發(fā)布時間：2018-06-10 19:50

  本文選題：潰瘍性結(jié)腸炎 + 臨床療效�。� 參考：《北京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：背景:潰瘍性結(jié)腸炎(ulcerative colitis,UC),是一種原因尚不明確的慢性非特異性炎癥性腸病,其病情遷延難愈,易于復(fù)發(fā),有一定的癌變傾向,近年來發(fā)病率呈明顯的上升趨勢,已逐漸成為消化內(nèi)科常見的疑難病。且該病病因尚不明確,臨床治療仍以控制炎癥、改善癥狀為主,療效并不十分滿意。中醫(yī)藥因其療效確切、不良反應(yīng)少、復(fù)發(fā)率低等優(yōu)勢逐漸受到社會的認可,體現(xiàn)了祖國醫(yī)學(xué)在治療UC上的優(yōu)勢和特色,展現(xiàn)了良好的臨床前景。本研究主要分為數(shù)據(jù)挖掘研究和臨床觀察研究兩個部分:一、基于數(shù)據(jù)挖掘技術(shù)探討張聲生教授治療潰瘍性結(jié)腸炎經(jīng)驗研究目的:運用數(shù)據(jù)挖掘技術(shù),探討張聲生教授治療潰瘍性結(jié)腸炎的用藥規(guī)律及辨治思路,以期為臨床遣方用藥提供客觀依據(jù)。方法:通過對張聲生教授治療的潰瘍性結(jié)腸炎患者的門診病例資料進行收集、整理,并嚴(yán)格按照納入標(biāo)準(zhǔn)、排除標(biāo)準(zhǔn)進行篩選,將符合條件的70例(275診次)的病案資料利用"一體化臨床病案分析系統(tǒng)"進行儲存、分析、處理,以探討張聲生教授治療潰瘍性結(jié)腸炎的臨證組方思路。結(jié)果:1、一般資料:70例研究對象中,男性共37例,女性共33例;年齡在23-79歲之間,平均年齡39.3歲。2、癥狀分析:排在前10位的癥狀頻次頻率依次為:大便黏液膿血,腹痛,便次增多,乏力,大便稀,睡眠欠佳,口干,形寒肢冷,性急,里急后重;3、中醫(yī)證候分析:統(tǒng)計分析70例UC患者首次就診時的中醫(yī)證候,按頻次排序依次為大腸濕熱證、肝郁脾虛證、脾虛濕蘊證、寒熱錯雜證、脾腎陽虛證及陰血虧虛證。4、用藥頻次分析:張聲生教授治療潰瘍性結(jié)腸炎最常用的分別為炒白術(shù)、三七、地榆炭、白扁豆、炙黃芪、木香、兒茶、白芍、黃連、山藥、延胡索、血余炭、炮姜、焦神曲、仙鶴草、薏苡仁、肉豆蔻、當(dāng)歸、生黃芪、墨睹旱蓮等。藥性功效方面,以補氣補血等補虛藥最為多見,其次涼血止血、收斂止血、化疲止血等亦為常用,同時兼顧理氣、消食、清熱、收斂等;用藥多偏甘、溫,搭配苦、微寒,寒熱并用;歸經(jīng)方面多從脾、胃、肝入手,兼顧肺、腎,同時本病病位在大腸,亦有所兼顧。5、關(guān)聯(lián)性分析:藥物與藥物:地榆炭和炒白術(shù),白扁豆和炒白術(shù),兒茶和三七,山藥和炒白術(shù)等呈強關(guān)聯(lián)性,為張聲生教授常用藥對,并以炙黃芪、炒白術(shù)、三七、木香、兒茶、地榆炭、白芍、黃連、白扁豆、山藥等為基礎(chǔ)的藥物組方。癥狀與藥物:當(dāng)患者出現(xiàn)性急、腹痛癥狀,常以延胡索;口干、脈細常以白芍、三七等。用藥與療效:應(yīng)用炮姜、血余炭、黃連后便次增多可得到減輕;仙鶴草、延胡索、血余炭、三七后腹痛癥狀可得到減輕等。癥狀變化與用藥變化:出現(xiàn)大便膿血的癥狀或大便膿血較前加重,則加用血余炭;當(dāng)睡眠欠佳,乏力等減輕或好轉(zhuǎn)則加用黃連等。6、主癥療效統(tǒng)計:通過統(tǒng)計診次間主癥療效的癥狀積分變化,發(fā)現(xiàn)對于包括大便次數(shù)增多、大便膿血、腹痛等常見癥狀具有較好的臨床療效。結(jié)論:1、潰瘍性結(jié)腸炎以大便黏液膿血、腹痛、便次增多、乏力、大便稀等為主要癥狀,根據(jù)其臨床表現(xiàn)一般可歸屬于"休息痢"等病范疇,中醫(yī)證型分布上以大腸濕熱證最為多見,其次為肝郁脾虛證及脾虛濕蘊證。2、通過常用藥物進行分析,可以發(fā)現(xiàn)張聲生教授治療UC多從"虛"、"疲"、"濕"、"熱"、"毒"入手,注重"調(diào)和氣血",臨證多以補氣補血藥為基礎(chǔ),配合活血、化瘀、止血等理血藥,同時不忘兼顧清熱、燥濕、解毒;藥物歸經(jīng)方面入脾、胃、肝,兼顧肺、腎,組方簡而準(zhǔn),少而精;臨證以炙黃芪、炒白術(shù)、三七、木香、兒茶、地榆炭、白芍、黃連、白扁豆、山藥等藥物應(yīng)用最多,逐漸形成了以此為中心的基礎(chǔ)方,并且對于本病具有良好的療效。二、清熱化濕涼血化瘀法治療活動期潰瘍性結(jié)腸炎的臨床觀察研究目的:觀察清熱化濕涼血化瘀法治療潰瘍性結(jié)腸炎活動期大腸濕熱證的臨床療效,并評價其安全性。方法:將30例確診為潰瘍性結(jié)腸炎活動期及中醫(yī)辨證為大腸濕熱證的患者,隨機分成兩組;治療組15例予清熱化濕涼血化疲法中藥湯劑聯(lián)合美沙拉嗪口服;對照組15例單純口服美沙拉嗪。療程均為3個月,治療結(jié)束后通過兩組的臨床療效、中醫(yī)證候療效、安全性指標(biāo)等方面評價治療效果。結(jié)果:1、本研究中,男性患者與女性患者的參與例數(shù)比為1:1.07;在年齡分布上,以30-60歲較多,尤其以30-39年齡段內(nèi)患者為多,平均年齡為42.34歲。2、比較治療后兩組的臨床療效情況,試驗組的臨床療效明顯優(yōu)于對照組,差異具有統(tǒng)計學(xué)意義(P0.05)。3、分別比較兩組的臨床緩解率及總有效率,未發(fā)現(xiàn)兩組差異具有統(tǒng)計學(xué)意義(P0.05),其中試驗組的臨床緩解率、總有效率分別為53.3%、93.3%,對照組的臨床緩解率、總有效率分別為21.4%、71.4%。4、在兩組中醫(yī)癥狀療效的比較中,試驗組明顯優(yōu)于對照組,差異具有統(tǒng)計學(xué)意義(P0.05)。5、分別比較兩組證候的緩解率、顯愈率及有效率,在顯愈率上試驗組優(yōu)于對照組(P0.05),差異具有統(tǒng)計學(xué)意義;在緩解率及有效率上未發(fā)現(xiàn)兩組差異具有統(tǒng)計學(xué)意義(P0.05)。6、在主要癥狀改善情況上,試驗組在腹瀉的消失率上明顯優(yōu)于對照組(P0.05),差異具有統(tǒng)計學(xué)意義,認為試驗組對于腹瀉的療效優(yōu)于對照組;在膿血便與腹痛的消失率比較中,未發(fā)現(xiàn)統(tǒng)計學(xué)差異(P0.05)。結(jié)論:清熱化濕涼血化瘀法對于活動期潰瘍性結(jié)腸炎的治療效果顯著而安全,對于癥狀的改善情況明顯優(yōu)于美沙拉嗪。
[Abstract]:Background: ulcerative colitis (UC) is a kind of chronic nonspecific inflammatory bowel disease, which is still unclear. The disease is difficult to recover, is easy to relapse and has a certain tendency of canceration. In recent years, the incidence of the disease has shown an obvious upward trend, and has gradually become a common difficult disease in the medicine department. The etiology of the disease is not yet clear and clinical treatment is not clear. The curative effect is not very satisfactory. The advantages of traditional Chinese medicine are gradually accepted by the society because of its definite curative effect, less adverse reaction and low recurrence rate, which embodies the advantages and characteristics of the Chinese medicine in the treatment of UC, and shows good clinical prospect. This study is mainly divided into data mining and clinical observation. Research two parts: first, based on data mining technology to explore the experience of Professor Zhang Sheng Sheng in the treatment of ulcerative colitis: using data mining technology to explore the rule of medicine and the thinking of treating ulcerative colitis by Professor Zhang Sheng Sheng, in order to provide an objective basis for clinical medication. The data of outpatient cases of ulcerative colitis were collected, arranged and selected strictly according to the inclusion criteria and exclusion criteria. The medical records of 70 cases (275 times of diagnosis) were stored, analyzed and processed by the integrated clinical case analysis system to discuss the clinical prescription of Professor Zhang Sheng Sheng in the treatment of ulcerative colitis. Results: 1, general data: among the 70 subjects, 37 cases were male and 33 were female; the average age was 23-79 years old, and the average age was 39.3 years old.2. The frequency of symptoms of the first 10 places was: stool mucus pus and blood, abdominal pain, stool, weakness, poor sleep, dry mouth, cold limbs cold, acute, in and back weight; 3, Analysis of TCM syndrome: Statistics and analysis of 70 cases of UC patients for the first time of TCM syndrome, according to the frequency order of large intestine damp heat syndrome, liver depression and spleen deficiency syndrome, spleen deficiency syndrome, cold and heat syndrome, spleen kidney yang deficiency syndrome and Yin blood deficiency syndrome.4, frequency analysis: Zhang Sheng Sheng Professor treatment ulcers colitis is the most commonly used to stir fry, 37, SM Charcoal, white lentil, Radix Astragalus, Radix Paeoniae, Paeonia lactiflora, Rhizoma Paeoniae, Rhizoma Coptidis, Rhizoma Corydalis, Rhizoma Corydalis, Rhizoma Corydalis, blood charcoal, ginger, charcoal, Coix, coix seed, nutmeg, Radix Angelicae, Radix Astragali, ink and glimpse of dry lotus. Eliminate food, heat, converge and so on; the drug is more partial, warm, bitter, cold, cold and hot and used; the return to the spleen, stomach, liver, the lung, the kidney, and the disease position in the large intestine, also.5, related analysis: medicine and medicine: the charcoal and stir fry, white lentil and Baizhu, catechu and 37, yam and Baizhu, and so on, In order to teach Zhang Sheng's commonly used drugs, the symptoms and drugs are based on the decoction of Radix Astragali, roasting Atractylodes, Chinese wood aroma, catechu, Radix lony charcoal, Radix Paeoniae Alba, Rhizoma Coptidis, white lentil and yam. Symptoms and drugs: when the patients appear acute, abdominal pain, often with yalhu; dry mouth, pulse fine often with Paeonia lactiflora, 37, and the curative effect: the use of ginger, blood charcoal, Huang Lianhou The increase can be reduced; cranes, corydalis, blood carbon, 37 abdominal pain symptoms can be reduced. Symptoms change and use of changes in medication: symptoms of pus and blood, pus and blood more aggravated than before, plus blood carbon; when poor sleep, fatigue and other mitigation or good turn is added to the.6, the main effect statistics: through statistical diagnosis The change of the symptom integral of the main symptom, found that the common symptoms, including the increasing number of stool, the pus and blood, abdominal pain, and other common symptoms, have good clinical effect. Conclusion: 1, ulcerative colitis is the main symptom of stool mucus, abdominal pain, anathema, weakness and dilute of stool. According to its clinical manifestation, it is generally attributable to "rest dysentery" and other diseases. The distribution of TCM syndrome type is most common in the syndrome of large intestine damp heat syndrome, followed by liver depression and spleen deficiency syndrome and spleen deficiency syndrome.2. Through the analysis of commonly used drugs, Professor Zhang Sheng Sheng can be found to treat UC more from "deficiency", "fatigue", "damp", "heat" and "poison", and pay attention to "harmonizing Qi and blood", and on the basis of Supplementing Qi and enriching blood drugs, combined with blood activating, stasis removing and hemostasis. Blood drugs, at the same time do not forget heat, dampness, detoxification; drugs into the spleen, stomach, liver, both lungs, kidneys, groups are simple and accurate, few and fine; the clinical evidence of Radix Astragalus, 37, wood, catechin, Radix lony charcoal, Radix Paeoniae, Rhizoma Coptidis, white lentil, yam has been used most, and gradually formed the basis of this center, and for the disease. Good curative effect. Two, the clinical observation and Study on the treatment of active ulcerative colitis by clearing away heat and removing blood stasis and removing stasis method: observe the clinical effect of clearing heat, cooling blood and removing stasis to treat ulcerative colitis, and evaluate its safety. Methods: 30 cases were diagnosed as ulcerative colitis and TCM syndrome differentiation was large The patients with intestinal damp heat syndrome were randomly divided into two groups; 15 patients in the treatment group were given the decoction of clearing heat, cooling blood, cooling blood and exhausting the Chinese medicine decoction combined with mesalazine, and 15 cases of the control group were only oral mesalazine. The course of treatment was 3 months. After the treatment, the curative effect was evaluated through the clinical efficacy of the two groups, the curative effect of TCM syndrome and the safety index. The result: 1, Ben. In the study, the number of participants in the male patients and the female patients was 1:1.07, and the age distribution was more than 30-60 years old, especially in the 30-39 age group, and the average age was 42.34 years.2. The clinical curative effect of the two groups after the treatment was compared. The clinical effect of the test group was obviously superior to the control group, the difference was statistically significant (P0.05).3, respectively. The clinical remission rate and total effective rate of the two groups were compared, and the difference between the two groups was not found statistically significant (P0.05). The clinical remission rate of the experimental group was 53.3%, 93.3% respectively, and the clinical remission rate of the control group was 21.4%, 71.4%.4 respectively. In the comparison of the two groups of TCM symptoms, the experimental group was obviously superior to the control group. The difference was statistically significant (P0.05).5, compared with the two groups of syndromes, the rate of remission, the rate of recovery and efficiency, the rate of recovery was better than the control group (P0.05), and the difference was statistically significant. The two groups were not found to have statistical meaning (P0.05).6 in the remission rate and the effective rate. In the main symptom improvement, the experimental group was in diarrhea. The disappearance rate was obviously better than that of the control group (P0.05), and the difference was statistically significant. The effect of the test group on diarrhea was better than that of the control group; the difference between the purulent and abdominal pain and the abdominal pain was not statistically significant (P0.05). Conclusion: the effect of clearing heat and removing blood stasis and removing blood stasis is significant and safe in the treatment of ulcerative colitis at active stage. The improvement of symptoms is better than mesalazine.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R249;R259

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