类风湿关节炎患者消化道（胃肠）症状临床调查及证候特点研究

发布时间：2018-01-16 20:04

本文关键词：类风湿关节炎患者消化道（胃肠）症状临床调查及证候特点研究　出处：《黑龙江中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过对确诊为类风湿关节炎患者进行问卷调查的方式,筛选出其中伴有消化道症状的患者,并整合调查问卷中的信息对其进行辨证分型,总结出脾胃湿热证的患者,对其使用半夏泻心汤加味进行治疗并观察疗效。方法:收集2015年6月到2016年12月期间就诊于中国人民解放军第二一一医院风湿免疫科确诊为类风湿关节炎的患者547例。通过采用自拟调查问卷进行问卷调查的方式,在547例患者中筛选出182例合并消化道症状的患者。对问卷调查中的信息进行整理,统计出患者的用药情况等病因学因素。并对具有消化道症状的患者进行辨证分型。根据辨证分型的结果,选择发病率最高的证候的患者进行中医辨证治疗,并对其疗效进行临床观察。结果:试验一:类风湿关节炎患者用药情况与合并消化道症状相关性的结果表明,服用双氯芬酸钠肠溶胶囊的患者出现消化道症状的几率为45.45%,发病率最高,其次为塞来昔布(发病率为29.45%),使用依托考昔的患者发病率最低为27.91%。而服用慢作用抗风湿药的患者当中,服用甲氨蝶呤片中有84.93%的患者出现不同程度的消化道症状。研究发现类风湿关节炎患者,出现最频繁的消化道症状依次为:胃脘胀满37.36%,嗳气反酸36.26%,胃中嘈杂31.32%,身重困倦25.82%其次所占比例较大的为恶心欲呕18.68%,大便不畅18.68%等症状。RA患者胃肠道症状的中医辨证分型结果表明,脾胃湿热证的患者有68例(37.36%),人数最多,发病率由高到低,出现最多的另外两个证型为寒热错杂证(12.64%),肝胃不和证(10.99%),其余证候相对较少。试验二:试验一的结果表明,RA患者出现消化道症状表现为脾胃湿热证的患者人数最多,因此,临床观察采用半夏泻心汤加味治疗脾胃湿热证的RA合并消化道症状的患者,结果表明,治疗组34例患者的临床疗效总有效率为94.12%,明显高于对照组的85.29%,说明半夏泻心汤加味治疗本病效果明确。结论:在类风湿关节炎患者消化道症状的调查中脾胃湿热证患者比例较高,半夏泻心汤加味可能有效减轻大部分类风湿关节炎患者的消化道症状。
[Abstract]:Objective: to screen out the patients with digestive tract symptoms by questionnaire survey on the patients with rheumatoid arthritis, and to combine the information in the questionnaire to classify them according to their syndrome differentiation. Summarizes the spleen and stomach damp-heat syndrome patients. The treatment and curative effect of Banxia Xiexin decoction were observed. A total of 547 patients with rheumatoid arthritis (RA) diagnosed in the Rheumatological Immunology Department of the 211 Hospital of the Chinese people's Liberation Army (PLA) from June 2015 to December 2016 were collected. The way of questionnaire survey. 182 patients with digestive tract symptoms were selected out of 547 patients. According to the results of syndrome differentiation, select the patients with the highest incidence of syndrome differentiation treatment. Results: test 1: the relationship between the drug use in patients with rheumatoid arthritis and the symptoms of digestive tract. Patients taking diclofenac sodium enteric-coated capsules had the highest incidence of gastrointestinal symptoms (45.45), followed by celecoxib (29.45%). The lowest incidence rate was 27.91 for those who took etoxib, while for those who took slow antirheumatic drugs. 84.93% of the patients taking methotrexate had different gastrointestinal symptoms. The study found that in patients with rheumatoid arthritis, the most frequent gastrointestinal symptoms occurred in the order: epigastric bloating over 37.36%. Belching and regurgitation 36.26, stomach noise 31.322.The proportion of heavy sleepiness 25.82% was 18.68%. TCM Syndrome differentiation of Gastrointestinal symptoms in RA patients: 68 patients with spleen and stomach dampness and Heat Syndrome have the highest number of patients, and the incidence rate is from high to low. The other two syndromes that appeared most frequently were cold and heat disorder syndrome (Y12.64), liver and stomach disharmony syndrome (10.99%), and the other syndromes were relatively less. Experiment 2: the result of experiment 1 showed that. The number of RA patients with symptoms of spleen and stomach dampness and heat is the most. Therefore, the clinical observation of patients with RA combined with digestive tract symptoms of spleen and stomach dampness heat syndrome treated with Banxia Xiexin decoction, the results show that. The total effective rate of 34 patients in the treatment group was 94.12, which was significantly higher than that in the control group (85.29%). Conclusion: in the investigation of digestive tract symptoms of patients with rheumatoid arthritis, the proportion of patients with spleen and stomach damp-heat syndrome is higher. Banxia Xiexin decoction may effectively alleviate the digestive tract symptoms of most rheumatoid arthritis patients.
【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】：2017
【分类号】：R259

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