隔物温和灸控制来氟米特引起的类风湿关节炎患者白细胞减少的临床观察

发布时间：2018-05-01 21:50

本文选题：类风湿关节炎 + 来氟米特　；参考：《湖北中医药大学》2015年硕士论文

【摘要】：目的:来氟米特(Leflunomide,LEF)是目前治疗类风湿关节炎(Rheumatoid arthritis,RA)的常用药物之一,但其在改善患者病情的同时,对患者的血液系统、消化系统等功能亦有损害作用,而白细胞减少则为其毒副反应之一。本研究通过观察RA患者服用来氟米特3个月内白细胞数量的变化情况,研究来氟米特对RA患者病情的控制;通过建立隔物温和灸联合来氟米特治疗RA和单纯来氟米特治疗RA之间的对比,观察隔物温和灸对RA患者服用来氟米特后白细胞减少的控制作用,揭示隔物温和灸升白细胞的原理,为隔物温和灸应用到免疫抑制剂引起的RA患者白细胞减少提供理论和实验依据。方法:1.临床资料:选取自2014年7月至2015年1月,在武汉市中医医院风湿科住院的类风湿关节炎患者中,随机抽取50名在口服来氟米特治疗前白细胞计数正常的患者,按就诊的先后顺序分为两组:隔物温和灸联合口服来氟米特组(治疗组),单纯口服来氟米特组(对照组),每组各25例。2.治疗方法:①对照组(来氟米特组):25例患者给予来氟米特片2片(每片10mg),每天一次,口服,连续口服3个月;②治疗组(隔物温和灸+来氟米特组):25例,在对照组基础上行隔物温和灸治疗,每周5次,连续治疗3个月;③当个别患者关节疼痛剧烈,不能忍受,酌情临时加用洛索洛芬钠片(60mg/片),每日3次,每次1片,但不为常规治疗,直到症状缓解时停服。此外,不使用和本病相关的其他任何中西药。3.观测指标:①症状及体征指标:晨僵时间,休息痛,关节功能,关节肿胀数和指数,关节压痛数和指数,双手平均握力,视觉模拟量表(VAS),患者评价,疾病活动度评分(医生),HAQ指数,DAS28等;②关节影像学:主要观察双手X射线图像。③实验室指标:类风湿因子,血沉,c-反应蛋白,ccp,白细胞计数,中性粒细胞计数;④毒副作用:胃肠道反应、脱发、皮疹、肝功能损害、血液系统改变。4.统计方法:采用spss19.0统计软件进行统计学处理,其中计量资料采用t检验,计数资料采用x2检验,等级资料则采用ridit检验,统计指标数据以x±s表示,当p0.05时表示差异有统计学意义。结果:两组患者(共50名),在医生的指导下用药物和进行隔物温和灸的治疗,对照组25人,治疗组25人,均依从性较好,没有自行停药或停止隔物温和灸的患者,未出现脱落、剔除等病例。1.经过3个月的治疗后,对照组总有效率(显效+有效)达84%,治疗组总有效率(显效+有效)达96%,两组数据比较,差异有统计学意义(p0.05),治疗组明显优于对照组。2.治疗前两组的关节影像学统计分析不存在显著性差异(p0.05);治疗后,两组的关节影像学组间及组内统计分析仍无显著性差异(p0.05)。3.治疗前,两组的rf、esr、crp数值比较,提示无显著性差异(p0.05),具有可比性;治疗后,将两组的rf、esr、crp数值再进行组间比较,经过统计分析,差异有统计学意义(p0.05)。将两组治疗前后rf、esr、crp数值进行组内比较,均存在显著性差异(p0.05)。说明来氟米特在控制类风湿关节炎的实验室指标上有重要意义,且治疗组在控制上述实验室指标方面明显优于对照组。4.治疗前,两组的白细胞计数、中性粒细胞计数比较,差异无统计学意义(p0.05),具有可比性;治疗后,将两组的白细胞计数、中性粒细胞计数再进行比较,统计分析差异有统计学意义(p0.05)。治疗组治疗前后比较,统计分析无显著性差异(p0.05)。说明来氟米特治疗类风湿关节炎的毒副作用之一是引起白细胞、中性粒细胞减少,但当来氟米特配合隔物温和灸同时治疗类风湿关节炎时能够降低毒副作用的发生。结论：隔物温和灸联合口服来氟米特治疗类风湿关节炎的疗效明显优于单纯口服来氟米特;同时隔物温和灸能够有效地控制患者在服用来氟米特的过程中出现的白细胞减少及中性粒细胞减少。
[Abstract]:Objective: Leflunomide (LEF) is one of the commonly used drugs for the treatment of Rheumatoid arthritis (RA), but it can also damage the blood system, digestive system and other functions of the patients while improving the patient's condition, and the reduction of white blood cells is one of the side effects of the patients. This study was conducted by observing the use of RA patients. Leflunomide (leflunomide) changes in the number of leucocytes within 3 months to study the control of leflunomide in patients with RA, and to observe the control effect of mild moxibustion on leflunomide after the treatment of RA and simple leflunomide in the treatment of RA by establishing a septate mild moxibustion combined with leflunomide and simple leflunomide treatment, and to reveal the mild septum of the septum. The principle of moxibustion raising white blood cells provides theoretical and experimental basis for the application of septum mild moxibustion to leukocytosis of RA patients induced by immunosuppressive agents. Methods: 1. clinical data were selected from July 2014 to January 2015, 50 of the patients with rheumatoid arthritis hospitalized in Department of rheumatism, Wuhan traditional Chinese medicine hospital were randomly selected for oral leflunomide treatment. The patients with normal white blood cell count were divided into two groups according to the order of medical treatment: the septum mild moxibustion combined with the oral leflunomide group (the treatment group), the only oral leflunomide group (control group), 25 cases of each group.2. treatment: (1) the control group (leflunomide group): 25 cases were given 2 tablets of Leflunomide Tablets (each tablet), once a day, oral, continuous. 3 months of oral administration; (2) the treatment group (septum mild moxibustion + leflunomide group): 25 cases were treated with mild moxibustion on the basis of the control group, 5 times a week for 3 months. (3) when the joint pain was severe and unbearable, Loxoprofen Sodium Tablets (60mg/ tablet) was temporarily added, 3 times a day, 1 tablets, but not until the symptoms were slow. In addition, any other Chinese and Western medicine.3. observation indexes related to the disease were not used: symptoms and signs: morning stiffness, rest pain, joint function, joint swelling number and index, joint pressure pain number and index, average grip strength of the two hands, visual analogue scale (VAS), patient evaluation, disease activity score (Doctor), HAQ index, DAS28 and so on (2) joint imaging: the main observation of X ray images of both hands. 3. Laboratory indexes: rheumatoid factor, erythrocyte sedimentation, c- reactive protein, CCP, white blood cell count, neutrophils count; 4. Toxic side effects: gastrointestinal reaction, alopecia, rash, liver function damage, blood system change.4. statistical method: spss19.0 statistical software for statistical processing, it T test was used in the measurement data, x2 test was used for counting data, and Ridit test was used for grade data. The statistical index data was expressed in X + s. The difference was statistically significant when P0.05. Results: two groups of patients (a total of 50) were treated with medicine and septum mild moxibustion under the guidance of the doctor, 25 in the control group and 25 in the treatment group. After 3 months of treatment, the total effective rate of the control group was 84%, the total effective rate of the treatment group (effective + effective) reached 96%, and the two groups of data were compared, the difference was statistically significant (P0.05), and the treatment group was obviously superior to the control group before.2. treatment. There was no significant difference in the statistical analysis of the two groups of joint imaging (P0.05). After treatment, there was no significant difference in the statistical analysis between the two groups of joint imaging groups and groups (P0.05) before.3. treatment, the two groups of RF, ESR, CRP numerical comparison showed no significant difference (P0.05) and was comparable; after treatment, the two groups of RF, ESR, CRP values were carried out again. The difference between the two groups was statistically significant (P0.05). There were significant differences between the RF, ESR and CRP values before and after the treatment (P0.05). It was suggested that leflunomide was of great significance in controlling the laboratory indexes of rheumatoid arthritis, and the treatment group was obviously better than the control in the control of the laboratory index. Before treatment, the white blood cell count and neutrophils count of the two groups were compared, the difference was not statistically significant (P0.05), and it was comparable. After treatment, the white blood cell count and neutrophils count of the two groups were compared, the statistical analysis difference was statistically significant (P0.05). There was no significant difference between the treatment group before and after treatment (P 0.05). One of the side effects of leflunomide in the treatment of rheumatoid arthritis is to cause leukocyte and neutrophils, but when leflunomide combined with septum mild moxibustion at the same time in the treatment of rheumatoid arthritis, it can reduce the side effects of rheumatoid arthritis. Conclusion: the therapeutic effect of mild moxibustion of septum combined with leflunomide in the treatment of rheumatoid arthritis It is obviously better than simple oral leflunomide, and mild septum moxibustion can effectively control leucocytic and neutrophils in patients taking leflunomide.

【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R593.22

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