温肾壮督法治疗强直性脊柱炎阳虚寒湿证的疗效观察

发布时间：2018-06-20 21:28

本文选题：强直性脊柱炎 + 阳虚寒湿证　；参考：《南京中医药大学》2016年硕士论文

【摘要】：目的:强直性脊柱炎的患者,因长期疼痛造成生活上的不便;而西药的治疗,对于其临床症状的疗效有限。加减阳和汤是导师汪悦教授临床治疗强直性脊柱炎阳虚寒湿证的经验方,通过系统性的临床研究,客观评价加减阳和汤对强直性脊柱炎阳虚寒湿证患者的治疗效果,尤其是对临床症状、体征、实验室检测指标等方面的变化,并评价其临床疗效及提升患者的生活质量,为临床应用提供客观依据。方法:根据平行对照的临床试验原则。将60例符合阳虚寒证的强直性脊柱炎患者分为三组。中药组、西药组、中西药组,每组20例。中药组予以加减阳和汤,西药组予以塞来昔布胶囊、柳氮磺胺吡啶肠溶片,中西药组则予以加减阳和汤、塞来昔布胶囊、柳氮磺胺吡啶肠溶片。4周为一疗程,共2疗程后以患者的中医证候积分、ASQoL、ASAS20标准评估疗效。主要采用ASAS20、BASFI评分及ESR、CRP等,评估病情整体变化程度,并以ASQoL评分评估患者治疗前后的生活质量。同时监测患者安全性指标。结果:通过60例患者8周的临床观察,总体在减轻患者疾病活动度、临床症状和体征、中医辨证证候、实验室指标及生活质量方面均有明显疗效(P0.05)。中西药组在疼痛、炎症指标、BASFI等临床症状有明显改善(P0.05),三组的ESR、CRP均有明显改善(P0.05),中西药组的ASQoL明显高于中药组、西药组。三组患者中,仅出现2例不良反应,均为西药组服用塞来昔布后出现轻度胃部不适,泄泻,与患者沟通后,表示继续服药,未予特殊处理,余后患者未出现明显不适。结论:加减阳和汤结合西药治疗强直性脊柱炎以温肾壮督、温经散寒为治法,在临床上获得了肯定的疗效,除了改善患者的症状体征,对患者的疾病活动度、生活质量等方面都去有疗好的疗效,安全性良好,具有广阔的应用前景。
[Abstract]:Objective: in patients with ankylosing spondylitis, it is difficult to live because of long-term pain, but the curative effect of western medicine is limited to its clinical symptoms. Jiajiayanghe decoction is an experiential prescription for professor Wang Yue's clinical treatment of Yang deficiency and cold dampness syndrome of ankylosing spondylitis. Through systematic clinical research, the therapeutic effect of Jiajiayanghe decoction on ankylosing spondylitis with Yang deficiency and cold dampness syndrome is evaluated objectively. Especially, the changes of clinical symptoms, signs, laboratory indicators and so on, and the evaluation of its clinical efficacy and improve the quality of life of patients, to provide an objective basis for clinical application. Methods: according to the principle of parallel control clinical trial. Sixty patients with ankylosing spondylitis were divided into three groups. Chinese medicine group, western medicine group, Chinese and western medicine group, 20 cases in each group. The western medicine group was given celecoxib capsule and sulfamyridine enteric coated tablets, while the Chinese and western medicine group was treated with Xianyang he decoction, celecoxib capsule and salicylosulfampyridine enteric-coated tablet for a course of 4 weeks. After 2 courses of treatment, the curative effect was evaluated by ASQOL ASAS 20 standard. The ASAS20 BASFI score and ESR-CRP were used to evaluate the overall changes of the disease and the quality of life of the patients before and after treatment was evaluated by ASQoL score. At the same time, the patient safety index was monitored. Results: according to the clinical observation of 60 patients for 8 weeks, there were obvious curative effects on reducing disease activity, clinical symptoms and signs, syndrome differentiation of TCM, laboratory indexes and quality of life (QOL). The clinical symptoms such as pain and inflammation index were significantly improved in the Chinese and western medicine group, and the ESR-CRP in the three groups were significantly improved. The ASQoL in the Chinese and western medicine group was significantly higher than that in the traditional Chinese medicine group and the western medicine group, and that in the western medicine group was significantly higher than that in the traditional Chinese medicine group and western medicine group. There were only 2 adverse reactions in the three groups, all of which were mild gastric discomfort after celecoxib in the western medicine group, diarrhea. After communication with the patients, the patients continued to take the medicine without special treatment, and the remaining patients did not have obvious discomfort after taking celecoxib. Conclusion: the treatment of ankylosing spondylitis by adding and reducing Yang and decoction combined with western medicine, with warming the kidney and strengthening the governor, warming the meridian and dispersing cold as the treatment method, has obtained the definite curative effect clinically, besides improving the patients' symptoms and signs, it can also improve the patients' disease activity. Quality of life and other aspects have good therapeutic efficacy, good safety, has a broad application prospects.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

【参考文献】