistically significant (P0.05).5, compared with the two groups of syndromes, the rate of remission, the rate of recovery and efficiency, the rate of recovery was better than the control group (P0.05), and the difference was statistically significant. The two groups were not found to have statistical meaning (P0.05).6 in the remission rate and the effective rate. In the main symptom improvement, the experimental group was in diarrhea. The disappearance rate was obviously better than that of the control group (P0.05), and the difference was statistically significant. The effect of the test group on diarrhea was better than that of the control group; the difference between the purulent and abdominal pain and the abdominal pain was not statistically significant (P0.05). Conclusion: the effect of clearing heat and removing blood stasis and removing blood stasis is significant and safe in the treatment of ulcerative colitis at active stage. The improvement of symptoms is better than mesalazine.
【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】：R249;R259

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