路氏润燥汤联合针刺疗法治疗原发性干燥综合征口干增效对照研究

发布时间：2018-06-04 00:48

本文选题：路志正 + 针刺疗法　；参考：《安徽中医药大学》2016年硕士论文

【摘要】：自身免疫性疾病原发性干燥综合征(PSS,Primary Sjogren’s syndrome)临床上侵犯唾液腺、泪腺,同时也伴随其他外分泌腺体的损害。口干、眼干是其临床的主要典型表现,此外腮腺的反复肿大、关节痛、龋齿、紫癜、多尿也是其临床的特征性表现。若病情继续进展,可以造成患者的多器官、多系统的损害,如肺间质性纤维化、萎缩性胃炎、慢性胰腺损害、肾功能不全等并发症。当前现代医学对于PSS的研究正处在开始阶段,其病因以及发病机制并不十分清楚,故而对于该病的治疗临床上缺乏有效性和针对性强的治疗药物和措施。临床上常用的药物多是作用于全身的糖皮质激素、免疫抑制剂等药物,对于局部症状如口干、眼干有一定的缓解作用,但是长期疗效不佳,而且长期作用于全身的副作用大,治疗效果也并不理想。因此运用中医中药联合针刺治疗此病,其临床有显著的优势,症状缓解显著、安全、副作用小等。从事临床科研70余载的国医大师路志正教授,是中医现代风湿病学科开创者,首创“燥痹”病名。原发性干燥综合征也被路老纳入“燥痹”中,路志正教授结合自己对于干燥综合征几十年的从医用药经验,创造了“益气养阴”的基本大法,并且创造“路氏润燥汤”来治疗此病。1目的评价路氏润燥汤联合针刺疗法治疗气阴两虚型的原发性干燥综合征口干症状的临床增效疗效及其临床价值。2方法本次临床试验研究是基于“首都临床特色应用研究”项目课题:“路氏润燥汤联合针刺疗法治疗原发性干燥综合征增效研究”,共收入62例(由于本次课题未完全结束,所以62例是按顺序截取已经完成数据统计的受试者)符合燥痹气阴两虚型的原发性干燥综合征患者,采用随机、对照、单盲(评价者盲)的研究方法,进行临床服用中药联合针刺疗法组(每周针刺两次以下穴位:三阴交、足三里、公孙、照海、中脘、合谷、内关、外关、廉泉等穴位)和服用中药的分组,即治疗组和对照组。治疗观察是四个月,在每个时间点进行评价随访,设置评价时间点,即分别均于治疗前以及试验开始后1、2、3、4、6、8、10、12、14、16周,进行中医口干症状、口干VAS(目视模拟尺)评分,中医证候评分,关节疼痛和夜尿多等症状进行观察对比,并且进行临床实验室检查,即分别在治疗0、3月,同时检查包括口腔的非刺激唾液流率试验、血尿常规、肝肾功能、类风湿因子RF、血沉、免疫球蛋白电泳、ANA抗体谱,从各个节点所得到的随访治疗数据及治疗前后的实验室检查数据进行统计、分析,以此来评价路氏润燥汤联合针刺疗法治疗气阴两虚型的PSS口干症状的临床增效疗效及其安全性。3结果:针刺对于干燥综合征口干症状的增效改善上没有显著的统计学差异,但是有改善的趋势,两组总有效率达84.1%。治疗组口干症状VAS评分较对照组均有统计学显著性差异(P0.01),安全性指标较疗前均无统计学显著性差异(P0.05)4结论:针刺针刺对于治疗原发性干燥综合征受试者口干症和降低血清免疫学指标增效治疗,在统计学上虽不具有显著差异,但是对于对于干燥综合征的治疗有改善的趋势和态势。下一步研究打算延长疗程、增加刺治疗频率,扩大样本量。
[Abstract]:The autoimmune disease PSS (Primary Sjogren 's syndrome) clinically infringes the salivary glands and lacrimal glands, and also is accompanied by other exocrine glands. Dry mouth and dry eye are the main typical manifestations of its clinical manifestations. The recurrent swelling of the parotid gland, joint pain, caries, purpura and polyuria are also the characteristic manifestations of the clinical. The continuous progress of the disease can cause multiple organs and multiple system damage, such as interstitial fibrosis of the lung, atrophic gastritis, chronic pancreatic damage, and renal dysfunction. The current research on PSS is in the beginning stage, its etiology and pathogenesis are not very clear, so the treatment of the disease is clinical Lack of effective and pertinent therapeutic drugs and measures. Most commonly used drugs are systemic glucocorticoids, immunosuppressants, such as immunosuppressive drugs, for local symptoms such as dry mouth, eye dry, but the long-term effect is not good, and long term side effects are large, the treatment effect is not ideal. Therefore, the use of traditional Chinese medicine and acupuncture in the treatment of this disease has remarkable advantages, significant relief, safety and minor side effects. Professor Lu Zhizheng, a master of Chinese medicine who has been engaged in clinical scientific research for more than 70 years, is the pioneer of modern rheumatism in traditional Chinese medicine, the first "dryness arthralgia", and the primary dry syndrome is also included in the "dryness Bi" by Lu Lao. Professor Lu Zhizheng created the basic law of "Nourishing Qi and nourishing Yin" with his experience in medical medicine for several decades, and created "Lu Shi run dryness soup" to treat the.1 in order to evaluate the effect of Lu Shi's moistening dryness soup combined with acupuncture on the symptoms of dry mouth dry syndrome. And its clinical value.2 method this clinical trial is based on the project of "clinical characteristic application research of capital" project: "Lu Shi run dryness soup combined acupuncture treatment for primary Sjogren syndrome synergy", a total of 62 cases (because the subject is not completely finished, so 62 cases are sequentially intercepted data statistics have been completed. " A randomized, controlled, single blind (evaluator blindness) study of patients with dryness Qi and yin deficiency type of primary Sjogren syndrome was used to carry out clinical use of traditional Chinese medicine combined acupuncture therapy group (acupuncture points below two times a week: Three Yin, Zusanli, Kung sun, sham Hai, Zhong Wan, Hegu, Neiguan, Wai Guan, Lian Quan and other acupoints) and Chinese Medicine The treatment group and the control group were divided into groups. The treatment observation was four months. At each time point, the evaluation was followed up and the time points were set. The symptoms of dry mouth, dry mouth VAS (visual analogue ruler) score, TCM syndrome score, joint pain and night urination, etc. were carried out before the treatment and 1,2,3,4,6,8,10,12,14,16 weeks after the start of the experiment. Clinical laboratory tests were performed, and the non irritating saliva flow rate test including oral cavity, hematuria routine, liver and kidney function, rheumatoid factor RF, erythrocyte sedimentation, immunoglobulin electrophoresis, ANA antibody spectrum, follow-up treatment data from each node and laboratory examination before and after treatment were examined at 0,3 month, respectively. Statistics, analysis, in order to evaluate the effect of Lu Shi Runzao Decoction Combined Acupuncture Therapy on the symptoms of Qi and yin deficiency of PSS on the clinical effect and safety of.3 results: there is no significant difference in the effect of acupuncture on dry syndrome, but there is a trend of improvement, the total effective rate of the two groups is up to 84.1%. The VAS score of dry mouth symptoms in the treatment group was significantly different than that in the control group (P0.01), and there was no significant difference in safety index (P0.05) 4 Conclusion: acupuncture was not statistically significant in the treatment of dry mouth syndrome of primary Sjogren syndrome and reducing serum immunological index. However, for the treatment of Sjogren's syndrome, the trend and trend of improvement will be improved. The next step is to extend the course of treatment, increase the frequency of acupuncture treatment and enlarge the sample size.
【学位授予单位】：安徽中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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