乌龙丹联合来氟米特治疗痰瘀痹阻型类风湿关节炎的临床观察

发布时间：2018-02-05 03:09

本文关键词： 乌龙丹来氟米特痰瘀痹阻类风湿关节炎　出处：《黑龙江中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：通过对比乌龙丹联合来氟米特与旭痹片联合来氟米特两种治疗方案治疗痰瘀痹阻型类风湿关节炎的疗效差异,从而评价乌龙丹联合来氟米特对痰瘀痹阻型类风湿关节炎的治疗效果。方法：筛选60例符合本课题研究方案的痰瘀痹阻型类风湿关节炎患者,经医院伦理委员会批准,按照1：1比例,随机分为治疗组(乌龙丹联合来氟米特)30例,与对照组(旭痹片联合来氟米特)30例,两组治疗周期均为12周。治疗前,经统计学分析,两组患者在性别、年龄、病程等方面具有可比性。观察并记录第0、12周患者疼痛评价、关节评价(压痛数与肿胀数)、患者对疾病活动性评价、医生对疾病活动性评价、体力功能的评价、急性期反应物水平等指标,用以评价ACR20标准的达标情况；观察并记录第0、12周患者关节疼痛程度、关节肿胀程度、关节压痛程度、屈伸不利、汗出、畏恶风寒、腰膝酸软、晨僵时间等指标,用以评价中医证候疗效情况；监测第0、4、8、12周时血、尿常规,肝、肾功能等安全性指标及可能出现的不良反应。采用ACR20、50、70标准及中医证候疗效判定标准作为疗效评价标准。用以评价乌龙丹联合来氟米特对痰瘀痹阻型类风湿关节炎的治疗效果。结果：1疾病疗效评价：治疗组ACR70达标1例、ACR50达标10例、ACR20达标15例,ACR20未达标4例,总有效率为86.67%；对照组ACR70达标0例、ACR50达标6例、ACR20达标13例,ACR20未达标11例,总有效率为63.33%。治疗组优于对照组。2中医证候疗效评价：治疗组临床控制2例、显效11例、有效15例、无效2例,总有效率为93.33%；对照组临床控制0例、显效6例、有效16例、无效8例,总有效率73.33%。治疗组优于对照组。3 ACR20标准各项指标比较：在改善患者疼痛评价(VAS-1)、关节评价(压痛数与肿胀数)、患者对疾病活动性评价(VAS-2)、医生对疾病活动性评价(VAS-3)、体力功能的评价(HAQ)、急性期反应物水平(ESR/CRP)等指标方面,治疗组优于对照组。4中医各症候评分比较：在改善关节疼痛程度、关节肿胀程度、关节压痛程度、关节屈伸不利、汗出、畏恶风寒、腰膝酸软、晨僵时间等指标方面,治疗组优于对照组。结论：乌龙丹联合来氟米特治疗痰瘀痹阻型类风湿关节炎,在临床总体疗效,改善患者症状、体征及急性期反应物水平(ESR/CRP)等方面效果显著,优于旭痹片联合来氟米特。
[Abstract]:Objective: to compare the therapeutic effects of Wulongdan combined with leflunomide and Xubi tablet in the treatment of phlegm and stasis obstruction rheumatoid arthritis. To evaluate the therapeutic effect of Wulong Dan combined with leflunomide on rheumatoid arthritis of phlegm and stasis obstruction. Methods: 60 cases of rheumatoid arthritis with phlegm and stasis obstruction were selected. According to the proportion of 1: 1, the patients were randomly divided into treatment group (30 cases with Wulongdan combined with leflunomide) and control group (30 cases with Xubi tablet combined with leflunomide). Before treatment, the two groups were comparable in sex, age, course of disease and so on. The pain evaluation of patients at week 0 was observed and recorded. Evaluation of joint (tenderness and swelling), patients' evaluation of disease activity, doctors' evaluation of disease activity, physical function evaluation, acute reaction level and other indicators. To evaluate the standard of ACR20; To observe and record the degree of joint pain, joint swelling, joint tenderness, unfavorable flexion and extension, perspiration, dread of wind and cold, weakness of waist and knee, time of morning stiffness and so on. To evaluate the curative effect of TCM syndrome; Blood, urine routine, liver and kidney function and possible adverse reactions were monitored at the 12th week of the 4th week. ACR2050 was used. To evaluate the therapeutic effect of Wulong Dan combined with leflunomide in treating rheumatoid arthritis of phlegm and stasis obstruction type. Results the curative effect of Wulong Dan combined with leflunomide on rheumatoid arthritis of phlegm and stasis obstruction type was evaluated. In the treatment group, ACR70 reached the standard in 1 case. The total effective rate of ACR50 was 86.67 with 10 cases of ACR20 meeting the standard of 15 cases of ACR20 and 4 cases of failing to reach the standard of ACR20. In the control group, 0 cases of ACR70 were up to standard and 6 cases of ACR50 were up to standard. 13 cases of ACR20 failed to reach the standard of ACR20 in 11 cases. The total effective rate was 63.33. The therapeutic effect of the treatment group was better than that of the control group (2 cases, 11 cases, 15 cases, 2 cases), and the total effective rate was 93.33%. In the control group, there were 0 cases of clinical control, 6 cases of remarkable effect, 16 cases of effective and 8 cases of ineffective. The total effective rate was 73.33.The treatment group was superior to the control group in the comparison of ACR20 criteria: in improving the pain evaluation of patients with VAS-1, the joint evaluation (number of tenderness and swelling). Patients were evaluated for disease activity (VAS-2), doctors for disease activity (VAS-3) and physical function (HAQ). The treatment group was superior to the control group in comparing the scores of TCM symptoms in improving the degree of joint pain, joint swelling and joint tenderness. The treatment group was superior to the control group in terms of joint flexion and extension, perspiration, dread of evil wind and cold, sore waist and knee, time of morning stiffness and so on. Conclusion: Wulong Dan combined with leflunomide in treating rheumatoid arthritis of phlegm and stasis obstruction type. It was better than Xubi tablet combined with leflunomide in general clinical efficacy, improving symptoms, signs and levels of ESR-CRP in acute phase.
【学位授予单位】：黑龙江中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R593.22

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