三四祛痹方治疗湿热痹阻型急性痛风性关节炎的临床研究

发布时间：2018-06-08 19:16

  本文选题：急性痛风性关节炎 + 湿热痹阻型　； 参考：《广州中医药大学》2017年硕士论文

【摘要】：研究背景:痛风是代谢病中常见的一类疾病、症状总称,不是一种单独的疾病,随着病程的进展,可随之表现出高尿酸血症、关节炎、痛风石及痛风肾等不同症状。随着新时代人们饮食、生活水平的改变及提高,痛风已成为令全世界各国人民闻风丧胆的,除糖尿病外的第二号代谢性疾病。近十年来,不仅痛风患者人数呈攀升趋势,其中青年患者比例也占据不小比例。现代医学对于痛风为什么发病、如何发病等都不清晰,治疗上对痛风的根治暂也束手无策。西医用药上虽有多种能有效缓解痛风性关节炎急性发作症状的药物,但其副作用大,患者不适感明显,难以接受。相反,中药方剂在患者耐受性及调节人体整体气血方面有其优势,秉持中医"整体观"和"辨证论治""思想,各医家有其治疗上的一套经验治法方药,疗效显著。本课题试验组研究药物为导师自拟方三四祛痹方,进行随机对照试验,进而探讨三四祛痹方对于湿热痹阻型急性痛风性关节炎的临床效果,并与西医用药相对比,观察其优势与不足,为临床痛风的治疗提供更多的思路与方向。研究目的:本临床研究遵循DME的原则和方法,进行临床随机对照试验,在日常生活基本治疗的基础上,对照组给以口服尼美舒利分散片,试验组单纯给予口服三四祛痹方,治疗后通过对比患者的疼痛、肿胀缓解时间,治疗1周后的疼痛程度、实验室炎症指标及中医症状积分,评估三四祛痹方的临床疗效,并观察三四祛痹方相对于尼美舒利分散片的优劣势,为中医药治疗痛风提供更深入的医疗应用及根据。研究方法:通过临床随机对照的方式,选取本院导师门诊中符合纳入标准的患者,时间由2016年1月至2016年12月,患者发作时间需在48h以内,将其根据随机数字表法以1:1的比例随机分组,最终结果进入数据统计的患者共60人,对照组30人,试验组30人。研究治疗时间为1周,治疗期间两组均予日常生活基本治疗,试验组予三四祛痹方煎服,1剂/日,早晚饭后分服;对照组尼美舒利分散片口服,1片/1次,2次/1日。两组患者于治疗前、治疗1周后予肝肾功能、C反应蛋白(CRP)、尿酸(UA)检查,并实时详确地记下患者症状、体征。记录到的结果数据采用SPSS22.0进行分析。研究结果:1、两组患者的年龄、性别、病程时间、治疗前疼痛程度、CRP、UA及中医症状积分等基线资料差异没有统计学意义(P0.05)。2、两组患者关节疼痛、肿胀缓解的时间,差异有统计学意义(P0.05),说明两组治疗的效果有可比性,对照组在缓解疼痛、肿胀上速度更快。3、两组患者在疼痛分数(VAS评分)、CRP、UA、中医症状积分方面,治疗前后经组内对比,均有统计学意义(P0.05);治疗后疼痛分数、UA组间比较无统计学意义(P0.05),CRP、中医症状积分组间比较有统计学意义(P0.05)。两组患者在疼痛、中医症状积分、CRP、UA方面都有改善,对照组降低CRP更明显,试验组改善中医症状体征更优秀。4、对治疗后两组患者总有效率进行对照,经卡方检验,无统计学意义(P0.05),两组试验对象临床疗效差不多。结论经过严格的试验及统计学分析,临床辨证给予口服三四祛痹方治疗急性痛风性关节炎,不仅可显著缓解关节疼痛程度,而且能有效降低CRP、UA水平,改善患者中医临床症状体征,迅速减轻患者痛苦,恢复患者劳动、生活能力,试验过程中无明显不良反应,亦未见明显肝肾功能损害指标,值得临床应用推广。
[Abstract]:Background: Gout is a common type of disease in metabolic diseases. Symptoms are generally called, not a single disease. With the progress of the course of disease, it can show hyperuricemia, arthritis, gout and gout kidney and other symptoms. With the change and improvement of people's diet and life water level in the new age, gout has become the people of the world. In the past ten years, not only the number of gout patients has been increasing, but the proportion of young patients has also occupied a small proportion in the past ten years. Modern medicine is not clear about why the gout is occurring, how to attack the disease and so on. The treatment of gout is also at a loss for the treatment of the gout. Although there are many kinds of medicine in western medicine, there are many kinds of drugs in the treatment of gout. It can effectively alleviate the symptoms of acute attack of gout arthritis, but its side effects are great, the patient's discomfort is obvious and it is difficult to accept. On the contrary, the prescription of traditional Chinese medicine has its advantages in the patient's tolerance and the regulation of the whole body and blood of the human body. The efficacy of the experiment group was studied in the study group. The drug was used as the three or four prescription of the tutor's self-made prescription. The randomized controlled trial was carried out to explore the clinical effect of the three or four expelling arthralgia syndrome on acute gouty arthritis of damp heat arthralgia type, and compared with the Western medicine, to observe its advantages and disadvantages, and to provide more ideas and directions for the treatment of clinical gout. Objective: This clinical study follows the principles and methods of DME and carries out clinical randomized controlled trials. On the basis of basic daily life treatment, the control group is given oral Nimesulide Dispersible Tablets, and the experimental group is given a simple oral administration of three or four expelling arthralgia. After treatment, the pain and swelling time of the patients are compared, and the pain degree after 1 weeks is treated. The index of laboratory inflammation and TCM symptom score were used to evaluate the clinical effect of three or four expelling Bi prescription, and to observe the advantages and disadvantages of three or four expelling Bi prescription relative to Nimesulide Dispersible Tablets, and provide more in-depth medical application and basis for the treatment of gout with traditional Chinese medicine. Standard patients, time from January 2016 to December 2016, patients need to be within 48h attack time, according to random numbers in the proportion of 1:1 in the proportion of random groups, the final results into the data of 60 patients, 30 in the control group, 30 in the experimental group. The treatment time for 1 weeks, during the treatment of two groups were given daily basic treatment, the basic treatment, during the treatment period, the basic treatment of daily life, two groups were given daily basic treatment, during the treatment period, The experimental group was given three or four decoction, 1 doses / day, after breakfast and dinner, and the control group was given Nimesulide Dispersible Tablets, 1 /1 times and 2 /1 days. Before the treatment, the liver and kidney function, the C reactive protein (CRP) and the uric acid (UA) were given for 1 weeks after treatment, and the symptoms and signs were recorded in real time. The recorded results were carried out by SPSS22.0. Analysis. Results: 1, two groups of patients of age, sex, course time, the degree of pain before treatment, CRP, UA and TCM symptom score of baseline data difference is not statistically significant (P0.05).2, two groups of patients with joint pain, swelling time, the difference is statistically significant (P0.05), indicating that the effect of the two groups is comparable, the control group is slow Pain, swelling speed.3 faster, two groups of patients in the pain score (VAS score), CRP, UA, traditional Chinese medicine symptom score, before and after the treatment, all were statistically significant (P0.05); after the treatment, there was no statistical significance (P0.05) between the UA group (P0.05), CRP, and the TCM symptom score group was statistically significant (P0.05). Two groups of patients were in the group (P0.05). Pain, TCM symptom score, CRP, UA were all improved, the control group reduced CRP more obvious, the experimental group improved the symptoms and signs of traditional Chinese medicine better.4, the total effective rate of the two groups of patients after treatment, after the chi square test, no statistical significance (P0.05), the two groups of subjects were similar in clinical efficacy. Conclusion after strict test and statistical credits conclusion The treatment of acute gouty arthritis by oral three or four prescription can not only significantly alleviate the degree of joint pain, but also effectively reduce the level of CRP, UA, improve the symptoms and signs of the clinical symptoms of the Chinese medicine, quickly reduce the pain of the patients, restore the patient's labor and life energy, and have no obvious adverse reactions in the test process, and no obvious liver is found. The index of renal function impairment is worthy of clinical application and promotion.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259
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本文编号：1996898