中西医结合治疗强直性脊柱炎不同证型疗效评价
|
摘要
研究目的
本文通过临床研究主要观察中西医结合治疗对强直性脊柱炎(anylosingspondy-litls,AS)不同证型的临床疗效,以分析中西医结合治疗对何种证型强直性脊柱炎疗效最佳,从而为中西医结合治疗强直性脊柱炎提供一种可靠的疗效分析依据。
研究方法
本研究筛选强直性脊柱炎患者75例,按中医辨证分为湿热痹阻证、寒湿痹阻证、瘀血痹阻证、肾阳亏虚证、肝肾不足证五个证型,各组入组病例15例,分别观察治疗前后五个证型患者的主要症状、体征、实验室指标的变化。
研究结果
中西医结合治疗一个疗程(12周)后五个证型患者主要症状积分、体征积分、主要实验室指标自身前后对照或组间比较有显著或非常显著性差异(P＜0.05或P＜0.01)。湿热痹阻证总有效率为93.33%,寒湿痹阻证总有效率为93.33%,瘀血痹阻证总有效率为73.33%,肾阳亏虚证总有效率为86.67%,肝肾不足证总有效率为80%。
结论
中西医结合治疗对湿热痹阻证和寒湿痹阻证疗效接近且明显优于瘀血痹阻证、肾阳亏虚证及肝肾不足证;后三者中肾阳亏虚型优于肝肾不足型及瘀血痹阻证,瘀血痹阻型疗效与其他各组相比较最差。
Objective:
The artilcle was to evaluate the clinical curative effect of the combination treatment of traditional Chinese and western medicine on Ankylosing Spondylitis of Diffrerent syndrome tapes and discuss that which kind of type that the combination treatment of traditional Chinese and western medicine has the best effect on.
Method:
75 cases selecte vere selected,and were derided into five syndrome tapes according to syndrome differentiation base on traditional Chinese medicine.Compairing scores of symptom,physical sign and laboratory index after treatment with them before treatment.
Results:
After 12 weeks,there was significant or very significant difference of the scores of symptom,physical sign and laboratory index between the five type,compared with themselves or either of the five types.The total effective rate of damp and heat blocking syndrome was 93.33%,of cold and damp blocking syndrome was 93.33%,of deficiency of kidney Yang syndrome was 86.33%,of blood damp blocking was 76.33%,,of deficiency of liver and kidney syndrome was 80%.
Conclusion:
The effect of the combination treatment of traditional Chinese and western medicine on heat and damp blocking syndrome is similar to that on deficiency of cold and damp blocking syndrome,while is batter than the three tapes of the rest.The curative effect of deficiency of kidney Yang syndrome is batter than deficiency of liver and kidney syndrome,while the curative effect of blood damp blocking is the worst of five tapes.
本文通过临床研究主要观察中西医结合治疗对强直性脊柱炎(anylosingspondy-litls,AS)不同证型的临床疗效,以分析中西医结合治疗对何种证型强直性脊柱炎疗效最佳,从而为中西医结合治疗强直性脊柱炎提供一种可靠的疗效分析依据。
研究方法
本研究筛选强直性脊柱炎患者75例,按中医辨证分为湿热痹阻证、寒湿痹阻证、瘀血痹阻证、肾阳亏虚证、肝肾不足证五个证型,各组入组病例15例,分别观察治疗前后五个证型患者的主要症状、体征、实验室指标的变化。
研究结果
中西医结合治疗一个疗程(12周)后五个证型患者主要症状积分、体征积分、主要实验室指标自身前后对照或组间比较有显著或非常显著性差异(P＜0.05或P＜0.01)。湿热痹阻证总有效率为93.33%,寒湿痹阻证总有效率为93.33%,瘀血痹阻证总有效率为73.33%,肾阳亏虚证总有效率为86.67%,肝肾不足证总有效率为80%。
结论
中西医结合治疗对湿热痹阻证和寒湿痹阻证疗效接近且明显优于瘀血痹阻证、肾阳亏虚证及肝肾不足证;后三者中肾阳亏虚型优于肝肾不足型及瘀血痹阻证,瘀血痹阻型疗效与其他各组相比较最差。
Objective:
The artilcle was to evaluate the clinical curative effect of the combination treatment of traditional Chinese and western medicine on Ankylosing Spondylitis of Diffrerent syndrome tapes and discuss that which kind of type that the combination treatment of traditional Chinese and western medicine has the best effect on.
Method:
75 cases selecte vere selected,and were derided into five syndrome tapes according to syndrome differentiation base on traditional Chinese medicine.Compairing scores of symptom,physical sign and laboratory index after treatment with them before treatment.
Results:
After 12 weeks,there was significant or very significant difference of the scores of symptom,physical sign and laboratory index between the five type,compared with themselves or either of the five types.The total effective rate of damp and heat blocking syndrome was 93.33%,of cold and damp blocking syndrome was 93.33%,of deficiency of kidney Yang syndrome was 86.33%,of blood damp blocking was 76.33%,,of deficiency of liver and kidney syndrome was 80%.
Conclusion:
The effect of the combination treatment of traditional Chinese and western medicine on heat and damp blocking syndrome is similar to that on deficiency of cold and damp blocking syndrome,while is batter than the three tapes of the rest.The curative effect of deficiency of kidney Yang syndrome is batter than deficiency of liver and kidney syndrome,while the curative effect of blood damp blocking is the worst of five tapes.
引文
[1]阎小萍等.强直性脊柱炎[M].中国医药科技出版社,2004:3.
[2]阎小萍等.强直性脊柱炎[M].中国医药科技出版社,2004:5.
[3]戴冽,汤美安.强直性脊柱炎的早期诊断和治疗进展[J].新医学,2001,32(8):495-496.
[4]郭粉莲,叶志中,等.深圳市强直性脊柱炎的患病率及患者生活质量调查[J].国际护理学杂志,2006,25(9):692-695.
[5]郭粉莲,叶志中,等.深圳市强直性脊柱炎的患病率及患者生活质量调查[J].国际护理学杂志,2006,25(9):692-695.
[6]曾庆馀.强直性脊柱炎的诊断[J].中国新药与临床杂志1999,18(6):381-382.
[7]孔繁华,陈兴国,金荔.中国健康人和AS患者的HLA-B27亚型分析[J].中国中西医结合风湿病杂志,1998,7(1):30-31.
[8]阎小萍等.强直性脊柱炎[M].中国医药科技出版社,2004:31.
[9]Hoehler Thomas,Schaeper Thomas,Schnerder Peter M,et al.Association of different tumor necrosis factor a promoterallele frequencies with ankylosing spondylitis in HLA-B27 positive individuals[J].Arthritis Rheum,1998,41(8):1489-1492.
[10]阎小萍等.强直性脊柱炎[M].中国医药科技出版社,2004:33.
[11]Uksila Jaakko,Gripenberg-lerche Christel,Toivanen,Raaro,etal.The rode of environmental factors and HLA-B27Der[J].Spondyloarthoropathies,1997,127:167-181.
[12]阎小萍等.强直性脊柱炎[M].中国医药科技出版社,2004:98.
[13]Calin A,Porta J,Fries JF,et al.The clinical history as a screening test for ankylosing spondylitis[J].JAMA 1997,237:2613-2619.
[14]阎小萍等.强制性脊柱炎[M]北京:中国医药科技出版社2004:151-163
[15]阎小萍等.强直性脊柱炎[M].中国医药科技出版社,2004:54.
[16]韩善夯.金实教授治疗强直性脊柱炎经验[J].四川中医,2005,23(11):1-3.
[17]王义军.胡荫奇治疗强直性脊柱炎经验[J].中国中医药信息杂志,2004,11(12):1102-1103.
[18]焦树德.大偻(强直性脊柱炎)病因病机及辨证论治探讨(上)[J].江苏中医药,2003.24(1):1-3.
[19]赵诗哲.黄仰模辨治强直性脊柱炎经验[J].浙江中医杂志2003;38(3):99.
[20]张梅红,等.解毒利湿化瘀法治疗强直性脊柱炎机理初探[J].浙江中医杂志,2004,(5):198-199.
[21]陈永彬.辨证论治强直性脊柱炎21例疗效观察[J].广西医科大学学报,1997,17(1):106-107.
[22]孟德儒,赵丛森,常忠等.强脊效灵丹治疗强直性脊柱炎临床研究[J].河北中医,1995,17(3):37-40.
[23]陆肇中.强直性脊柱炎的辨证论治体会[J].天津中医,1996,13(3):19.
[24]林昌松,刘晓玲,关彤.陈纪藩教授治疗强直性脊柱炎经验[J].新中医,2001,33(2):10-11.
[25]阎小萍等.强直性脊柱炎[M].中国医药科技出版社,2004:77-84.
[26]路志正,焦树德主编.实用中医风湿病学[M].人民卫生出版社,1996:598-599.
[27]刘志勤.王为兰治疗强直性脊柱炎经验[J].中医杂志,2005,46(5):341-342.
[28]唐先平.胡荫奇治疗强直性脊柱炎经验[J].中医杂志,2003,44(9):650-652.
[29]赵诗哲.黄仰模辨治强直性脊柱炎经验[J].浙江中医杂志2003;38(3):99
[30]郑筱萸主编.中药新药临床研究指导原则(试行)[M].中国医药科技出版社,2002:120.
[31]马镇川,等.CT引导下骶髂关节注射配合中医辨证治疗强直性脊柱炎[J].中国骨伤,2004,17(10):606.
[32]陈胜.强直性脊柱炎的中药治疗[J].张家口医学院学报,2004,21(3):60.
[33]李岳渤.中医治疗强直性脊柱炎43例临床分析[J].中国实用乡村医生杂志,2006,13(5):39.
[34]朱辉等.莫成荣治疗强直性脊柱炎的经验[J].辽宁中医杂志,2004,31(3):184-185
[35]侯春英等.温针灸治疗强直性脊柱炎33例[J].中医研究,2004,17(3):52-53.
[36]万学文.针罐结合治疗强直性脊柱炎临床观察[J].中国针灸,2005,25(8):551-552.
[37]朱蜀云.中药内外合治强直性脊柱炎[J].湖北中医杂志,2004,26(9):46-47.
[38]丁之江.中医外治法治疗强直性脊柱炎的36例[J].陕西中医,2005,26(3):237-238.
[39]覃光辉等.苏励教授治疗强直性脊柱炎经验介绍[J].新中医2005,37(6):15-16.
[40]王卫力 强直性脊柱炎的康复疗法[J].中华中西医学杂志.2006,4(5):112.
[41]国家技术监督局中华人民共和国国家标准·中医临床诊疗术语[M].1997.
[42]朱文峰.中医诊断学[M].上海:上海科学技术出版社。1997.
[43]叶应陵等.强制性脊柱炎的诊断和治疗[M]人民军医出版社 北京 2004:54.
[44]郑筱英.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002年,第一版:119-123.
[45]王兆铭.中国中西医结合治疗风湿类疾病[M].天津:天津科技出版社,1989年,第1版:542-551.
[46]曹蔚蔚,郑钦岳,王洪斌.等四物汤对小鼠淋巴细胞增殖及巨噬细胞产生白细胞介素Ⅰ的影响[J].第二军医大学学报,1998;19(1):91-92.
[47]郑钦岳,曹蔚蔚,曹颖瑛.等四物汤增加小鼠脾细胞分泌IL-6及促进IL-6RNA的表达[J].第二军医大学学报,1998;19(3):290-292.
[48]陈玉春,王碧英.四物汤刺激淋巴细胞3H-TdR掺入及分泌IL-2[J].福建中医学院学报,1999;9(2):34-38.
[49]曹蔚蔚,郑钦岳,林文.四物汤对小鼠脾细胞产生IL-2的影响[J].中国药理学会通讯,1998;15(4):3.
[50]白树平,龚传美,刘丹等.四物汤对小鼠免疫功能的影响[J].细胞与分子免疫学杂志,1998;14(3):22.
[51]阴键,郭立弓 中药现代化研究与临床应用[M].北京.学苑出版社.2002;89.
[52]章亭,谭允育,潘彦舒.四物汤对红细胞及脊髓干细胞增殖能力的影响[J].北京中医药大学学报,2000;23(1):36-38.
[53]陈如泉,梁毅,欧敏,等.血虚证红细胞免疫功能和变形性淋巴细胞转化功能及自由基代谢的研究[J].中西医结台临床急救,1999;6(4):151-153.
[54]四物汤对健康受试者球结膜微循环和血液流变学参数的效应[J].国外医药.植物药分册,1999;14(1):24-25.
[55]沈传勇,等.海风藤酮及其类似物抗氧化活性研究[J].北京医科大学学报,1995;27(1):62.
[56]孙绍美,等.海风藤及其代用品药理作用的比较研究[J].中草药,1998;29(10):677.
[2]阎小萍等.强直性脊柱炎[M].中国医药科技出版社,2004:5.
[3]戴冽,汤美安.强直性脊柱炎的早期诊断和治疗进展[J].新医学,2001,32(8):495-496.
[4]郭粉莲,叶志中,等.深圳市强直性脊柱炎的患病率及患者生活质量调查[J].国际护理学杂志,2006,25(9):692-695.
[5]郭粉莲,叶志中,等.深圳市强直性脊柱炎的患病率及患者生活质量调查[J].国际护理学杂志,2006,25(9):692-695.
[6]曾庆馀.强直性脊柱炎的诊断[J].中国新药与临床杂志1999,18(6):381-382.
[7]孔繁华,陈兴国,金荔.中国健康人和AS患者的HLA-B27亚型分析[J].中国中西医结合风湿病杂志,1998,7(1):30-31.
[8]阎小萍等.强直性脊柱炎[M].中国医药科技出版社,2004:31.
[9]Hoehler Thomas,Schaeper Thomas,Schnerder Peter M,et al.Association of different tumor necrosis factor a promoterallele frequencies with ankylosing spondylitis in HLA-B27 positive individuals[J].Arthritis Rheum,1998,41(8):1489-1492.
[10]阎小萍等.强直性脊柱炎[M].中国医药科技出版社,2004:33.
[11]Uksila Jaakko,Gripenberg-lerche Christel,Toivanen,Raaro,etal.The rode of environmental factors and HLA-B27Der[J].Spondyloarthoropathies,1997,127:167-181.
[12]阎小萍等.强直性脊柱炎[M].中国医药科技出版社,2004:98.
[13]Calin A,Porta J,Fries JF,et al.The clinical history as a screening test for ankylosing spondylitis[J].JAMA 1997,237:2613-2619.
[14]阎小萍等.强制性脊柱炎[M]北京:中国医药科技出版社2004:151-163
[15]阎小萍等.强直性脊柱炎[M].中国医药科技出版社,2004:54.
[16]韩善夯.金实教授治疗强直性脊柱炎经验[J].四川中医,2005,23(11):1-3.
[17]王义军.胡荫奇治疗强直性脊柱炎经验[J].中国中医药信息杂志,2004,11(12):1102-1103.
[18]焦树德.大偻(强直性脊柱炎)病因病机及辨证论治探讨(上)[J].江苏中医药,2003.24(1):1-3.
[19]赵诗哲.黄仰模辨治强直性脊柱炎经验[J].浙江中医杂志2003;38(3):99.
[20]张梅红,等.解毒利湿化瘀法治疗强直性脊柱炎机理初探[J].浙江中医杂志,2004,(5):198-199.
[21]陈永彬.辨证论治强直性脊柱炎21例疗效观察[J].广西医科大学学报,1997,17(1):106-107.
[22]孟德儒,赵丛森,常忠等.强脊效灵丹治疗强直性脊柱炎临床研究[J].河北中医,1995,17(3):37-40.
[23]陆肇中.强直性脊柱炎的辨证论治体会[J].天津中医,1996,13(3):19.
[24]林昌松,刘晓玲,关彤.陈纪藩教授治疗强直性脊柱炎经验[J].新中医,2001,33(2):10-11.
[25]阎小萍等.强直性脊柱炎[M].中国医药科技出版社,2004:77-84.
[26]路志正,焦树德主编.实用中医风湿病学[M].人民卫生出版社,1996:598-599.
[27]刘志勤.王为兰治疗强直性脊柱炎经验[J].中医杂志,2005,46(5):341-342.
[28]唐先平.胡荫奇治疗强直性脊柱炎经验[J].中医杂志,2003,44(9):650-652.
[29]赵诗哲.黄仰模辨治强直性脊柱炎经验[J].浙江中医杂志2003;38(3):99
[30]郑筱萸主编.中药新药临床研究指导原则(试行)[M].中国医药科技出版社,2002:120.
[31]马镇川,等.CT引导下骶髂关节注射配合中医辨证治疗强直性脊柱炎[J].中国骨伤,2004,17(10):606.
[32]陈胜.强直性脊柱炎的中药治疗[J].张家口医学院学报,2004,21(3):60.
[33]李岳渤.中医治疗强直性脊柱炎43例临床分析[J].中国实用乡村医生杂志,2006,13(5):39.
[34]朱辉等.莫成荣治疗强直性脊柱炎的经验[J].辽宁中医杂志,2004,31(3):184-185
[35]侯春英等.温针灸治疗强直性脊柱炎33例[J].中医研究,2004,17(3):52-53.
[36]万学文.针罐结合治疗强直性脊柱炎临床观察[J].中国针灸,2005,25(8):551-552.
[37]朱蜀云.中药内外合治强直性脊柱炎[J].湖北中医杂志,2004,26(9):46-47.
[38]丁之江.中医外治法治疗强直性脊柱炎的36例[J].陕西中医,2005,26(3):237-238.
[39]覃光辉等.苏励教授治疗强直性脊柱炎经验介绍[J].新中医2005,37(6):15-16.
[40]王卫力 强直性脊柱炎的康复疗法[J].中华中西医学杂志.2006,4(5):112.
[41]国家技术监督局中华人民共和国国家标准·中医临床诊疗术语[M].1997.
[42]朱文峰.中医诊断学[M].上海:上海科学技术出版社。1997.
[43]叶应陵等.强制性脊柱炎的诊断和治疗[M]人民军医出版社 北京 2004:54.
[44]郑筱英.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002年,第一版:119-123.
[45]王兆铭.中国中西医结合治疗风湿类疾病[M].天津:天津科技出版社,1989年,第1版:542-551.
[46]曹蔚蔚,郑钦岳,王洪斌.等四物汤对小鼠淋巴细胞增殖及巨噬细胞产生白细胞介素Ⅰ的影响[J].第二军医大学学报,1998;19(1):91-92.
[47]郑钦岳,曹蔚蔚,曹颖瑛.等四物汤增加小鼠脾细胞分泌IL-6及促进IL-6RNA的表达[J].第二军医大学学报,1998;19(3):290-292.
[48]陈玉春,王碧英.四物汤刺激淋巴细胞3H-TdR掺入及分泌IL-2[J].福建中医学院学报,1999;9(2):34-38.
[49]曹蔚蔚,郑钦岳,林文.四物汤对小鼠脾细胞产生IL-2的影响[J].中国药理学会通讯,1998;15(4):3.
[50]白树平,龚传美,刘丹等.四物汤对小鼠免疫功能的影响[J].细胞与分子免疫学杂志,1998;14(3):22.
[51]阴键,郭立弓 中药现代化研究与临床应用[M].北京.学苑出版社.2002;89.
[52]章亭,谭允育,潘彦舒.四物汤对红细胞及脊髓干细胞增殖能力的影响[J].北京中医药大学学报,2000;23(1):36-38.
[53]陈如泉,梁毅,欧敏,等.血虚证红细胞免疫功能和变形性淋巴细胞转化功能及自由基代谢的研究[J].中西医结台临床急救,1999;6(4):151-153.
[54]四物汤对健康受试者球结膜微循环和血液流变学参数的效应[J].国外医药.植物药分册,1999;14(1):24-25.
[55]沈传勇,等.海风藤酮及其类似物抗氧化活性研究[J].北京医科大学学报,1995;27(1):62.
[56]孙绍美,等.海风藤及其代用品药理作用的比较研究[J].中草药,1998;29(10):677.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |