發(fā)布時(shí)間：2018-06-12 03:06

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

【摘要】：研究目的:類風(fēng)濕關(guān)節(jié)炎是臨床常見的系統(tǒng)性、自身免疫性疾病,其發(fā)病率、致殘率高,嚴(yán)重影響患者的生活質(zhì)量,患者一般預(yù)后較差。常規(guī)西藥治療或僅能改善疼痛癥狀,或起效時(shí)間較長,不良反應(yīng)較多。導(dǎo)師根據(jù)多年臨床經(jīng)驗(yàn),使用補(bǔ)腎活血方聯(lián)合常規(guī)西藥甲氨喋呤和來氟米特治療肝腎虧虛、瘀血痹阻型類風(fēng)濕關(guān)節(jié)炎,獲得很好療效,故設(shè)計(jì)本實(shí)驗(yàn),通過臨床療效評價(jià)、癥狀體征觀察、實(shí)驗(yàn)室檢查結(jié)果,評價(jià)其治療的臨床療效及安全性以更好地指導(dǎo)臨床。研究方法:本研究收集符合西醫(yī)類風(fēng)濕關(guān)節(jié)炎診斷,且中醫(yī)辯證屬痹證肝腎虧虛、瘀血痹阻證型的患者64例。根據(jù)隨機(jī)對照原則,將64例類風(fēng)濕關(guān)節(jié)炎患者隨機(jī)分為對照組32人、治療組32人。經(jīng)統(tǒng)計(jì)學(xué)分析,兩組患者在性別比例、年齡、病程和關(guān)節(jié)功能分級等方面無顯著性差異,具有可比性。對照組給予甲氨蝶呤聯(lián)合來氟米特,治療組在對照組基礎(chǔ)上給予中藥補(bǔ)腎活血方湯劑,臨床觀察8周。每2周記錄患者臨床療效和與類風(fēng)濕關(guān)節(jié)炎相關(guān)的癥狀體征,不能耐受的不良反應(yīng)者將退出本次實(shí)驗(yàn)。治療8周后復(fù)查心電圖、肝腎功能和三大常規(guī),以判斷其安全性。最后統(tǒng)計(jì)兩組患者治療前后臨床療效、癥狀體征和實(shí)驗(yàn)室指標(biāo)的差異。研究結(jié)果:1、兩組患者綜合療效比較,治療組治療后達(dá)ACR20、ACR50患者數(shù)目明顯多于對照組;治療組臨床顯效率也明顯高于對照組。2、在改善晨僵癥狀方面,治療組與對照組比較,不僅起效時(shí)間明顯縮短,而且治療8周后晨僵時(shí)間明顯縮短。治療2周后,治療組患者腫脹關(guān)節(jié)數(shù)較治療前明顯減少,治療6周后患者腫脹關(guān)節(jié)數(shù)較對照組明顯減少。治療6周后,治療組患者壓痛關(guān)節(jié)數(shù)較對照組明顯減少。治療8周后,治療組患者關(guān)節(jié)功能障礙指數(shù)較對照組明顯好轉(zhuǎn)。DAS28評分比較,治療8周后,治療組患者關(guān)節(jié)功能障礙指數(shù)較對照組明顯降低。治療4周后,治療組患者雙手平均握力較單純西藥組明顯升高。疼痛10cm水平視力評分比較,治療4周后,治療組患者疼痛程度較治療前明顯減輕,其起效時(shí)間較對照組提前2周。健康評估積分比較,治療4周后,治療組患者總體健康狀況較治療前明顯好轉(zhuǎn),其起效時(shí)間較對照組提前2周;治療8周后患者健康狀況較對照組明顯好轉(zhuǎn)。3、治療8周后,治療組患者急性期反應(yīng)物、類風(fēng)濕因子及炎癥因子水平較對照組明顯降低。8周治療后,治療組與對照組免疫球蛋白水平均明顯降低,兩者之間統(tǒng)計(jì)學(xué)差異不明顯。4、中藥補(bǔ)腎活血方不增加常規(guī)西藥肝腎功能損傷、骨髓造血功能異常等副作用出現(xiàn)的概率。結(jié)論:中藥補(bǔ)腎活血方聯(lián)合常規(guī)西藥治療較常規(guī)西藥組比較,雖然不能完全改善實(shí)驗(yàn)室指標(biāo),但可顯著改善患者臨床癥狀體征、生活質(zhì)量,提高綜合顯效率,而不增加不良反應(yīng)及副作用出現(xiàn)的概率,廣泛適用于肝腎虧虛、瘀血痹阻型類風(fēng)濕關(guān)節(jié)炎患者。
[Abstract]:Research objective: rheumatoid arthritis is a common systematic, autoimmune disease, its incidence and disability rate are high, the patient's quality of life is seriously affected, the patient's general prognosis is poor. Routine western medicine treatment or only can improve the pain symptoms, or the onset time is longer, and no good reaction is more. The tutor uses tonifying kidney according to years of clinical experience. The blood side combined with the conventional western medicine methotrexate and leflunomide to treat the deficiency of the liver and kidney and the stagnation of blood stasis type rheumatoid arthritis, it has got a good effect. Therefore, this experiment is designed by the clinical efficacy evaluation, the observation of symptoms and signs, the results of laboratory examination, the evaluation of the clinical efficacy and safety of the treatment to better guide the clinical. In order to collect 64 cases of rheumatoid arthritis in the diagnosis of Western medicine, and the TCM dialectical belongs to the deficiency of the liver and kidney of arthralgia syndrome and blood stasis syndrome type, according to the random control principle, 64 cases of rheumatoid arthritis were randomly divided into 32 people in the control group and 32 in the treatment group. By statistical analysis, the two groups were in the sex ratio, age, course of disease and the classification of joint function. The control group was given the combination of methotrexate and leflunomide in the control group, and the treatment group was given the decoction of invigorating kidney and activating blood for 8 weeks on the basis of the control group. The clinical efficacy and symptoms related to rheumatoid arthritis were recorded every 2 weeks. The patients who were not able to tolerate the adverse reactions would be withdrawn from this experiment. After 8 weeks of treatment, reexamination of electrocardiogram, liver and kidney function and three general routine to judge its safety. Finally, the difference between the clinical curative effect, symptoms and signs and laboratory indexes of the two groups before and after treatment was statistically analyzed. The results were as follows: 1, two groups were compared, the treatment group was ACR20, the number of ACR50 patients was obviously more than that of the control group; the clinical efficacy of the treatment group was markedly effective. The rate of the treatment group was significantly higher than that of the control group.2. In the improvement of the symptoms of morning stiffness, the treatment group was significantly shorter than the control group, and the time of morning stiffness shortened obviously after 8 weeks of treatment. After 2 weeks of treatment, the number of swelling joints in the treatment group was significantly lower than that before the treatment. The number of swelling joints in the patients was significantly reduced after 6 weeks of treatment. 6 weeks after treatment, the number of swelling joints was significantly reduced. After 8 weeks, the index of joint dysfunction index of the treatment group was significantly better than that of the control group. After 8 weeks of treatment, the joint dysfunction index of the patients in the treatment group was significantly lower than that of the control group. After 4 weeks of treatment, the average grip strength of the two hands in the treatment group was more than that of the simple western medicine group. After 4 weeks of treatment, the pain degree of the treatment group was significantly lower than that before the treatment, and the onset time of the treatment group was 2 weeks earlier than that of the control group. After 4 weeks of health assessment, the overall health status of the patients in the treatment group was significantly better than before the treatment. The onset time of the treatment group was 2 weeks ahead of the control group, and the treatment time was 2 weeks ahead of the control group, and the treatment group was treated for 8 weeks. After 8 weeks of treatment, the level of acute phase reactant, rheumatoid factor and inflammatory factor in the treatment group were significantly lower than that of the control group after 8 weeks of treatment, and the level of immunoglobulin in the treatment group and the control group decreased significantly after 8 weeks of treatment. The difference of the total immunoglobulin between the two groups was not obvious, and the traditional Chinese medicine for invigorating kidney and promoting blood circulation did not increase. Compared with conventional western medicine, the combination of traditional Chinese medicine and conventional western medicine can not completely improve the laboratory index, but it can significantly improve the clinical symptoms and signs, quality of life, improve the comprehensive efficiency, without increasing adverse reaction. The probability of occurrence of side effects should be widely applied to patients with rheumatoid arthritis of liver and kidney deficiency and stagnation of blood stasis.
【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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本文編號：2008005