加味柴胡疏肝散颗粒对溃疡性结肠炎气滞湿阻证的临床观察

发布时间：2018-09-07 13:49

【摘要】：目的:观察加味柴胡疏肝散颗粒治疗UC气滞湿阻证的临床疗效,为今后在临床中应用加味柴胡疏肝散治疗UC提供客观依据。方法:选取广西中医药大学第一附属医院2014年11月~2016年8月期间脾胃病科病房及导师门诊就诊的UC气滞湿阻证患者。依据纳入标准,共选取60例患者,按照就诊顺序随机分组各30例对照观察的研究方法。治疗组应用加味柴胡疏肝散颗粒联合美沙拉嗪肠溶片,对照组单纯口服美沙拉嗪肠溶片,两组疗程均为2个月,疗程后观察两组治疗前后相关检测指标的变化,包括患者的总体疗效、临床症状积分、舌脉象变化、肠镜结果、疾病活动度及患者生活质量改善情况等方面,并进行统计学分析。结果:治疗组剔除1例,共29例;对照组脱落1例,共29例。(1)治疗组总有效率86.2%,对照组总有效率68.9%,治疗组综合疗效明显优于对照组,两组比较差异具有统计学意义(P0.05);(2)在改善腹泻、粘脓血便、腹痛、里急后重、腹部胀闷及不思饮食等症状方面,治疗组优于对照组,两组比较有显著性差异,具有统计学意义(P0.05);(3)治疗前后中医证候疗效的比较,治疗组总有效率89.7%,其中临床痊愈10例,显效9例,有效7例,提示加味柴胡疏肝散颗粒能改善UC中医临床症状,具有统计学意义(P0.05);(4)治疗前后舌脉象变化的比较,治疗组较对照组能改善患者的舌脉象状况,具有显著性差异(P0.05);(5)治疗前后结肠镜情况的比较,治疗组的有效率为86.2%,对照组的有效率为68.9%,经统计学分析得出P=0.028(P0.05),差异具有统计学意义;(6)肠黏膜组织学病理比较,治疗前后差异具有统计学意义(P0.05),治疗组可明显减轻肠黏膜组织学病理分级状况;(7)治疗前后两组药物对粪便常规所见红、白细胞数量改善情况,治疗组优于对照组,两组相比有显著性差异(P0.05);(8)治疗2个月后,共有58例患者复查肠镜,对患者行疾病活动度的评定,治疗组治疗前:轻度活动为17例,中度活动为12例;治疗后:临床缓解为15例,轻度活动为10例,中度活动为4例,治疗前后差异具有统计学意义(P0.05);(9)随访半年复发率治疗组为4%,明显低于美沙拉嗪肠溶片治疗UC后半年内复发率45%;(10)治疗前后生存质量评分的比较,治疗组患者生活质量包括肠道症状、全身症状、情感能力均较对照组明显改善,具有统计学意义(P0.05),但社会能力未见明显差异(P0.05)。结论:加味柴胡疏肝散颗粒治疗UC气滞湿阻证疗效确切,优于美沙拉嗪肠溶片对照组,能够有效地改善UC患者临床症状及舌脉象,提高生活质量,降低疾病活动度,促进肠道粘膜修复,减少疾病复发率,该方疗效显著,安全可靠,具有推广价值。
[Abstract]:Objective: to observe the clinical efficacy of Jiawei Chaihu Shugan Powder in treating UC with Qi stagnation and dampness obstruction, and to provide objective basis for the treatment of UC with Jiawei Bupleurum Shugan Powder. Methods: UC patients with Qi stagnation and dampness obstruction syndrome were selected from the first affiliated Hospital of Guangxi University of traditional Chinese Medicine from November 2014 to August 2016. According to the inclusion criteria, 60 patients were randomly divided into two groups. The treatment group was treated with modified Chaihu Shugan Powder combined with mesalazine enteric-coated tablets, and the control group was given only mezalazine enteric-coated tablets. The course of treatment in both groups was 2 months. After the treatment, the changes of related indexes before and after treatment were observed. The general curative effect, clinical symptom score, tongue pulse change, colonoscopy results, disease activity and the improvement of patients' quality of life were analyzed statistically. Results: one case was eliminated in the treatment group, 29 cases were eliminated in the treatment group, and 29 cases in the control group. (1) the total effective rate of the treatment group was 86.2, and the total effective rate of the control group was 68.9. The comprehensive curative effect of the treatment group was obviously better than that of the control group. The difference between the two groups was statistically significant (P0.05); (2). The treatment group was superior to the control group in improving the symptoms such as diarrhea, mucous purulent stool, abdominal pain, severe abdominal distension and non-thinking about diet, etc. There was significant difference between the two groups. There was statistical significance (P0.05); (3) before and after the treatment of TCM syndromes comparison, the treatment group total effective rate of 89.7, including 10 cases of clinical recovery, 9 cases of remarkable effect, 7 cases of effective, suggesting that Jiawei Chaihu Shugan Powder granule can improve the clinical symptoms of UC Chinese medicine, There was significant difference (P0.05); (4) before and after treatment of tongue pulse changes, the treatment group compared with the control group can improve the tongue pulse status, with significant differences (P0.05); (5) before and after treatment of colonoscopy comparison, The effective rate of the treatment group was 86.2 and that of the control group was 68.9. By statistical analysis, the difference was statistically significant. (6) the histopathological comparison of intestinal mucosa. The difference before and after treatment was statistically significant (P0.05), the treatment group can significantly reduce the intestinal mucosal histological grading; (7) before and after treatment of the two groups of drugs to routine stool red, white blood cell number improvement, the treatment group is better than the control group, There was significant difference between the two groups (P0.05); (8). After 2 months of treatment, 58 patients underwent enteroscopy to evaluate their disease activity. Before treatment, 17 patients had mild activity, 12 patients had moderate activity, and 15 patients had clinical remission after treatment. There were 10 cases of mild activity and 4 cases of moderate activity. The difference before and after treatment was statistically significant (P0.05); (9) the recurrence rate in the treatment group was 4, which was significantly lower than that in the mesalazine enteric-coated tablet group within half a year after the treatment of UC. (10) the quality of life score was compared before and after treatment. The quality of life of patients in the treatment group including intestinal symptoms, systemic symptoms, emotional ability were significantly improved compared with the control group (P0.05), but there was no significant difference in social ability (P0.05). Conclusion: the modified Chaihu Shugan Powder granule is more effective than mesalazine enteric-coated tablet in treating UC syndrome of qi stagnation and dampness obstruction. It can effectively improve the clinical symptoms and tongue pulse, improve the quality of life and reduce the disease activity in patients with UC. It is effective, safe and reliable to promote intestinal mucosal repair and reduce the recurrence rate of the disease.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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