通督除痹方治疗中轴型脊柱关节炎的临床研究

发布时间：2018-05-15 07:25

本文选题：中轴型脊柱关节炎 + 中医外治　；参考：《河北大学》2017年硕士论文

【摘要】：中轴型脊柱关节炎是一种慢性免疫性疾病,主要是侵犯骶髂关节、脊柱及脊柱旁软组织,并可以累及外周关节。其病理改变为骶髂关节炎、肌腱端炎、外周关节炎等。我国的患病率约为1%,目前对于该病的治疗主要有非甾体类抗炎药、改善病情的抗风湿药和生物制剂。但是长期用药的副作用让多数患者苦不堪言。导师郝斌教授自拟通督除痹方外敷,以期能够达到更好的控制病情活动、缓解疼痛症状等作用。通过监测患者的临床症状、炎性指标,探讨通督除痹方对于axSpA的临床作用和安全性,为该法该方提供循证学依据。目的:通过对axSpA运用通督除痹方外敷治疗的临床研究,为中西医结合治疗axSpA提供新的方法。方法:将符合纳入标准的患者按照随机分组原则分为治疗组和对照组。两组均有常规的运动疗法及洛索洛芬钠片60mg 1/8小时口服;柳氮磺胺吡啶0.25g口服3/日,以每周递增0.25g,直至1.0g口服2/日;正清风痛宁60mg口服3/日。治疗组在此基础上加用通督除痹方外敷治疗,选取脊柱及两侧旁开1.5寸范围,将药泥用纱布、胶布固定于施术部位上,操作时间为每天18点至第二天晨起6点,4周为一疗程。分别在第2周、第4周、第12周结束时进行统计,采用ASAS20、ASAS40、BASDAI50标准及中医证候疗效评价标准。对中医证候评分、BASDAI、BASFI、BASMI、脊柱痛评分、夜间痛评分、患者总体评价(PGA)及血沉、CRP等指标进行评估。用统计学软件对两组治疗前后结果进行分析处理。结果:两组治疗前一般资料、BASDAI、BASFI、BASMI、脊柱痛评分、夜间痛评分、PGA、血沉、CRP等指标无统计学意义(P0.05);在治疗2周时,在中医证候积分、PGA、夜间痛评分及BASDAI、BASFI治疗组明显优于对照组,具有统计学意义(P0.05)。治疗4周后,在中医证候积分、中医证候疗效比较、PGA、脊柱痛评分、夜间痛评分及BASDAI、BASFI、ESR、CRP、ASAS40、BASDAI50达标率治疗组均明显优于对照组,具有统计学意义(P0.05)。在治疗12周时,治疗组与对照组ESR有差异,差异具有统计学意义(P0.05),其余指标的差异无统计学意义(P0.05)。治疗组不良反应发生比例低于对照组。结论:通督除痹方外敷可以明显缓解axSpA患者临床症状,加快患者临床症状的好转,应用该方治疗axSpA疗效安全确切,适合临床推广。
[Abstract]:Axial spondylitis is a chronic immune disease involving sacroiliac joints, spine and perispinal soft tissue, and may involve peripheral joints. The pathological changes were sacroiliac arthritis, tendinitis and peripheral arthritis. The prevalence rate of this disease is about 1 in China. At present, the main treatment for the disease is non-steroidal anti-inflammatory drugs, anti-rheumatic drugs and biological agents to improve the condition of the disease. But the side effects of long-term medication make most patients miserable. The tutor Professor Hao Bin made up the external application of du Zubi Fang in order to better control the disease activity and relieve the pain symptoms and so on. By monitoring the clinical symptoms and inflammatory indexes of the patients, the clinical effect and safety of Tongdu-Zubi prescription for axSpA were discussed, and the evidence-based basis for the prescription was provided. Objective: to provide a new method for the treatment of axSpA by applying Tongdu-Zubi prescription in axSpA. Methods: patients who met the inclusion criteria were randomly divided into treatment group and control group. Both groups were given routine exercise therapy and 60mg 1 / 8 hour oral, salicylate sulfamyridine 0.25g / d, increasing by 0.25 g per week until 1.0g / d, and Zhengqing Fengtongning 60mg oral 3 / day. On this basis, the treatment group was treated by external application of Tongdu Zhibi prescription, and 1.5 inch range of spinal column and bilateral side was selected. The gauze and glue cloth were fixed on the site of the operation. The operating time was from 18:00 to 6: 00 am (6: 00 am, 4 weeks) every day as a course of treatment. At the end of week 2, week 4 and week 12, the standard ASAS20 / ASAS40 / BASDAI50 and the criteria for evaluating the efficacy of TCM syndromes were used. The indexes of TCM syndromes were evaluated, such as basic syndrome, spinal pain score, nocturnal pain score, total evaluation of PGA and ESR CRP. The results before and after treatment were analyzed with statistical software. Results: there was no significant difference in general data before treatment between the two groups, such as basic, spinal pain score, nocturnal pain score, PGA, ESR CRP, etc. After 2 weeks of treatment, the treatment group was superior to the control group in TCM syndrome score (PGA), nocturnal pain score and BASDAIBASFI treatment group. It has statistical significance (P 0.05). After 4 weeks of treatment, the scores of TCM syndromes, the curative effects of TCM syndromes and the scores of spinal pain, nocturnal pain and BASDAI50 were significantly better in the treatment group than in the control group (P 0.05). At the 12th week of treatment, the ESR of the treatment group and the control group was significantly different (P 0.05), but the other indexes had no statistical significance. The incidence of adverse reactions in the treatment group was lower than that in the control group. Conclusion: the external application of Tongdu-Zubi prescription can obviously relieve the clinical symptoms of patients with axSpA and accelerate the improvement of clinical symptoms. It is safe and accurate in the treatment of axSpA and is suitable for clinical popularization.
【学位授予单位】：河北大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R593.2

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