温阳活络汤联合DMARDs药治疗活动期类风湿关节炎的临床观察

发布时间：2018-03-25 00:10

本文选题：温阳活络汤　切入点：DMARDs　出处：《广西中医药大学》2016年硕士论文

【摘要】：目的:观察温阳活络汤联合改善病情抗风湿药(DMARDs)治疗寒湿痹阻型类风湿关节炎(RA)的临床疗效及安全性评价,为活动期寒湿痹阻型RA提供更有效的治疗方法。方法:选取2014年12月1日至2015年10月31日广西中医药大学第一附属医院风湿病科门诊及住院55例患者。所有患者符合纳入标准的55例患者按随机数字表法随机分为对照组28例和治疗组27例。对照组患者给予三联DMARDs治疗,治疗组在对照组上加用温阳活络汤,疗程8周。主要结局指标:美国风湿病协会(ACR)反应标准、中医总疗效评价。次要结局指标:临床症状体征(关节肿胀数、关节压痛数)、疾病评分[(患者对疼痛评分、患者对病情的总评价、医生对病情总评价、28个关节的平均疾病活性评分(DAS28)、HAQ残疾指数(HAQ-DI)、中医单项证侯积分)]、实验室检查[C反应蛋白(CRP)]及不良反应。结果:(1)两组ACR反应标准比较:对照组达ACR20、ACR50、ACR70分别为35.71%、14.29%、3.57%,治疗组达ACR20、ACR50、ACR70分别为62.96%、40.74%、14.81%,ACR20、ACR50两组比较差异有统计学意义(P0.05),治疗组优于对照组;ACR70两组比较无差异(P0.05)。(2)两组中医总疗效评价比较:对照组中医总有效率82.14%,治疗组中医总有效率96.3%,两者差异有统计学意义P0.01,治疗组优于对照组;(3)两组临床症状体征比较:治疗后两组患者肿胀关节数、压痛关节数均较前改善(P0.01),治疗组优于对照组(P0.01);(4)两组疾病评分比较:治疗后两组患者对疼痛评价、医生对疾病活动评价、患者对疾病活动评价、DAS28、HAQ-DI均较前改善(P0.01),但治疗组优于对照组(P0.01);(5)两组实验室检查比较:治疗后两组患者CRP、下降(P0.01),但治疗组优于对照组(P0.01);(6)两组不良反应发生率对比无统计学意义(P0.05)。结论:温阳活络汤联合DMARDs可有效减轻RA患者临床症状、改善疾病活动评分及实验室指标,使患者达到更好临床疗效,值得临床推广。
[Abstract]:Objective: to observe the clinical efficacy and safety evaluation of Wenyang Huoluo decoction combined with DMARDs in the treatment of rheumatoid arthritis with cold and dampness obstruction. Methods: from December 1, 2014 to October 31, 2015, 55 patients with rheumatism in the department of rheumatology, first affiliated hospital of Guangxi university of traditional Chinese medicine were selected. 55 patients who met the inclusion criteria were randomly divided into control group (n = 28) and treatment group (n = 27) according to random digital table method. Patients in control group were treated with triple DMARDs. The treatment group was treated with Wenyang Huoluo decoction for 8 weeks. Main outcome measures: ACR-response standard of American Rheumatology Association, evaluation of total curative effect of TCM. Secondary outcome index: clinical symptoms and signs (number of joint swelling, Joint tenderness score, disease score [(patient score for pain, total evaluation of patient's condition, The average disease activity score of 28 joints was DAS28 / HAQ disability index (TCM single syndrome score)], laboratory examination [C-reactive protein (CRP)] and adverse reactions. Results comparison of ACR reaction criteria between the two groups: control group:. ACR20 + ACR50 + ACR70 = 35.71 / 14.290.57, ACR20 / ACR50 / ACR70 / ACR70 = 62.96 / 40.74A / ACR50, respectively. There is a significant difference between two groups (P0.055.The treatment group is better than the control group (P 0.05N / ACR70).) the total effective rate of TCM in the control group is 82.140.In the treatment group, the total effective rate of TCM is 82.14%, while in the treatment group there is no difference between the two groups. The total effective rate of the two groups was 96.3B, the difference was statistically significant (P0.01, the treatment group was superior to the control group (P0.01)) the clinical symptoms and signs of the two groups were compared: after treatment, the number of swollen joints in the two groups was higher than that in the control group. The number of tenderness joints was improved compared with the former, and the treatment group was superior to the control group (P 0.01). The disease scores of the two groups were compared: after treatment, the patients in the two groups were evaluated for pain, and the doctors for the evaluation of disease activity. DAS28 HAQ-DI was better than the former, but the treatment group was better than the control group (P 0.01). The two groups were compared: after treatment, the CRP of the two groups decreased P 0.01, but the treatment group was superior to the control group (P 0. 01 and P 0. 01) the incidence of adverse reactions in the two groups was not statistically significant compared with that in the control group (P 0. 01, P 0. 01, P 0. 01, P 0. 01, P 0. 01, P 0. 01, P 0. 01). Conclusion: Wenyang Huoluo decoction combined with DMARDs can effectively alleviate the clinical symptoms of RA patients. Improve the disease activity score and laboratory indicators, so that patients achieve better clinical efficacy, worthy of clinical promotion.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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