独活寄生汤加减对强直性脊柱炎肾虚督寒证骨代谢和炎症因子的影响

发布时间：2018-07-20 20:48

【摘要】：目的:观察独活寄生汤加减治疗强直性脊柱炎(AS)肾虚督寒证的临床疗效及对骨代谢指标和肿瘤坏死因子-α(TNF-α),白细胞介素-6(IL-6)等炎症因子的影响。方法:将120例AS患者随机按数字表法分为对照组和观察组各60例。对照组采用美洛昔康片+柳氮磺胺吡啶片治疗。观察组采用独活寄生汤加减内服。两组疗程均为4个月。评价治疗前后脊柱疼痛视觉模拟评分(VAS),巴氏强直性脊柱炎功能指数(BASFI),炎症病情活动指数(BASDAI),胸廓活动度,腰椎活动度(Schober)试验,枕-墙距、臀-地距、"4"字试验和患者整体评分(PGA)和肾虚督寒证评分等指标;检测治疗前后血沉(ESR),C反应蛋白(CRP),TNF-α,IL-6,降钙素(HCT),甲状旁腺激素(PTH),骨碱性磷酸酶(BALP)和骨钙素(BGP)等指标;进行安全性评价。结果:观察组达到AS疗效评价标准20反应(ASAS20)达标率为70.91%,高于对照组的51.79%(χ~2=4.275,P0.05);观察组ASAS50达标率为54.54%,高于对照组的19.64%(χ~2=14.513,P0.01);观察组ASAS70达标率为32.72%,高于对照组的8.93%(χ~2=9.566,P0.01);观察组BASDAI50达标率为50.91%,高于对照组的16.07%(χ~2=15.156,P0.01);治疗后观察组患者疼痛VAS,BASFI,BASDAI,PGA,"4"字试验评分均低于对照组,枕-墙距、指-地距均短于对照组,胸廓活动度和腰椎活动度均大于对照组(P0.05,P0.01);观察组肾虚督寒证评分低于对照组(P0.01);观察组患者ESR,CRP,TNF-α,IL-6水平均低于对照组(P0.01);治疗后两组患者PTH水平均下降(P0.01),组间PTH水平差异无统计学意义;治疗后观察组患者BGP水平高于对照组(P0.05);观察组的不良反应发生情况少于对照组。结论:采用独活寄生汤加减内服治疗AS肾虚督寒证患者能缓解症状,提高运动活动能力,降低疾病活动度,并能下调炎症因子,防止骨量丢失,临床疗效优于对照组,且副作用少。
[Abstract]:Objective: To observe the effect of addition and subtraction of single live parasitic soup in the treatment of ankylosing spondylitis (AS) kidney deficiency and cold syndrome and its effect on bone metabolism index, tumor necrosis factor - alpha (TNF- alpha), interleukin -6 (IL-6) and other inflammatory factors. Methods: 120 cases of AS were randomly divided into control group and 60 cases in observation group. The treatment group was treated with the tablets of sulfasalazine and sulfasalazine in the observation group. The two groups were treated for 4 months. The visual analogue score of spinal pain (VAS), the function index of pasteurized ankylosing spondylitis (BASFI), the inflammatory disease activity index (BASDAI), the thoracic activity degree, the lumbar activity (Schober) test, the occipital wall distance, the buttocks, were evaluated before and after the treatment. Ground distance, "4" test and patient overall score (PGA) and kidney deficiency and cold syndrome score, and other indicators, before and after treatment of erythrocyte sedimentation (ESR), C reactive protein (CRP), TNF- alpha, IL-6, calcitonin (HCT), parathyroid hormone (PTH), bone alkaline phosphatase (BALP) and Osteocalcin (BGP), and other indexes, and safety evaluation. Results: the observation group reached the AS efficacy evaluation standard 20 counter. The standard rate of (ASAS20) was 70.91%, higher than 51.79% of the control group (x ~2=4.275, P0.05), and the standard rate of ASAS50 in the observation group was 54.54%, higher than that of the control group (x ~2=14.513, P0.01), and the ASAS70 standard rate in the observation group was 32.72%, higher than that of the control group (8.93% ~2=9.566, P0.01), and the rate of BASDAI50 in the observation group was 50.91%, higher than the 16.07% of the control group (chi ~2=15.156). After treatment, P0.01), after treatment, the pain VAS, BASFI, BASDAI, PGA, "4" test scores were all lower than the control group, the occipital wall distance, the finger to ground distance were shorter than the control group, the thoracic activity degree and the lumbar motion degree were greater than the control group (P0.05, P0.01), the observation group was lower than the control group (P0.01), and the observation group patients ESR, CRP, TNF- a, IL-6 water averages Lower than the control group (P0.01), after treatment, the level of PTH in the two groups decreased (P0.01), and there was no significant difference in the level of PTH between the groups. The level of BGP in the observation group was higher than that of the control group (P0.05). The incidence of adverse reactions in the observation group was less than that of the control group. Conclusion: the patients in the observation group were less than the control group. The treatment of AS kidney deficiency and the cold syndrome was relieved by the use of single live parasitic decoction. It can improve motor activity, reduce disease activity, and reduce inflammatory factors and prevent bone loss. The clinical efficacy is better than that of the control group, with fewer side effects.
【作者单位】：天津中医药大学第一附属医院;天津市泰达医院;
【基金】：天津市科学技术研究计划项目(2015JQ4014G)
【分类号】：R259

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