發(fā)布時間：2018-04-29 18:27

  本文選題：路氏潤燥湯 + 原發(fā)性干燥綜合征　； 參考：《北京中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：原發(fā)性干燥綜合征(Primary sjogren's syndrome,pSS)是一種以侵犯淚腺、唾液腺等外分泌腺體,具有淋巴細(xì)胞浸潤和特異性自身抗體(抗SSA/SSB)為特征的彌漫性結(jié)締組織病。臨床上主要表現(xiàn)為干燥性角結(jié)膜炎、口腔干燥癥、反復(fù)腮腺腫大、關(guān)節(jié)疼痛等,還可累及其他多個器官而出現(xiàn)腎功能不全、肺間質(zhì)纖維化等復(fù)雜的臨床表現(xiàn)。目前,現(xiàn)代醫(yī)學(xué)對本病的發(fā)病機(jī)制尚不明確,治療上也無特效療法及藥物,臨床常用療法有:替代治療(人工淚液、人工唾液等)和系統(tǒng)治療(糖皮質(zhì)激素類、免疫抑制劑類藥物),現(xiàn)有療法對患者的癥狀緩解作用有限,且長期療效不佳,全身性副作用大。中醫(yī)治療本病有可明顯緩解癥狀,且副作用小、應(yīng)用安全的優(yōu)勢特點,探索、規(guī)范本病的中醫(yī)療法十分必要。國醫(yī)大師路志正教授首創(chuàng)"燥痹"的病名,并將原發(fā)性干燥綜合征納入其中。路志正教授結(jié)合自身多年臨床經(jīng)驗,總結(jié)出本病"氣陰兩虛、瘀血阻絡(luò)"的基本病機(jī),并創(chuàng)立"益氣養(yǎng)陰,潤燥通絡(luò)"的治療原則,自擬"路氏潤燥湯",并配合經(jīng)驗組穴,以治療本病。目的:評價路氏潤燥湯治療氣陰兩虛、瘀血阻絡(luò)型原發(fā)性干燥綜合征患者眼干癥狀的療效及聯(lián)合針刺療法對療效的增加作用。同時評價路氏潤燥湯及針刺療法的臨床應(yīng)用價值。方法:本項研究收錄符合納入標(biāo)準(zhǔn)的原發(fā)性干燥綜合征氣陰兩虛、瘀血阻絡(luò)型患者106例,將所納入的病例隨機(jī)分為治療組和對照組,每組53例。治療組以路氏潤燥湯為基本方隨證加減并聯(lián)合針刺療法治療受試者,對照組予路氏潤燥湯為基本方隨證加減湯劑治療,兩組患者總療程均為3個月。采用隨機(jī)、單盲、對照、前瞻性臨床試驗方法,分別于治療0、1、2、3、4、8、12周時評價受試者的臨床療效與安全性指標(biāo),并于第0、12周評價實驗室檢查指標(biāo),以評價路氏潤燥湯聯(lián)合針刺療法的療效和安全性。結(jié)果:(1)路氏潤燥湯聯(lián)合針刺療法治療及路氏潤燥湯單方治療,對于受試者眼干癥狀均有緩解效果。且路氏潤燥湯聯(lián)合針刺療法對于癥狀的改善更為快速、顯著。且隨治療時間延長,療效呈持續(xù)增加趨勢。(2)路氏潤燥湯聯(lián)合針刺療法及路氏潤燥湯單方均可改善原發(fā)性干燥綜合征患者吸墨試驗結(jié)果,即對患者的淚腺分泌功能有改善作用。(3)路氏潤燥湯聯(lián)合針刺療法治療及路氏潤燥湯單方治療,對于受試者中醫(yī)整體證候均有緩解效果。且路氏潤燥湯聯(lián)合針刺療法更加快速、顯著地改善了受試者的中醫(yī)整體證候。且隨治療時間延長,療效呈持續(xù)增加趨勢。(4)在路氏潤燥湯及針刺療法的安全性評價方面,治療期間無血液系統(tǒng)受損、肝腎功能受損等不良反應(yīng)發(fā)生,表明路氏潤燥湯及針刺療法安全可靠。結(jié)論:本次研究體現(xiàn)了路氏潤燥湯治療原發(fā)性干燥綜合征的顯著臨床療效,及方藥聯(lián)合針刺療法對臨床療效的增加作用。治療可有效緩解受試者的眼干癥狀,改善受試者的淚腺分泌功能,并可降低受試者的病情活動度指標(biāo)。治療過程中對受試者的安全性指標(biāo)無不良影響。本療法有較大的臨床推廣價值。
[Abstract]:Primary sjogren's syndrome (pSS) is a diffuse connective tissue disease characterized by infiltration of the lacrimal gland, salivary glands, lymphocytic infiltration and specific autoantibodies (anti SSA/SSB). The main manifestations are dry keratoconjunctivitis, oral desiccation, repeated parotid enlargement, and joint pain. There are complicated clinical manifestations of renal insufficiency and pulmonary interstitial fibrosis in other organs. At present, the pathogenesis of the disease is not clear, there is no special treatment and drugs in the treatment of modern medicine. The common clinical treatments are replacement therapy (artificial lacrimal fluid, artificial saliva, etc.) and systematic therapy (glucocorticoids, exempts) The current therapy has limited effect on relieving the symptoms of the patients, and the long-term effect is poor and the systemic side effects are large. Traditional Chinese medicine treatment of this disease can obviously alleviate the symptoms, and the side effects are small. It is necessary to explore and standardize the traditional Chinese medicine therapy of this disease. Professor Lu Zhizheng of the Chinese medicine is the first to create a "dry arthralgia" disease. According to his years of clinical experience, Professor Lu Zhizheng summed up the basic pathogenesis of the disease "Qi Yin deficiency, blood stasis obstructing collaterals", and established the principle of "Nourishing Qi and nourishing Yin, moistening dryness dredging collaterals", drawing up "Lu Shi run dryness soup" and combining with experience group points to treat the disease. Objective: To evaluate the treatment of Lu Shi Runzao soup. The effect of the eye dry symptoms of the patients with Qi and yin deficiency, blood stasis type primary Sjogren syndrome and the effect of combined acupuncture therapy on the curative effect. At the same time, the clinical application value of Lu's moistening dryness soup and acupuncture therapy was evaluated. Methods: This study included 106 cases of primary Sjogren syndrome, Qi and yin deficiency, and blood stasis obstructing collaterals. The cases were randomly divided into the treatment group and the control group, with 53 cases in each group. The treatment group was treated with Lu Shi Runzao soup as the basic prescription and combined with acupuncture therapy. The control group was treated with Lu Shi Runzao soup as the basic prescription, and the two group of patients had a total course of 3 months. The treatment was randomized, single blind, control, prospective clinical. The test method was used to evaluate the clinical efficacy and safety indexes of the subjects at 0,1,2,3,4,8,12 week, and to evaluate the laboratory test indexes at week 0,12 to evaluate the efficacy and safety of Lu Shi Runzao decoction combined with acupuncture. Results: (1) Lu Zao Runzao decoction combined with acupuncture therapy and Lu Shi Runzao Decoction single prescription treatment, for subjects. The effect of Lu's moistening dryness soup combined with acupuncture on symptoms was more rapid and significant. And with the prolonged treatment time, the curative effect continued to increase. (2) Lu's moistening decoction combined with acupuncture and Lu's moistening dryness decoction could improve the results of ink absorption test in patients with primary Sjogren syndrome, that is, to the patients. The secretion function of lacrimal gland has improved effect. (3) Lu Shi Runzao decoction combined with acupuncture therapy and Lu Shi Runzao Decoction single prescription treatment, the subjects have relieved effect on the whole syndrome of Chinese medicine. And Lu Shi run dryness soup combined acupuncture therapy is more rapid, significantly improved the whole syndrome of the subjects of Chinese medicine. (4) in the safety evaluation of Lu Shi Runzao Decoction and acupuncture therapy, there was no damage of blood system and impaired liver and kidney function during the treatment, which showed that Lu Shi Runzao soup and acupuncture therapy were safe and reliable. Conclusion: This study shows the significant clinical effect of Lu's moistening dryness soup in the treatment of primary Sjogren syndrome. The effect of acupuncture combined with acupuncture on clinical efficacy. The treatment can effectively relieve the symptoms of the eyes of the subjects, improve the secretory function of the lacrimal gland, and reduce the index of the degree of activity of the subjects. There is no adverse effect on the safety index of the subjects during the treatment. This therapy has great clinical value.

【學(xué)位授予單位】：北京中醫(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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