發(fā)布時(shí)間：2018-05-15 07:25

  本文選題：中軸型脊柱關(guān)節(jié)炎 + 中醫(yī)外治　； 參考：《河北大學(xué)》2017年碩士論文

【摘要】：中軸型脊柱關(guān)節(jié)炎是一種慢性免疫性疾病,主要是侵犯骶髂關(guān)節(jié)、脊柱及脊柱旁軟組織,并可以累及外周關(guān)節(jié)。其病理改變?yōu)轺诀年P(guān)節(jié)炎、肌腱端炎、外周關(guān)節(jié)炎等。我國的患病率約為1%,目前對于該病的治療主要有非甾體類抗炎藥、改善病情的抗風(fēng)濕藥和生物制劑。但是長期用藥的副作用讓多數(shù)患者苦不堪言。導(dǎo)師郝斌教授自擬通督除痹方外敷,以期能夠達(dá)到更好的控制病情活動(dòng)、緩解疼痛癥狀等作用。通過監(jiān)測患者的臨床癥狀、炎性指標(biāo),探討通督除痹方對于axSpA的臨床作用和安全性,為該法該方提供循證學(xué)依據(jù)。目的:通過對axSpA運(yùn)用通督除痹方外敷治療的臨床研究,為中西醫(yī)結(jié)合治療axSpA提供新的方法。方法:將符合納入標(biāo)準(zhǔn)的患者按照隨機(jī)分組原則分為治療組和對照組。兩組均有常規(guī)的運(yùn)動(dòng)療法及洛索洛芬鈉片60mg 1/8小時(shí)口服;柳氮磺胺吡啶0.25g口服3/日,以每周遞增0.25g,直至1.0g口服2/日;正清風(fēng)痛寧60mg口服3/日。治療組在此基礎(chǔ)上加用通督除痹方外敷治療,選取脊柱及兩側(cè)旁開1.5寸范圍,將藥泥用紗布、膠布固定于施術(shù)部位上,操作時(shí)間為每天18點(diǎn)至第二天晨起6點(diǎn),4周為一療程。分別在第2周、第4周、第12周結(jié)束時(shí)進(jìn)行統(tǒng)計(jì),采用ASAS20、ASAS40、BASDAI50標(biāo)準(zhǔn)及中醫(yī)證候療效評價(jià)標(biāo)準(zhǔn)。對中醫(yī)證候評分、BASDAI、BASFI、BASMI、脊柱痛評分、夜間痛評分、患者總體評價(jià)(PGA)及血沉、CRP等指標(biāo)進(jìn)行評估。用統(tǒng)計(jì)學(xué)軟件對兩組治療前后結(jié)果進(jìn)行分析處理。結(jié)果:兩組治療前一般資料、BASDAI、BASFI、BASMI、脊柱痛評分、夜間痛評分、PGA、血沉、CRP等指標(biāo)無統(tǒng)計(jì)學(xué)意義(P0.05);在治療2周時(shí),在中醫(yī)證候積分、PGA、夜間痛評分及BASDAI、BASFI治療組明顯優(yōu)于對照組,具有統(tǒng)計(jì)學(xué)意義(P0.05)。治療4周后,在中醫(yī)證候積分、中醫(yī)證候療效比較、PGA、脊柱痛評分、夜間痛評分及BASDAI、BASFI、ESR、CRP、ASAS40、BASDAI50達(dá)標(biāo)率治療組均明顯優(yōu)于對照組,具有統(tǒng)計(jì)學(xué)意義(P0.05)。在治療12周時(shí),治療組與對照組ESR有差異,差異具有統(tǒng)計(jì)學(xué)意義(P0.05),其余指標(biāo)的差異無統(tǒng)計(jì)學(xué)意義(P0.05)。治療組不良反應(yīng)發(fā)生比例低于對照組。結(jié)論:通督除痹方外敷可以明顯緩解axSpA患者臨床癥狀,加快患者臨床癥狀的好轉(zhuǎn),應(yīng)用該方治療axSpA療效安全確切,適合臨床推廣。
[Abstract]:Axial spondylitis is a chronic immune disease involving sacroiliac joints, spine and perispinal soft tissue, and may involve peripheral joints. The pathological changes were sacroiliac arthritis, tendinitis and peripheral arthritis. The prevalence rate of this disease is about 1 in China. At present, the main treatment for the disease is non-steroidal anti-inflammatory drugs, anti-rheumatic drugs and biological agents to improve the condition of the disease. But the side effects of long-term medication make most patients miserable. The tutor Professor Hao Bin made up the external application of du Zubi Fang in order to better control the disease activity and relieve the pain symptoms and so on. By monitoring the clinical symptoms and inflammatory indexes of the patients, the clinical effect and safety of Tongdu-Zubi prescription for axSpA were discussed, and the evidence-based basis for the prescription was provided. Objective: to provide a new method for the treatment of axSpA by applying Tongdu-Zubi prescription in axSpA. Methods: patients who met the inclusion criteria were randomly divided into treatment group and control group. Both groups were given routine exercise therapy and 60mg 1 / 8 hour oral, salicylate sulfamyridine 0.25g / d, increasing by 0.25 g per week until 1.0g / d, and Zhengqing Fengtongning 60mg oral 3 / day. On this basis, the treatment group was treated by external application of Tongdu Zhibi prescription, and 1.5 inch range of spinal column and bilateral side was selected. The gauze and glue cloth were fixed on the site of the operation. The operating time was from 18:00 to 6: 00 am (6: 00 am, 4 weeks) every day as a course of treatment. At the end of week 2, week 4 and week 12, the standard ASAS20 / ASAS40 / BASDAI50 and the criteria for evaluating the efficacy of TCM syndromes were used. The indexes of TCM syndromes were evaluated, such as basic syndrome, spinal pain score, nocturnal pain score, total evaluation of PGA and ESR CRP. The results before and after treatment were analyzed with statistical software. Results: there was no significant difference in general data before treatment between the two groups, such as basic, spinal pain score, nocturnal pain score, PGA, ESR CRP, etc. After 2 weeks of treatment, the treatment group was superior to the control group in TCM syndrome score (PGA), nocturnal pain score and BASDAIBASFI treatment group. It has statistical significance (P 0.05). After 4 weeks of treatment, the scores of TCM syndromes, the curative effects of TCM syndromes and the scores of spinal pain, nocturnal pain and BASDAI50 were significantly better in the treatment group than in the control group (P 0.05). At the 12th week of treatment, the ESR of the treatment group and the control group was significantly different (P 0.05), but the other indexes had no statistical significance. The incidence of adverse reactions in the treatment group was lower than that in the control group. Conclusion: the external application of Tongdu-Zubi prescription can obviously relieve the clinical symptoms of patients with axSpA and accelerate the improvement of clinical symptoms. It is safe and accurate in the treatment of axSpA and is suitable for clinical popularization.
【學(xué)位授予單位】：河北大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R593.2

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