中医治未病综合干预对原发性骨关节炎高危状态的防治作用

发布时间：2018-03-09 20:05

本文选题：原发性骨关节炎高危状态　切入点：中药辩证综合干预治疗　出处：《山东中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:骨关节炎(osteoarthrisis,OA)是一种由多种因素引起的关节软骨的变性、破坏及骨质增生为特征的慢性关节疾病,又称骨关节病、退行性关节病、增生性关节炎、肥大性关节炎、老年性关节炎。目前对于处于具有关节不适症状(排除其他原因导致的关节症状)同时具备骨关节炎高危因素但尚未达到骨关节炎诊断标准的“未病状态”的患者来说接受中药治疗接受度不高,故本研究在中医治未病临床实践指南——“原发性骨关节炎高危状态的干预”项目基础上,对原发性骨关节炎高危状态患者进行早期中药干预,观察其临床疗效。方法:根据纳入标准选择符合原发性骨关节炎高危状态的患者36例,随机对照分为对照组和试验组两组,对照组给予非药物干预方案加中药安慰剂,非药物干预方案:(1)健康教育(2)运动锻炼(3)生活起居调摄,中药安慰剂:焦三仙150g,剂型:中药免煎颗粒冲剂,用法:每日一剂,分早、晚两次冲服,疗程:患者共连续用药12周。试验组给予相同的非药物干预方案及指南中制定的辨证用药方案,疗程为12周。根据“尼莫地平评分计算公式”,统计患者治疗前后的关节症状评分及SF-36生存质量各维度评分,分别计算疗效及临床有效率,通过统计学处理,得出结论。结果:给药前对照组与试验组的性别数据、年龄数据、年龄分层、体重数据、病程数据、关节症状评分数据、SF-36生存质量8个维度评分经检验均得到p0.05,对照组与试验组在以上指标中无显著性差异,具有可比性;治疗12周后关节症状评分总有效率方面试验组(83.33%)明显优于对照组(58.82%)(P0.05);SF-36生存质量评分中的生理功能维度、生理职能维度、躯体疼痛维度、社会功能维度总有效率方面试验组明显优于对照组(P0.05);SF-36生存质量评分中的总体健康维度、活力维度、情感职能维度及精神健康维度总有效率方面对照组与试验组无明显差异(p0.05)。结论:非药物干预方案对原发性骨关节炎高危状态患者的关节症状及生存质量的改善有一定的效果,但是相比之下,配合中药辨证治疗的方法有效率更高。对于原发性骨关节炎高危状态人群,实施早期的中药辩证综合干预治疗,在关节症状以及SF-36量表中的生理功能、生理职能、躯体疼痛、社会功能方面相对于单纯的非药物干预有较为显著的疗效,但是在SF-36量表中的总体健康、活力、情感职能及精神健康维度相对于非药物干预方案无明显差异。还需进行更大样本、更长疗程的试验疗效观察及回访以探究“原发性骨关节炎高危状态的干预”临床实践指南草案中制定的中药辨证综合干预方案更深入的临床实用价值,以及观察中药辨证综合干预方案对骨关节炎的发病率的影响作用。
[Abstract]:Objective: osteoarthritis osteoarthritis (OAA) is a chronic articular disease characterized by degeneration, destruction and hyperosteomatosis of articular cartilage, also known as osteoarthropathy, degenerative arthropathy, proliferative arthritis, hypertrophic arthritis, and hypertrophic arthritis. Senile arthritis. At present, patients with joint discomfort (excluding other causes of joint symptoms) have a high risk factor for osteoarthritis but have not yet met the diagnostic criteria for osteoarthritis "non-disease state" of the disease. For those who received traditional Chinese medicine treatment, the acceptance rate was not high. Therefore, on the basis of "intervention of high risk state of primary osteoarthritis", which is the guideline of clinical practice of traditional Chinese medicine (TCM), this study carried out early Chinese medicine intervention to patients with primary osteoarthritis at high risk. Methods: according to the inclusion criteria, 36 patients with primary osteoarthritis were randomly divided into two groups: the control group and the experimental group. The control group was treated with non-drug intervention plus Chinese medicine placebo. Non-drug intervention program: 1) Health education 2) exercise and exercise 3) daily living adjustment, traditional Chinese medicine placebo: Jiao San Xian 150 g, dosage form: traditional Chinese medicine Fan-Fen granule, usage: one dose daily, early morning, two times late, Course of treatment: the patients were treated continuously for 12 weeks. The trial group was given the same non-drug intervention program and the drug differentiation program developed in the guidelines. The course of treatment was 12 weeks. According to the formula of Nimodipine score, the scores of joint symptom and SF-36 quality of life of the patients before and after treatment were counted, and the curative effect and clinical effective rate were calculated respectively. Results: sex data, age data, age stratification, weight data, course of disease data of control group and trial group before administration, The scores of 8 dimensions of SF-36 quality of life (QOL) of SF-36 were all tested and obtained p0.05. There was no significant difference between the control group and the experimental group in the above indexes, which was comparable. After 12 weeks of treatment, the total effective rate of joint symptom score in the test group was significantly better than that in the control group in the score of physiological function, physiological function and somatic pain. The total effective rate of the social function dimension in the trial group was significantly better than that in the overall health dimension and vitality dimension in the P0.05 / SF-36 quality of life score of the control group. There was no significant difference between the control group and the experimental group in the total effective rate of affective function and mental health. Conclusion: Non-drug intervention can improve the joint symptoms and quality of life of patients with primary osteoarthritis at high risk. But in contrast, the effective rate of TCM dialectical therapy is higher. For the high risk group of primary osteoarthritis, the early Chinese medicine dialectical comprehensive intervention treatment, the physiological function in the joint symptom and SF-36 scale, Physiological function, physical pain, social function are more effective than non-drug intervention alone, but in the SF-36 scale, the overall health, vitality, There was no significant difference in emotional functions and mental health dimensions compared to non-drug intervention programs. A larger sample was needed. In order to explore the clinical practical value of the comprehensive intervention program based on TCM syndrome differentiation in the draft clinical practice guide of "intervention in high risk state of primary osteoarthritis", And observe the influence of comprehensive intervention program of TCM differentiation on the incidence of osteoarthritis.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R274.9

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