针刀镜治疗急性膝痛风性关节炎的疗效观察及机制研究

发布时间：2018-01-08 05:33

本文关键词：针刀镜治疗急性膝痛风性关节炎的疗效观察及机制研究　出处：《广州中医药大学》2016年博士论文　论文类型：学位论文

【摘要】：急性痛风性关节炎(Acute Gout Arthritis)是由于机体内嘌呤代谢紊乱,导致尿酸盐关节内沉积,导致发作性急性关节红肿热痛的一种疾病,是临床常见的关节炎之一。中医认为痛风的发生多因患者肆食酒肉膏粱厚味等品为外因,内因为痰湿日久损伤脾胃,导致脾胃运化失调,致气血亏虚。微创针刀镜是一种以中医理论为指导、西医手术操作为基础的微创诊疗技术。该技术融合了传统医学的小针刀技术、现代医学的微创外科技术和内窥镜设备,在诊疗过程中能够不破坏整体结构,处理体内微细组织结构的病变,是传统针刀疗法和普通开刀手术所无法替代的新技术。目的:对微创针刀镜治疗急性痛风性关节炎的近期疗效及远期疗效进行综合评价,探讨其治疗急性痛风性关节炎的部分作用机理,为微创针刀镜的在临床上的应用提供理论依据。方法:根据随机、对照、非盲的临床试验原则,收集符合诊断纳入标准和排除标准的急性痛风性关节炎患者42例。其中针镜治疗组21例,入组后立即给予依托考昔120mg/次,1次/日,连服8日,之后改为60mg/日,1次/日;入院第2天下午行微创针刀镜。对照组21例,入组后治疗上立即予口服依托考昔120mg/次,1次/日,连服8日,之后改为60mg/日,1次/日。两组患者在入组后均给予基础治疗,两周后开始常规控尿酸治疗,之后随访半年,计算半年内两组患者的总复发人次数。对两组患者分别于治疗前、入组第3天(微创针刀镜治疗第2天)、第7天、第10天及第14天进行评价。临床观察指标包括关节肿胀、疼痛、压痛、关节灼热、关节疼痛评分(VAS评分)。实验室指标包括检测患者血清尿酸、ESR、CRP、D-二聚体水平;使用ELISA法及RT-PCR法检测血清中IL-1β、IL-6及TNF-α的水平。分析各实验室及观察检测指标,并对其进行统计学分析。结果:微创针刀镜治疗急性痛风性关节炎疗效确切,对比单纯运用药物的对照组,能降低血清中血沉、C反应蛋白、D二聚体、IL-1β、IL-6及TNF-α水平,差异具有统计学意义(P0.05);能缓解关节肿胀、疼痛、压痛、关节灼热症状,其中关节疼痛评分差异具有统计学意义(P0.05);在随后为期半年的随访中,治疗组急性痛风性关节炎的复发率更低,差异具有统计学意义(P0.05)。本研究在整个治疗和观察过程中无病例脱落。在治疗期间,治疗组和对照组中无一例患者出现不良反应。结论:微创针刀镜治疗急性痛风性关节炎对比单纯药物治疗组近期疗效及远期疗效更为显著,具有疗效优、创伤小、术后恢复时间短,无明显毒副作用等优点,患者接受度高,值得在临床推广和运用。
[Abstract]:Acute Gout arthritisis is caused by the disturbance of purine metabolism in the body, resulting in the deposition of uric acid salt in the joint. It is one of the most common arthritis in clinic. Chinese medicine thinks gout occurs mostly because patients eat wine, meat, paste, thick taste and other products as external cause, which is caused by dampness of phlegm and dampness of spleen and stomach for a long time. Minimally invasive needle knife mirror is a minimally invasive diagnosis and treatment technology based on the theory of traditional Chinese medicine and the operation of western medicine. This technique combines the small needle knife technology of traditional medicine. Modern medical minimally invasive surgical techniques and endoscopes, in the course of diagnosis and treatment can not destroy the overall structure, the treatment of the body of micro-tissue structure lesions. It is a new technique that can not be replaced by traditional needle-knife therapy and general operation. Objective: to evaluate the short-term and long-term effects of minimally invasive needle knife endoscope in the treatment of acute gouty arthritis. To explore the mechanism of the treatment of acute gouty arthritis and provide the theoretical basis for the clinical application of minimally invasive needle knife. Methods: according to the principles of randomized, controlled and non-blind clinical trials. A total of 42 patients with acute gouty arthritis who met the diagnostic inclusion criteria and exclusion criteria were collected. Among them, 21 cases in the acupuncture treatment group were given etacoxib 120 mg / d once a day on 8th. Then it was changed to 60 mg / day / day; In the afternoon of the second day of admission, the patients in the control group were treated with minimally invasive needle-knife endoscope. The patients in the control group were given orally etacoxib 120mg / d once a day immediately after admission, then 60 mg / day on 8th. Once a day. Two groups of patients were given basic treatment after entering the group, two weeks after the routine control of uric acid treatment, and then follow up for half a year, calculate the total number of relapse in the two groups within half a year. The two groups of patients before treatment. The third day (day 2, day 7, day 10 and day 14) of minimally invasive needle knife therapy were evaluated. The clinical parameters included swelling, pain, tenderness and burning of joints. Joint pain score and VAS score. The laboratory indexes included the detection of serum uric acid (ESRA) CRP- dimer level. The levels of IL-1 尾 -IL-6 and TNF- 伪 in serum were detected by ELISA and RT-PCR. The indexes of IL-1 尾 -IL-6 and TNF- 伪 were analyzed. Results: the curative effect of minimally invasive needle knife microscope on acute gouty arthritis was definite. Compared with the control group, the serum ESR C reactive protein D dimer could be reduced. The levels of IL-1 尾 -IL-6 and TNF- 伪 were significantly different (P 0.05). Can alleviate the joint swelling, pain, tenderness, joint burning symptoms, in which the difference in joint pain score was statistically significant (P 0.05); The recurrence rate of acute gouty arthritis in the treatment group was lower during the subsequent half year follow-up. The difference was statistically significant (P 0.05). No cases fell off during the whole course of treatment and observation. There were no adverse reactions in the treatment group and control group. Conclusion: the treatment of acute gouty arthritis with minimally invasive needle knife endoscope is more effective than that of the control group. It is worth popularizing and applying in clinic because of the advantages of small trauma, short recovery time and no obvious side effects.
【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R246.9

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