新制柴连汤联合西药治疗肝经风热型前葡萄膜炎的临床观察

发布时间：2018-03-23 14:41

本文选题：新制柴连汤　切入点：肝经风热　出处：《浙江中医药大学》2017年硕士论文

【摘要】：目的前葡萄膜炎是眼科常见的急重病症,也是主要的致盲疾病之一。根据对前葡萄膜炎病因病机的认识,针对临床上常见的肝经风热型前葡萄膜炎,治疗应以疏风散邪、清肝泻热为主,选用经典方新制柴连汤随症加减对症治疗。本课题通过对60例肝经风热型前葡萄膜炎病人的临床观察研究,验证新制柴连汤的临床疗效,探讨了新制柴连汤的疗效机理及降低复发的原因。方法临床研究建立标准后,将入选的60例肝经风热型前葡萄膜炎的病人,随机分为治疗组30例和对照组30例。对照组给予全身激素联合局部点眼治疗,治疗组予新制柴连汤随证加减及全身激素联合局部点眼治疗。对治疗前后的主要症状及体征、实验室检查结果、治愈天数及复发率等指标的变化进行观察,并进行分析比较。结果通过观察患者治疗前后主要症状及体征、免疫类检查结果及治愈天数、复发率的改变情况,发现无论是新制柴连汤联合治疗还是纯粹的西医治疗均可改善患者的中医症候及临床症状,降低患者的CRP、ESR水平,缩短病程及减少复发率。而中西医联合治疗对改善患者主要症状与体征,降低炎症介质水平,缩短病程及减少复发率方面的优势更为明显。同时,通过观察患者经两种治疗方法后的免疫球蛋白及补体水平的变化,尽管个别指标在治疗后变化不明显,或者治疗后治疗组和对照组无显著性差异,但总体来说,新制柴连汤联合西医药综合治疗的方法使得患者的免疫球蛋白和补体水平大大降低,且降低效率明显优于对照组治疗方案。结论第一,新制柴连汤随证加减联合西药治疗肝经风热型前葡萄膜炎的临床疗效明确,患者的临床症状、体征及各项检查指标均有明显改善。第二,新制柴连汤联合西药治疗可明显降低肝经风热型前葡萄膜炎患者的ESR、CRP、免疫球蛋白及补体的水平,提示新制柴连汤具有较好的抗炎和改善免疫功能的作用。第三,新制柴连汤联合西药治疗在缩短肝经风热型前葡萄膜炎病程方面优于单纯的西药治疗。第四,新制柴连汤联合西药治疗在降低肝经风热型前葡萄膜炎的复发率方面优于单纯的西药治疗。值得在临床治疗中广泛应用。
[Abstract]:Objective anterior uveitis is one of the most common acute and severe diseases in ophthalmology. According to the understanding of the etiology and pathogenesis of anterior uveitis, it is necessary to treat the common anterior uveitis of liver meridian with wind-heat type. In this study, 60 patients with anterior uveitis of the type of liver meridian and heat were observed and studied in order to verify the clinical effect of the new Chailian decoction, which was mainly used to clear the liver and reduce the heat, and to treat the disease with the addition or subtraction of the syndrome. This paper discussed the mechanism of curative effect and the reason of reducing recurrence of the new Chailian decoction. Methods after the establishment of clinical research standard, 60 patients with anterior uveitis of the type of liver passing through wind and heat were selected. The treatment group was randomly divided into treatment group (n = 30) and control group (n = 30). Results the changes of the main symptoms and signs before and after treatment, the results of immunological examination, the days of cure and the rate of recurrence were observed and compared. It was found that both the combined treatment of the new Cailian decoction and the pure western medicine treatment could improve the TCM symptoms and clinical symptoms of the patients, and lower the level of CRPN ESR in the patients. The combination of traditional Chinese and western medicine can improve the main symptoms and signs of the patients, reduce the level of inflammatory mediators, shorten the course of disease and reduce the recurrence rate. At the same time, By observing the changes of immunoglobulin and complement levels after two treatments, although the changes of individual indexes were not obvious after treatment, or there was no significant difference between the treatment group and the control group after treatment, generally speaking, there was no significant difference between the treatment group and the control group. The combined therapy of Xinzhen-Chailian decoction combined with western medicine can greatly reduce the level of immunoglobulin and complement, and the efficiency of the reduction is obviously better than that of the control group. The clinical curative effect of new Chailian decoction combined with western medicine in the treatment of anterior uveitis of the type of liver meridian and heat is clear, and the clinical symptoms, signs and various examination indexes of the patients have been obviously improved. Second, there is a significant improvement in the clinical symptoms, physical signs and various examination indexes of the patients. The level of ESR-CRP, immunoglobulin and complement in patients with anterior uveitis of the type of liver meridian and heat can be significantly reduced by the combination of Xinzhailian decoction and western medicine, indicating that the new decoction has better anti-inflammatory and improved immune function. Third, The treatment of new Chailian decoction combined with western medicine is superior to that of western medicine alone in shortening the course of anterior uveitis of the wind-heat type of liver meridian. Fourth, The treatment of new Chailian decoction combined with western medicine is superior to that of western medicine in reducing the recurrence rate of anterior uveitis of the type of liver meridian wind and heat and is worthy of wide application in clinical treatment.
【学位授予单位】：浙江中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R773.9

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