本文選題：類風(fēng)濕關(guān)節(jié)炎 + 來氟米特��； 參考：《湖北中醫(yī)藥大學(xué)》2015年碩士論文

【摘要】：目的:來氟米特(Leflunomide,LEF)是目前治療類風(fēng)濕關(guān)節(jié)炎(Rheumatoid arthritis,RA)的常用藥物之一,但其在改善患者病情的同時,對患者的血液系統(tǒng)、消化系統(tǒng)等功能亦有損害作用,而白細(xì)胞減少則為其毒副反應(yīng)之一。本研究通過觀察RA患者服用來氟米特3個月內(nèi)白細(xì)胞數(shù)量的變化情況,研究來氟米特對RA患者病情的控制;通過建立隔物溫和灸聯(lián)合來氟米特治療RA和單純來氟米特治療RA之間的對比,觀察隔物溫和灸對RA患者服用來氟米特后白細(xì)胞減少的控制作用,揭示隔物溫和灸升白細(xì)胞的原理,為隔物溫和灸應(yīng)用到免疫抑制劑引起的RA患者白細(xì)胞減少提供理論和實驗依據(jù)。方法:1.臨床資料:選取自2014年7月至2015年1月,在武漢市中醫(yī)醫(yī)院風(fēng)濕科住院的類風(fēng)濕關(guān)節(jié)炎患者中,隨機(jī)抽取50名在口服來氟米特治療前白細(xì)胞計數(shù)正常的患者,按就診的先后順序分為兩組:隔物溫和灸聯(lián)合口服來氟米特組(治療組),單純口服來氟米特組(對照組),每組各25例。2.治療方法:①對照組(來氟米特組):25例患者給予來氟米特片2片(每片10mg),每天一次,口服,連續(xù)口服3個月;②治療組(隔物溫和灸+來氟米特組):25例,在對照組基礎(chǔ)上行隔物溫和灸治療,每周5次,連續(xù)治療3個月;③當(dāng)個別患者關(guān)節(jié)疼痛劇烈,不能忍受,酌情臨時加用洛索洛芬鈉片(60mg/片),每日3次,每次1片,但不為常規(guī)治療,直到癥狀緩解時停服。此外,不使用和本病相關(guān)的其他任何中西藥。3.觀測指標(biāo):①癥狀及體征指標(biāo):晨僵時間,休息痛,關(guān)節(jié)功能,關(guān)節(jié)腫脹數(shù)和指數(shù),關(guān)節(jié)壓痛數(shù)和指數(shù),雙手平均握力,視覺模擬量表(VAS),患者評價,疾病活動度評分(醫(yī)生),HAQ指數(shù),DAS28等;②關(guān)節(jié)影像學(xué):主要觀察雙手X射線圖像。③實驗室指標(biāo):類風(fēng)濕因子,血沉,c-反應(yīng)蛋白,ccp,白細(xì)胞計數(shù),中性粒細(xì)胞計數(shù);④毒副作用:胃腸道反應(yīng)、脫發(fā)、皮疹、肝功能損害、血液系統(tǒng)改變。4.統(tǒng)計方法:采用spss19.0統(tǒng)計軟件進(jìn)行統(tǒng)計學(xué)處理,其中計量資料采用t檢驗,計數(shù)資料采用x2檢驗,等級資料則采用ridit檢驗,統(tǒng)計指標(biāo)數(shù)據(jù)以x±s表示,當(dāng)p0.05時表示差異有統(tǒng)計學(xué)意義。結(jié)果:兩組患者(共50名),在醫(yī)生的指導(dǎo)下用藥物和進(jìn)行隔物溫和灸的治療,對照組25人,治療組25人,均依從性較好,沒有自行停藥或停止隔物溫和灸的患者,未出現(xiàn)脫落、剔除等病例。1.經(jīng)過3個月的治療后,對照組總有效率(顯效+有效)達(dá)84%,治療組總有效率(顯效+有效)達(dá)96%,兩組數(shù)據(jù)比較,差異有統(tǒng)計學(xué)意義(p0.05),治療組明顯優(yōu)于對照組。2.治療前兩組的關(guān)節(jié)影像學(xué)統(tǒng)計分析不存在顯著性差異(p0.05);治療后,兩組的關(guān)節(jié)影像學(xué)組間及組內(nèi)統(tǒng)計分析仍無顯著性差異(p0.05)。3.治療前,兩組的rf、esr、crp數(shù)值比較,提示無顯著性差異(p0.05),具有可比性;治療后,將兩組的rf、esr、crp數(shù)值再進(jìn)行組間比較,經(jīng)過統(tǒng)計分析,差異有統(tǒng)計學(xué)意義(p0.05)。將兩組治療前后rf、esr、crp數(shù)值進(jìn)行組內(nèi)比較,均存在顯著性差異(p0.05)。說明來氟米特在控制類風(fēng)濕關(guān)節(jié)炎的實驗室指標(biāo)上有重要意義,且治療組在控制上述實驗室指標(biāo)方面明顯優(yōu)于對照組。4.治療前,兩組的白細(xì)胞計數(shù)、中性粒細(xì)胞計數(shù)比較,差異無統(tǒng)計學(xué)意義(p0.05),具有可比性;治療后,將兩組的白細(xì)胞計數(shù)、中性粒細(xì)胞計數(shù)再進(jìn)行比較,統(tǒng)計分析差異有統(tǒng)計學(xué)意義(p0.05)。治療組治療前后比較,統(tǒng)計分析無顯著性差異(p0.05)。說明來氟米特治療類風(fēng)濕關(guān)節(jié)炎的毒副作用之一是引起白細(xì)胞、中性粒細(xì)胞減少,但當(dāng)來氟米特配合隔物溫和灸同時治療類風(fēng)濕關(guān)節(jié)炎時能夠降低毒副作用的發(fā)生。結(jié)論：隔物溫和灸聯(lián)合口服來氟米特治療類風(fēng)濕關(guān)節(jié)炎的療效明顯優(yōu)于單純口服來氟米特;同時隔物溫和灸能夠有效地控制患者在服用來氟米特的過程中出現(xiàn)的白細(xì)胞減少及中性粒細(xì)胞減少。
[Abstract]:Objective: Leflunomide (LEF) is one of the commonly used drugs for the treatment of Rheumatoid arthritis (RA), but it can also damage the blood system, digestive system and other functions of the patients while improving the patient's condition, and the reduction of white blood cells is one of the side effects of the patients. This study was conducted by observing the use of RA patients. Leflunomide (leflunomide) changes in the number of leucocytes within 3 months to study the control of leflunomide in patients with RA, and to observe the control effect of mild moxibustion on leflunomide after the treatment of RA and simple leflunomide in the treatment of RA by establishing a septate mild moxibustion combined with leflunomide and simple leflunomide treatment, and to reveal the mild septum of the septum. The principle of moxibustion raising white blood cells provides theoretical and experimental basis for the application of septum mild moxibustion to leukocytosis of RA patients induced by immunosuppressive agents. Methods: 1. clinical data were selected from July 2014 to January 2015, 50 of the patients with rheumatoid arthritis hospitalized in Department of rheumatism, Wuhan traditional Chinese medicine hospital were randomly selected for oral leflunomide treatment. The patients with normal white blood cell count were divided into two groups according to the order of medical treatment: the septum mild moxibustion combined with the oral leflunomide group (the treatment group), the only oral leflunomide group (control group), 25 cases of each group.2. treatment: (1) the control group (leflunomide group): 25 cases were given 2 tablets of Leflunomide Tablets (each tablet), once a day, oral, continuous. 3 months of oral administration; (2) the treatment group (septum mild moxibustion + leflunomide group): 25 cases were treated with mild moxibustion on the basis of the control group, 5 times a week for 3 months. (3) when the joint pain was severe and unbearable, Loxoprofen Sodium Tablets (60mg/ tablet) was temporarily added, 3 times a day, 1 tablets, but not until the symptoms were slow. In addition, any other Chinese and Western medicine.3. observation indexes related to the disease were not used: symptoms and signs: morning stiffness, rest pain, joint function, joint swelling number and index, joint pressure pain number and index, average grip strength of the two hands, visual analogue scale (VAS), patient evaluation, disease activity score (Doctor), HAQ index, DAS28 and so on (2) joint imaging: the main observation of X ray images of both hands. 3. Laboratory indexes: rheumatoid factor, erythrocyte sedimentation, c- reactive protein, CCP, white blood cell count, neutrophils count; 4. Toxic side effects: gastrointestinal reaction, alopecia, rash, liver function damage, blood system change.4. statistical method: spss19.0 statistical software for statistical processing, it T test was used in the measurement data, x2 test was used for counting data, and Ridit test was used for grade data. The statistical index data was expressed in X + s. The difference was statistically significant when P0.05. Results: two groups of patients (a total of 50) were treated with medicine and septum mild moxibustion under the guidance of the doctor, 25 in the control group and 25 in the treatment group. After 3 months of treatment, the total effective rate of the control group was 84%, the total effective rate of the treatment group (effective + effective) reached 96%, and the two groups of data were compared, the difference was statistically significant (P0.05), and the treatment group was obviously superior to the control group before.2. treatment. There was no significant difference in the statistical analysis of the two groups of joint imaging (P0.05). After treatment, there was no significant difference in the statistical analysis between the two groups of joint imaging groups and groups (P0.05) before.3. treatment, the two groups of RF, ESR, CRP numerical comparison showed no significant difference (P0.05) and was comparable; after treatment, the two groups of RF, ESR, CRP values were carried out again. The difference between the two groups was statistically significant (P0.05). There were significant differences between the RF, ESR and CRP values before and after the treatment (P0.05). It was suggested that leflunomide was of great significance in controlling the laboratory indexes of rheumatoid arthritis, and the treatment group was obviously better than the control in the control of the laboratory index. Before treatment, the white blood cell count and neutrophils count of the two groups were compared, the difference was not statistically significant (P0.05), and it was comparable. After treatment, the white blood cell count and neutrophils count of the two groups were compared, the statistical analysis difference was statistically significant (P0.05). There was no significant difference between the treatment group before and after treatment (P 0.05). One of the side effects of leflunomide in the treatment of rheumatoid arthritis is to cause leukocyte and neutrophils, but when leflunomide combined with septum mild moxibustion at the same time in the treatment of rheumatoid arthritis, it can reduce the side effects of rheumatoid arthritis. Conclusion: the therapeutic effect of mild moxibustion of septum combined with leflunomide in the treatment of rheumatoid arthritis It is obviously better than simple oral leflunomide, and mild septum moxibustion can effectively control leucocytic and neutrophils in patients taking leflunomide.

【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R593.22

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