黄芪寄生汤治疗肝肾气血亏虚型膝骨关节炎的临床研究

发布时间：2018-05-12 09:34

本文选题：黄芪寄生汤 + 膝骨关节炎　；参考：《云南中医学院》2017年硕士论文

【摘要】：目的:探讨黄芪寄生汤治疗骨关节炎(OA)的理论依据及可行性,评价黄芪寄生汤治疗膝骨关节炎(KOA)的临床疗效及安全性,为进一步筛选黄芪寄生汤方药及研发OA中药新药提供理论依据。方法:1.理论分析:查阅相关文献,分析黄芪寄生汤治疗骨关节炎(OA)的理论依据及其方药配伍关系;2.临床研究:采用随机、开放、平行对照临床研究,将72例KOA(肝肾、气血亏虚型)患者,随机分为治疗组36例和对照组36例,分别采用黄芪寄生汤和金乌骨通胶囊治疗,8周后,观察两药对两组KOA患者的关节疼痛、肿胀、关节活动、晨僵、关节功能、中医证候积分、Michel Lequesen指数、WOMAC评分、ESR、CRP及肝肾功能等指标的影响。结果:1.黄芪寄生汤治疗骨关节炎从病因病机出发,辨病与辨证相结合,其方药君臣佐使配伍合理。2.治疗前后,两组疾病疗效、证候疗效比较,差异有统计学意义(P0.05),其中治疗组证候疗效、疾病疗效总有效率均为93.94%,对照组证候疗效、疾病疗效总有效率均为70.59%。治疗前后,两组均能明显改善患者中医证候总积分、关节疼痛、肿胀、关节活动、晨僵时间、关节功能、Michel Lequesen指数、WOMAC指数(P0.01);其中关节疼痛、关节肿胀、关节活动不利、Michel Lequesen指数、WOMAC指数两组间对比,差异有统计学意义(P0.05),晨僵时间两组对比无统计学差异(P0.05)。治疗4周后,两组患者中医证候总积分、关节疼痛、关节肿胀、关节活动不利、WOMAC指数、Michel Lequesen指数均得到明显改善(P0.01),晨僵时间也均有改善(P0.05);其中中医证候总积分、关节疼痛、关节活动不利、WOMAC指数两组间对比,差异有统计学意义(P0.05);治疗组Michel Lequesen指数明显优于对照组(P0.01);关节肿胀、晨僵时间两组对比,无统计学差异(P0.05);研究过程中,治疗组醋氯芬酸片服用剂量及服用人数均少于对照组,其使用人数比较,差异有统计学意义(P0.05)。治疗前后,两组关节功能分级在治疗后较治疗前均有明显改善,差异有统计学意义(P0.05),治疗后两组无明显差异(P0.05)。治疗前后,两组ESR、CRP指标均无统计意义(P0.05)。研究过程中,治疗组和对照组均未出现明显毒副作用和不良反应。研究过程中,两组患者的血常规、肝功、肾功、心电图、大便常规、尿常规均未发现不良影响。结论:1.黄芪寄生汤是治疗骨关节炎的有效方剂。2.黄芪寄生汤能改善KOA(肝肾、气血亏虚型)患者关节疼痛、肿胀、关节活动、晨僵时间、关节功能、Michel Lequesen指数、WOMAC指数等,是临床治疗OA安全有效的方法,值得进一步推广应用和深入研究。
[Abstract]:Objective: to explore the theoretical basis and feasibility of Huangqizhongtang in treating osteoarthritis and osteoarthritis (OAA), and to evaluate the clinical efficacy and safety of Huangqizhongtang in the treatment of knee osteoarthritis. To provide theoretical basis for further screening of astragalus parasitic decoction and the development of new OA Chinese medicine. Method 1: 1. Theoretical analysis: to review the relevant literature and analyze the theoretical basis and prescription compatibility of Huangqi parasitic decoction for treatment of osteoarthritis and OAA. Clinical study: 72 patients with KOA-deficiency type were randomly divided into treatment group (n = 36) and control group (n = 36). To observe the effects of the two drugs on pain, swelling, joint movement, morning stiffness, joint function, TCM syndromes score of Michel Lequesen and Lequesen score and liver and kidney function in patients with KOA. The result is 1: 1. Huangqi parasitic decoction in the treatment of osteoarthritis from the etiology and pathogenesis, disease differentiation and syndrome differentiation, its prescription Junchen adjuvant compatibility is reasonable. 2. Before and after treatment, the difference between the two groups was statistically significant (P 0.05). In the treatment group, the syndromes curative effect and the total effective rate of the disease were all 93.94g, while the control group was 70.59g in the syndromes and syndromes. Before and after treatment, the total score of TCM syndromes, joint pain, swelling, joint activity, time of morning stiffness, Lequesen index of articular function and WOMAC index were significantly improved in both groups. The difference between the two groups was statistically significant (P 0.05), but there was no significant difference in morning stiffness time between the two groups (P 0.05). After 4 weeks of treatment, the total score of TCM syndromes, joint pain, joint swelling, joint unfavorable movement and Lequesen index of WOMAC index were all significantly improved in both groups, and the morning stiffness time was also improved in both groups, and the total score of TCM syndromes and joint pain were also improved. The Michel Lequesen index of the treatment group was significantly better than that of the control group (P 0.01); the joint swelling and morning stiffness time were not significantly different between the two groups (P 0.05); in the course of the study, there was no significant difference between the two groups. The dosage and number of acaclofenac tablets in the treatment group were lower than those in the control group, and the difference was statistically significant (P 0.05). Before and after treatment, the grade of joint function in the two groups was significantly improved after treatment compared with before treatment, the difference was statistically significant (P 0.05), and there was no significant difference between the two groups after treatment. Before and after treatment, there was no statistical significance of ESR-CRP in both groups. In the course of the study, there were no obvious side effects and adverse reactions in the treatment group and the control group. During the study, no adverse effects were found in blood test, liver function, renal function, electrocardiogram, stool routine and urine routine. Conclusion 1. Astragalus parasitic decoction is an effective prescription for osteoarthritis. Astragalus parasitic decoction can improve pain, swelling, joint activity, morning stiffness time, Lequesen index of articular function and so on in patients with KOAA (liver and kidney, deficiency of qi and blood). It is a safe and effective method for clinical treatment of OA. It is worth further popularizing and studying.
【学位授予单位】：云南中医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R274.9

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