發(fā)布時間：2018-02-14 07:25

  本文關(guān)鍵詞： 膝關(guān)節(jié)骨性關(guān)節(jié)炎 炎性因子 中醫(yī)辨證分型　出處：《北京中醫(yī)藥大學》2017年碩士論文　論文類型：學位論文

【摘要】：近年來,膝關(guān)節(jié)骨性關(guān)節(jié)炎在人群的發(fā)病率逐年增高,對患者日常生活帶來不便,防治膝關(guān)節(jié)骨性關(guān)節(jié)炎,提高患者生活質(zhì)量具有重大意義,而利用現(xiàn)代醫(yī)學與傳統(tǒng)中醫(yī)理論相結(jié)合對膝關(guān)節(jié)骨性關(guān)節(jié)炎做進一步研究,提供更多的臨床實驗證據(jù),對膝關(guān)節(jié)骨性關(guān)節(jié)炎的早期診斷與治療尤為重要。目的:觀察膝關(guān)節(jié)骨性關(guān)節(jié)炎(Knee osteoarthritis KOA)患者中醫(yī)證型的分布特點,以及KOA與年齡、性別等因素的相關(guān)性,并探索KOA不同中醫(yī)證型之間與血清炎性指標的相關(guān)性。方法:采用前瞻、隨機、對照的研究方法,以膝關(guān)節(jié)骨性關(guān)節(jié)炎患者為研究對象。對在2012年10月至2015年12月期間就診于北京中醫(yī)藥大學東直門醫(yī)院和北京市房山區(qū)大安山鄉(xiāng)社區(qū)衛(wèi)生服務中心的膝關(guān)節(jié)骨性關(guān)節(jié)炎患者進行篩選,篩選出符合入組條件的患者122例,參考《中藥新藥臨床研究指導原則》(2002年)劃分患者證候類型,根據(jù)中醫(yī)辨證,將患者分為三型,這三型分別為:肝腎陰虧、筋脈瘀滯證,脾腎兩虛、濕注骨節(jié)證,腎陽虛衰、痰瘀交阻證。在此期間,選取就診于東直門醫(yī)院門診年齡在54-63歲之間的22例健康體檢者作為正常對照組。留取患者晨起靜脈血,檢測炎性因子(IL-6、TNF-α、sVCAM-1、sICAM-1)。在此次臨床實驗中統(tǒng)計觀察KOA中醫(yī)證型的分布情況,KOA與年齡、性別等因素的相關(guān)性,以及各中醫(yī)證型與炎性因子(IL-6、TNF-α、sVCAM-1、sICAM-1)之間的相關(guān)性。結(jié)果:在本臨床實驗中,膝關(guān)節(jié)骨性關(guān)節(jié)炎中醫(yī)的證型以肝腎陰虧、筋脈瘀滯證最為常見。腎陽虛衰、痰瘀交阻證與脾腎兩虛、濕注骨節(jié)證所占比例相近,后者略高于前者4.92%。本病多見于56-65歲之間的中老年人群,且隨著年齡的增長,肝腎陰虧、筋脈瘀滯證的患者數(shù)量逐漸增加。本病男女發(fā)病率的差異較大,在本臨床研究中,本病多發(fā)于女性,但膝關(guān)節(jié)骨性關(guān)節(jié)炎的三種中醫(yī)證型在男女分布方面無明顯差異。經(jīng)實驗室檢查,IL-6、TNF-α、sICAM-1單位指標值方面,正常組顯著低于其他三組中醫(yī)證型,而三組中醫(yī)證型之間則沒有顯著差異。在sVCAM-1單位指標值方面,腎陽虛衰、痰瘀交阻組與正常組沒有顯著差異,肝腎陰虧、筋脈瘀滯組與脾腎兩虛、濕注骨節(jié)組也沒有顯著差異,但是肝腎陰虧、筋脈瘀滯組與脾腎兩虛、濕注骨節(jié)組顯著低于腎陽虛衰、痰瘀交阻組與正常組。結(jié)論:1膝關(guān)節(jié)骨性關(guān)節(jié)炎中醫(yī)證型以肝腎陰虧、筋脈瘀滯型最常見,且與年齡正相關(guān)。2在膝關(guān)節(jié)骨性關(guān)節(jié)炎患者中,女性患者數(shù)量多于男性患者。3肝腎陰虧、筋脈瘀滯組,脾腎兩虛、濕注骨節(jié)組,腎陽虛衰、痰瘀交阻組三組中醫(yī)證型在炎性因子IL-6、TNF-α、sICAM-1指標值之間無差異,但顯著高于正常組。表明膝關(guān)節(jié)骨性關(guān)節(jié)炎與炎性因子IL-6、TNF-α、sICAM-1有相關(guān)性,為膝關(guān)節(jié)骨性關(guān)節(jié)炎的早期診斷和治療提供新的思路,為臨床應用中醫(yī)藥治療KOA提供理論依據(jù)。4在炎性因子sVCAM-1的單位指標值方面,腎陽虛衰、痰瘀交阻組與正常組沒有顯著差異,肝腎陰虧、筋脈瘀滯組與脾腎兩虛、濕注骨節(jié)組沒有顯著差異,但是肝腎陰虧、筋脈瘀滯組與脾腎兩虛、濕注骨節(jié)組顯著低于腎陽虛衰、痰瘀交阻組與正常組。
[Abstract]:In recent years, osteoarthritis of the knee in the crowd incidence increased year by year, bring inconvenience to the daily life of patients, prevention and treatment of knee osteoarthritis, is of great significance to improve the quality of life of patients, and the use of modern medicine and traditional Chinese medicine theory to do further research on knee osteoarthritis, provide more evidence of clinical trials, early diagnosis and treatment of knee osteoarthritis is particularly important. Objective: To observe the effect of knee osteoarthritis (Knee osteoarthritis KOA) the distribution characteristic of TCM syndrome in patients with KOA, and the correlation with age, gender and other factors, and to explore the relationship between KOA in different TCM syndromes and serum inflammatory indexes.: a prospective, randomized, controlled study method, with knee osteoarthritis patients as the research object. In the period from October 2012 to December 2015 in Beijing Hospital of traditional Chinese Medicine Knee osteoarthritis patients in Dongzhimen hospital and Beijing city Fangshan District Daan Township Community Health Service Center were screened, 122 patients were eligible, with reference to "Chinese medicine clinical research guiding principles > (2002) of patients with syndrome type according to TCM, the patients were divided into three types. These three types were: liver and kidney Yin deficiency, blood stasis syndrome, spleen and kidney two empty, wet condyle syndrome, kidney yang deficiency, phlegm. In the meantime, recruited from outpatient age Dongzhimen hospital health examination in 22 patients between the ages of 54-63 volunteers as normal control group. The patients were taken the morning from the venous blood, detection of inflammatory factors (IL-6, TNF- alpha, sVCAM-1, sICAM-1). In the clinical experiment statistics to observe the distribution of TCM syndrome type of KOA, KOA and age, gender related factors, and the TCM syndrome type and inflammatory factors (IL-6, TNF- alpha, sVCAM-1, sI The correlation between CAM-1). Results: in the clinical trials, syndrome type of knee osteoarthritis in TCM of liver and kidney yin deficiency, blood stasis syndrome is the most common. Kidney yang deficiency, phlegm and spleen kidney two empty, wet condyle permit a proportion similar to that of the latter is slightly higher than the former 4.92% 56-65. The disease is more common in aged people, and with the increase of age, the number of patients with liver and kidney yin deficiency, stasis of the channels gradually increased. The difference between the incidence rate of disease, in this clinical study, the disease is more common in women, but three kinds of TCM Syndrome type of knee osteoarthritis arthritis in gender distribution is not obvious. By laboratory tests, IL-6, TNF- alpha, sICAM-1 unit index value, the normal group was significantly lower than the other three groups of TCM syndrome, but there was no significant difference between the three groups of TCM syndrome type. The sVCAM-1 value in the unit index, kidney yang deficiency, phlegm and blood stasis There was no significant difference with the normal group, liver and kidney yin deficiency, blood stasis group and the spleen kidney two empty, wet condyle group was no significant difference, but the liver and kidney yin deficiency, blood stasis group and the spleen kidney two empty, wet condyle group was significantly lower than that of kidney yang deficiency, phlegm blood stasis group and normal group 1. Conclusion: knee joint bone arthritis with TCM syndrome type of liver and kidney yin deficiency, the most common blood stasis type, and was positively correlated with age of.2 in knee osteoarthritis patients, female patients were more than the number of male patients with.3 liver and kidney yin deficiency, blood stasis group, spleen and kidney two empty, wet condyle group, kidney yang deficiency, phlegm blood stasis group, three groups of TCM in inflammatory cytokines IL-6, TNF- alpha, sICAM-1 index had no difference, but was significantly higher than the normal group. The knee osteoarthritis and inflammatory factor IL-6, TNF- alpha, sICAM-1 correlation, provide new thinking for the early diagnosis and the treatment of knee osteoarthritis The way, provide a theoretical basis for the.4 value in the unit index of inflammatory factor sVCAM-1 for the clinical application of Chinese medicine for the treatment of KOA, kidney yang deficiency, phlegm and blood stasis group had no significant difference with the normal group, liver and kidney yin deficiency, blood stasis group and the spleen kidney two empty, there is no significant difference between the wet condyle group, but the liver and kidney yin, vein stasis group and spleen kidney two empty, wet condyle group was significantly lower than that of kidney yang deficiency, phlegm blood stasis group and normal group.

【學位授予單位】：北京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R274.9

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