独附方治疗强直性脊柱炎的临床研究

发布时间：2018-03-14 18:25

本文选题：强直性脊柱炎　切入点：独附方　出处：《中国人民解放军医学院》2016年硕士论文　论文类型：学位论文

【摘要】：目的：评价中药独附方治疗强直性脊柱炎(ankylosing spondylitis,AS)的临床疗效,探明该方药治疗本病的作用特点,为该方药在临床上服务患者提供有力依据。方法：本研究为随机对照实验,随机收集了98例AS患者纳入实验组和对照组,实验组在给予双氯芬酸钠肠溶片和柳氮磺胺吡啶的基础上给予独附方治疗,对照组给予双氯芬酸钠肠溶片柳氮磺胺吡啶片口服,疗程24周。分别在治疗12周、治疗24周采用ASAS20、ASAS40及Bath强直性脊柱炎病情活动性指数(BASDAI50)标准及中医证候疗效评价标准。观察治疗前后患者Bath强直性脊柱炎病情活动指数(BASDAI)、 Bath强直性脊柱炎功能指数(BASFI)、Bath强直性脊柱炎计量指数(BASMI)、脊柱痛评分、夜间痛评分、患者总体评价(PGA)、红细胞沉降率(ESR)、C反应蛋白(CRP)、肿瘤坏死因子-α (TNF-α)、白介素-1(IL-1)、白介素-6(IL-6)、核因子-K-B受体活化因子配体(RANKL)、骨保护素(OPG)、RANKL/OPG等指标评价疗效。结果：治疗12周后,实验组达到ASAS20、ASAS40、BASDAI50标准患者分别占70.45%、43.18%、31.81%,对照组患者达标率为54.34%、21.73%、13.04%,差异有统计学意义(P0.05)；治疗24周后,实验者达到ASAS20、ASAS40、BASDAI50标准患者分别占86.36%、79.54%、72.73%,对照组患者达标率分别为67.39%、58.69%、52.17%,差异有统计学意义(P0.05)。两组患者分别治疗12周、24周后中医症候积分均出现明显差异,差异有统计学意义(P0.05)。治疗24周后实验组中医症候疗效达81.81%,对照组为56.52%,差异有统计学意义(P0.05)。两组患者在治疗12周和24周后BASDAI、BASFI、脊柱痛、夜间痛、PGA评分均出现明显差异,差异有统计学意义(P0.05,P0.01)；实验组和对照组患者TNF-α、IL-1、IL-6水平在治疗12周、24周后两组结果比较出现明显差异,差异有明显统计学意义(P0.01)；实验组和对照组患者血清RANKL水平,RANKL/OPG比值在治疗24周后两组结果比较出现明显差异,差异有统计学意义(P0.05),但两组患者经治疗后ESR、CRP并未出现显著差异,两组治疗后中药组不良反应发生比例低于对照组。结论：独附方可以缓解AS患者临床症状,调节患者骨代谢失衡,应用该方药治疗AS疗效确切,适合临床应用。
[Abstract]:Objective: to evaluate the clinical efficacy of Dufu prescription in the treatment of ankylosing spondylitis (ASA), to find out the characteristics of the treatment, and to provide a strong basis for the treatment of the disease. Methods: this study was a randomized controlled trial. 98 patients with as were randomly enrolled in the experimental group and control group. The experimental group was treated with diclofenac sodium enteric-coated tablets and sulfamyridine, while the control group was treated with diclofenac sodium enteric-coated tablets and salicylazenepyridine tablets orally. The course of treatment was 24 weeks. After 24 weeks of treatment, patients with Bath ankylosing spondylitis were treated with ASAS20 ASAS40 and Bath ankylosing spondylitis activity index (BASDAI50) and traditional Chinese medicine syndrome evaluation criteria. The activity index of Bath ankylosing spondylitis (Bath) and the function index of Bath ankylosing spondylitis (Bath) were observed before and after treatment. Bath ankylosing spondylitis measurement index, basic pain score, Nocturnal pain score, total evaluation of patients with PGAN, erythrocyte sedimentation rate and erythrocyte sedimentation rate of ESR-C reactive protein, tumor necrosis factor- 伪 TNF- 伪, interleukin-1, interleukin-6, nuclear factor-K-B receptor activator ligand RANKLLand osteoprotegerin OPGG, RANKL- / OPG, etc. Results: 12 weeks after treatment, In the experimental group, 70.45 patients reached the ASAS20 ASAS40BASDAI50 standard and 43.18and 31.81, respectively, while the control group reached the standard rate of 54.34 and 21.730.74, the difference was statistically significant (P 0.05), and after 24 weeks of treatment, the patients in the control group achieved the standard rate of 54.34 and 21.73, the difference was statistically significant (P 0.05), and after 24 weeks of treatment, there were significant differences between the two groups. The rate of reaching the standard of ASAS20 / ASAS40 / BASDAI50 was 86.36 / 79.54 / 72.73respectively, while that of the control group was 67.39 / 58.690.The difference was statistically significant (P 0.05). There was a significant difference in the scores of TCM symptoms between the two groups after treatment for 12 weeks and 24 weeks. After 24 weeks of treatment, the curative effect of TCM symptoms in the experimental group was 81.81 and that in the control group was 56.52.There was significant difference between the two groups after 12 and 24 weeks of treatment in basic basic, spinal pain, nocturnal pain and PGA scores. There were significant differences in the levels of TNF- 伪 IL-1and IL-6 between the experimental group and the control group after 12 weeks and 24 weeks of treatment, and there was a significant difference between the two groups after 12 weeks and 24 weeks of treatment. There was a significant difference in serum RANKL level and RANKL / OPG ratio between the two groups after 24 weeks of treatment, but there was no significant difference between the two groups after treatment, however, there was no significant difference between the two groups in the level of serum RANKL and the ratio of RANKL / OPG after 24 weeks of treatment, however, there was no significant difference between the two groups in the level of serum RANKL and the ratio of RANKL / OPG after 24 weeks of treatment. Conclusion: Dufu prescription can relieve the clinical symptoms and regulate the imbalance of bone metabolism in patients with as.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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