發(fā)布時(shí)間：2018-03-25 00:10

  本文選題：溫陽活絡(luò)湯　切入點(diǎn)：DMARDs　出處：《廣西中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的:觀察溫陽活絡(luò)湯聯(lián)合改善病情抗風(fēng)濕藥(DMARDs)治療寒濕痹阻型類風(fēng)濕關(guān)節(jié)炎(RA)的臨床療效及安全性評價(jià),為活動(dòng)期寒濕痹阻型RA提供更有效的治療方法。方法:選取2014年12月1日至2015年10月31日廣西中醫(yī)藥大學(xué)第一附屬醫(yī)院風(fēng)濕病科門診及住院55例患者。所有患者符合納入標(biāo)準(zhǔn)的55例患者按隨機(jī)數(shù)字表法隨機(jī)分為對照組28例和治療組27例。對照組患者給予三聯(lián)DMARDs治療,治療組在對照組上加用溫陽活絡(luò)湯,療程8周。主要結(jié)局指標(biāo):美國風(fēng)濕病協(xié)會(huì)(ACR)反應(yīng)標(biāo)準(zhǔn)、中醫(yī)總療效評價(jià)。次要結(jié)局指標(biāo):臨床癥狀體征(關(guān)節(jié)腫脹數(shù)、關(guān)節(jié)壓痛數(shù))、疾病評分[(患者對疼痛評分、患者對病情的總評價(jià)、醫(yī)生對病情總評價(jià)、28個(gè)關(guān)節(jié)的平均疾病活性評分(DAS28)、HAQ殘疾指數(shù)(HAQ-DI)、中醫(yī)單項(xiàng)證侯積分)]、實(shí)驗(yàn)室檢查[C反應(yīng)蛋白(CRP)]及不良反應(yīng)。結(jié)果:(1)兩組ACR反應(yīng)標(biāo)準(zhǔn)比較:對照組達(dá)ACR20、ACR50、ACR70分別為35.71%、14.29%、3.57%,治療組達(dá)ACR20、ACR50、ACR70分別為62.96%、40.74%、14.81%,ACR20、ACR50兩組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),治療組優(yōu)于對照組;ACR70兩組比較無差異(P0.05)。(2)兩組中醫(yī)總療效評價(jià)比較:對照組中醫(yī)總有效率82.14%,治療組中醫(yī)總有效率96.3%,兩者差異有統(tǒng)計(jì)學(xué)意義P0.01,治療組優(yōu)于對照組;(3)兩組臨床癥狀體征比較:治療后兩組患者腫脹關(guān)節(jié)數(shù)、壓痛關(guān)節(jié)數(shù)均較前改善(P0.01),治療組優(yōu)于對照組(P0.01);(4)兩組疾病評分比較:治療后兩組患者對疼痛評價(jià)、醫(yī)生對疾病活動(dòng)評價(jià)、患者對疾病活動(dòng)評價(jià)、DAS28、HAQ-DI均較前改善(P0.01),但治療組優(yōu)于對照組(P0.01);(5)兩組實(shí)驗(yàn)室檢查比較:治療后兩組患者CRP、下降(P0.01),但治療組優(yōu)于對照組(P0.01);(6)兩組不良反應(yīng)發(fā)生率對比無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:溫陽活絡(luò)湯聯(lián)合DMARDs可有效減輕RA患者臨床癥狀、改善疾病活動(dòng)評分及實(shí)驗(yàn)室指標(biāo),使患者達(dá)到更好臨床療效,值得臨床推廣。
[Abstract]:Objective: to observe the clinical efficacy and safety evaluation of Wenyang Huoluo decoction combined with DMARDs in the treatment of rheumatoid arthritis with cold and dampness obstruction. Methods: from December 1, 2014 to October 31, 2015, 55 patients with rheumatism in the department of rheumatology, first affiliated hospital of Guangxi university of traditional Chinese medicine were selected. 55 patients who met the inclusion criteria were randomly divided into control group (n = 28) and treatment group (n = 27) according to random digital table method. Patients in control group were treated with triple DMARDs. The treatment group was treated with Wenyang Huoluo decoction for 8 weeks. Main outcome measures: ACR-response standard of American Rheumatology Association, evaluation of total curative effect of TCM. Secondary outcome index: clinical symptoms and signs (number of joint swelling, Joint tenderness score, disease score [(patient score for pain, total evaluation of patient's condition, The average disease activity score of 28 joints was DAS28 / HAQ disability index (TCM single syndrome score)], laboratory examination [C-reactive protein (CRP)] and adverse reactions. Results comparison of ACR reaction criteria between the two groups: control group:. ACR20 + ACR50 + ACR70 = 35.71 / 14.290.57, ACR20 / ACR50 / ACR70 / ACR70 = 62.96 / 40.74A / ACR50, respectively. There is a significant difference between two groups (P0.055.The treatment group is better than the control group (P 0.05N / ACR70).) the total effective rate of TCM in the control group is 82.140.In the treatment group, the total effective rate of TCM is 82.14%, while in the treatment group there is no difference between the two groups. The total effective rate of the two groups was 96.3B, the difference was statistically significant (P0.01, the treatment group was superior to the control group (P0.01)) the clinical symptoms and signs of the two groups were compared: after treatment, the number of swollen joints in the two groups was higher than that in the control group. The number of tenderness joints was improved compared with the former, and the treatment group was superior to the control group (P 0.01). The disease scores of the two groups were compared: after treatment, the patients in the two groups were evaluated for pain, and the doctors for the evaluation of disease activity. DAS28 HAQ-DI was better than the former, but the treatment group was better than the control group (P 0.01). The two groups were compared: after treatment, the CRP of the two groups decreased P 0.01, but the treatment group was superior to the control group (P 0. 01 and P 0. 01) the incidence of adverse reactions in the two groups was not statistically significant compared with that in the control group (P 0. 01, P 0. 01, P 0. 01, P 0. 01, P 0. 01, P 0. 01, P 0. 01). Conclusion: Wenyang Huoluo decoction combined with DMARDs can effectively alleviate the clinical symptoms of RA patients. Improve the disease activity score and laboratory indicators, so that patients achieve better clinical efficacy, worthy of clinical promotion.
【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R259

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