本文選題：原發(fā)性骨關(guān)節(jié)炎高危狀態(tài)　切入點(diǎn)：中藥辯證綜合干預(yù)治療　出處：《山東中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:骨關(guān)節(jié)炎(osteoarthrisis,OA)是一種由多種因素引起的關(guān)節(jié)軟骨的變性、破壞及骨質(zhì)增生為特征的慢性關(guān)節(jié)疾病,又稱骨關(guān)節(jié)病、退行性關(guān)節(jié)病、增生性關(guān)節(jié)炎、肥大性關(guān)節(jié)炎、老年性關(guān)節(jié)炎。目前對(duì)于處于具有關(guān)節(jié)不適癥狀(排除其他原因?qū)е碌年P(guān)節(jié)癥狀)同時(shí)具備骨關(guān)節(jié)炎高危因素但尚未達(dá)到骨關(guān)節(jié)炎診斷標(biāo)準(zhǔn)的“未病狀態(tài)”的患者來說接受中藥治療接受度不高,故本研究在中醫(yī)治未病臨床實(shí)踐指南——“原發(fā)性骨關(guān)節(jié)炎高危狀態(tài)的干預(yù)”項(xiàng)目基礎(chǔ)上,對(duì)原發(fā)性骨關(guān)節(jié)炎高危狀態(tài)患者進(jìn)行早期中藥干預(yù),觀察其臨床療效。方法:根據(jù)納入標(biāo)準(zhǔn)選擇符合原發(fā)性骨關(guān)節(jié)炎高危狀態(tài)的患者36例,隨機(jī)對(duì)照分為對(duì)照組和試驗(yàn)組兩組,對(duì)照組給予非藥物干預(yù)方案加中藥安慰劑,非藥物干預(yù)方案:(1)健康教育(2)運(yùn)動(dòng)鍛煉(3)生活起居調(diào)攝,中藥安慰劑:焦三仙150g,劑型:中藥免煎顆粒沖劑,用法:每日一劑,分早、晚兩次沖服,療程:患者共連續(xù)用藥12周。試驗(yàn)組給予相同的非藥物干預(yù)方案及指南中制定的辨證用藥方案,療程為12周。根據(jù)“尼莫地平評(píng)分計(jì)算公式”,統(tǒng)計(jì)患者治療前后的關(guān)節(jié)癥狀評(píng)分及SF-36生存質(zhì)量各維度評(píng)分,分別計(jì)算療效及臨床有效率,通過統(tǒng)計(jì)學(xué)處理,得出結(jié)論。結(jié)果:給藥前對(duì)照組與試驗(yàn)組的性別數(shù)據(jù)、年齡數(shù)據(jù)、年齡分層、體重?cái)?shù)據(jù)、病程數(shù)據(jù)、關(guān)節(jié)癥狀評(píng)分?jǐn)?shù)據(jù)、SF-36生存質(zhì)量8個(gè)維度評(píng)分經(jīng)檢驗(yàn)均得到p0.05,對(duì)照組與試驗(yàn)組在以上指標(biāo)中無顯著性差異,具有可比性;治療12周后關(guān)節(jié)癥狀評(píng)分總有效率方面試驗(yàn)組(83.33%)明顯優(yōu)于對(duì)照組(58.82%)(P0.05);SF-36生存質(zhì)量評(píng)分中的生理功能維度、生理職能維度、軀體疼痛維度、社會(huì)功能維度總有效率方面試驗(yàn)組明顯優(yōu)于對(duì)照組(P0.05);SF-36生存質(zhì)量評(píng)分中的總體健康維度、活力維度、情感職能維度及精神健康維度總有效率方面對(duì)照組與試驗(yàn)組無明顯差異(p0.05)。結(jié)論:非藥物干預(yù)方案對(duì)原發(fā)性骨關(guān)節(jié)炎高危狀態(tài)患者的關(guān)節(jié)癥狀及生存質(zhì)量的改善有一定的效果,但是相比之下,配合中藥辨證治療的方法有效率更高。對(duì)于原發(fā)性骨關(guān)節(jié)炎高危狀態(tài)人群,實(shí)施早期的中藥辯證綜合干預(yù)治療,在關(guān)節(jié)癥狀以及SF-36量表中的生理功能、生理職能、軀體疼痛、社會(huì)功能方面相對(duì)于單純的非藥物干預(yù)有較為顯著的療效,但是在SF-36量表中的總體健康、活力、情感職能及精神健康維度相對(duì)于非藥物干預(yù)方案無明顯差異。還需進(jìn)行更大樣本、更長療程的試驗(yàn)療效觀察及回訪以探究“原發(fā)性骨關(guān)節(jié)炎高危狀態(tài)的干預(yù)”臨床實(shí)踐指南草案中制定的中藥辨證綜合干預(yù)方案更深入的臨床實(shí)用價(jià)值,以及觀察中藥辨證綜合干預(yù)方案對(duì)骨關(guān)節(jié)炎的發(fā)病率的影響作用。
[Abstract]:Objective: osteoarthritis osteoarthritis (OAA) is a chronic articular disease characterized by degeneration, destruction and hyperosteomatosis of articular cartilage, also known as osteoarthropathy, degenerative arthropathy, proliferative arthritis, hypertrophic arthritis, and hypertrophic arthritis. Senile arthritis. At present, patients with joint discomfort (excluding other causes of joint symptoms) have a high risk factor for osteoarthritis but have not yet met the diagnostic criteria for osteoarthritis "non-disease state" of the disease. For those who received traditional Chinese medicine treatment, the acceptance rate was not high. Therefore, on the basis of "intervention of high risk state of primary osteoarthritis", which is the guideline of clinical practice of traditional Chinese medicine (TCM), this study carried out early Chinese medicine intervention to patients with primary osteoarthritis at high risk. Methods: according to the inclusion criteria, 36 patients with primary osteoarthritis were randomly divided into two groups: the control group and the experimental group. The control group was treated with non-drug intervention plus Chinese medicine placebo. Non-drug intervention program: 1) Health education 2) exercise and exercise 3) daily living adjustment, traditional Chinese medicine placebo: Jiao San Xian 150 g, dosage form: traditional Chinese medicine Fan-Fen granule, usage: one dose daily, early morning, two times late, Course of treatment: the patients were treated continuously for 12 weeks. The trial group was given the same non-drug intervention program and the drug differentiation program developed in the guidelines. The course of treatment was 12 weeks. According to the formula of Nimodipine score, the scores of joint symptom and SF-36 quality of life of the patients before and after treatment were counted, and the curative effect and clinical effective rate were calculated respectively. Results: sex data, age data, age stratification, weight data, course of disease data of control group and trial group before administration, The scores of 8 dimensions of SF-36 quality of life (QOL) of SF-36 were all tested and obtained p0.05. There was no significant difference between the control group and the experimental group in the above indexes, which was comparable. After 12 weeks of treatment, the total effective rate of joint symptom score in the test group was significantly better than that in the control group in the score of physiological function, physiological function and somatic pain. The total effective rate of the social function dimension in the trial group was significantly better than that in the overall health dimension and vitality dimension in the P0.05 / SF-36 quality of life score of the control group. There was no significant difference between the control group and the experimental group in the total effective rate of affective function and mental health. Conclusion: Non-drug intervention can improve the joint symptoms and quality of life of patients with primary osteoarthritis at high risk. But in contrast, the effective rate of TCM dialectical therapy is higher. For the high risk group of primary osteoarthritis, the early Chinese medicine dialectical comprehensive intervention treatment, the physiological function in the joint symptom and SF-36 scale, Physiological function, physical pain, social function are more effective than non-drug intervention alone, but in the SF-36 scale, the overall health, vitality, There was no significant difference in emotional functions and mental health dimensions compared to non-drug intervention programs. A larger sample was needed. In order to explore the clinical practical value of the comprehensive intervention program based on TCM syndrome differentiation in the draft clinical practice guide of "intervention in high risk state of primary osteoarthritis", And observe the influence of comprehensive intervention program of TCM differentiation on the incidence of osteoarthritis.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R274.9

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