本文選題：黃芪寄生湯 + 膝骨關(guān)節(jié)炎��； 參考：《云南中醫(yī)學院》2017年碩士論文

【摘要】：目的:探討黃芪寄生湯治療骨關(guān)節(jié)炎(OA)的理論依據(jù)及可行性,評價黃芪寄生湯治療膝骨關(guān)節(jié)炎(KOA)的臨床療效及安全性,為進一步篩選黃芪寄生湯方藥及研發(fā)OA中藥新藥提供理論依據(jù)。方法:1.理論分析:查閱相關(guān)文獻,分析黃芪寄生湯治療骨關(guān)節(jié)炎(OA)的理論依據(jù)及其方藥配伍關(guān)系;2.臨床研究:采用隨機、開放、平行對照臨床研究,將72例KOA(肝腎、氣血虧虛型)患者,隨機分為治療組36例和對照組36例,分別采用黃芪寄生湯和金烏骨通膠囊治療,8周后,觀察兩藥對兩組KOA患者的關(guān)節(jié)疼痛、腫脹、關(guān)節(jié)活動、晨僵、關(guān)節(jié)功能、中醫(yī)證候積分、Michel Lequesen指數(shù)、WOMAC評分、ESR、CRP及肝腎功能等指標的影響。結(jié)果:1.黃芪寄生湯治療骨關(guān)節(jié)炎從病因病機出發(fā),辨病與辨證相結(jié)合,其方藥君臣佐使配伍合理。2.治療前后,兩組疾病療效、證候療效比較,差異有統(tǒng)計學意義(P0.05),其中治療組證候療效、疾病療效總有效率均為93.94%,對照組證候療效、疾病療效總有效率均為70.59%。治療前后,兩組均能明顯改善患者中醫(yī)證候總積分、關(guān)節(jié)疼痛、腫脹、關(guān)節(jié)活動、晨僵時間、關(guān)節(jié)功能、Michel Lequesen指數(shù)、WOMAC指數(shù)(P0.01);其中關(guān)節(jié)疼痛、關(guān)節(jié)腫脹、關(guān)節(jié)活動不利、Michel Lequesen指數(shù)、WOMAC指數(shù)兩組間對比,差異有統(tǒng)計學意義(P0.05),晨僵時間兩組對比無統(tǒng)計學差異(P0.05)。治療4周后,兩組患者中醫(yī)證候總積分、關(guān)節(jié)疼痛、關(guān)節(jié)腫脹、關(guān)節(jié)活動不利、WOMAC指數(shù)、Michel Lequesen指數(shù)均得到明顯改善(P0.01),晨僵時間也均有改善(P0.05);其中中醫(yī)證候總積分、關(guān)節(jié)疼痛、關(guān)節(jié)活動不利、WOMAC指數(shù)兩組間對比,差異有統(tǒng)計學意義(P0.05);治療組Michel Lequesen指數(shù)明顯優(yōu)于對照組(P0.01);關(guān)節(jié)腫脹、晨僵時間兩組對比,無統(tǒng)計學差異(P0.05);研究過程中,治療組醋氯芬酸片服用劑量及服用人數(shù)均少于對照組,其使用人數(shù)比較,差異有統(tǒng)計學意義(P0.05)。治療前后,兩組關(guān)節(jié)功能分級在治療后較治療前均有明顯改善,差異有統(tǒng)計學意義(P0.05),治療后兩組無明顯差異(P0.05)。治療前后,兩組ESR、CRP指標均無統(tǒng)計意義(P0.05)。研究過程中,治療組和對照組均未出現(xiàn)明顯毒副作用和不良反應(yīng)。研究過程中,兩組患者的血常規(guī)、肝功、腎功、心電圖、大便常規(guī)、尿常規(guī)均未發(fā)現(xiàn)不良影響。結(jié)論:1.黃芪寄生湯是治療骨關(guān)節(jié)炎的有效方劑。2.黃芪寄生湯能改善KOA(肝腎、氣血虧虛型)患者關(guān)節(jié)疼痛、腫脹、關(guān)節(jié)活動、晨僵時間、關(guān)節(jié)功能、Michel Lequesen指數(shù)、WOMAC指數(shù)等,是臨床治療OA安全有效的方法,值得進一步推廣應(yīng)用和深入研究。
[Abstract]:Objective: to explore the theoretical basis and feasibility of Huangqizhongtang in treating osteoarthritis and osteoarthritis (OAA), and to evaluate the clinical efficacy and safety of Huangqizhongtang in the treatment of knee osteoarthritis. To provide theoretical basis for further screening of astragalus parasitic decoction and the development of new OA Chinese medicine. Method 1: 1. Theoretical analysis: to review the relevant literature and analyze the theoretical basis and prescription compatibility of Huangqi parasitic decoction for treatment of osteoarthritis and OAA. Clinical study: 72 patients with KOA-deficiency type were randomly divided into treatment group (n = 36) and control group (n = 36). To observe the effects of the two drugs on pain, swelling, joint movement, morning stiffness, joint function, TCM syndromes score of Michel Lequesen and Lequesen score and liver and kidney function in patients with KOA. The result is 1: 1. Huangqi parasitic decoction in the treatment of osteoarthritis from the etiology and pathogenesis, disease differentiation and syndrome differentiation, its prescription Junchen adjuvant compatibility is reasonable. 2. Before and after treatment, the difference between the two groups was statistically significant (P 0.05). In the treatment group, the syndromes curative effect and the total effective rate of the disease were all 93.94g, while the control group was 70.59g in the syndromes and syndromes. Before and after treatment, the total score of TCM syndromes, joint pain, swelling, joint activity, time of morning stiffness, Lequesen index of articular function and WOMAC index were significantly improved in both groups. The difference between the two groups was statistically significant (P 0.05), but there was no significant difference in morning stiffness time between the two groups (P 0.05). After 4 weeks of treatment, the total score of TCM syndromes, joint pain, joint swelling, joint unfavorable movement and Lequesen index of WOMAC index were all significantly improved in both groups, and the morning stiffness time was also improved in both groups, and the total score of TCM syndromes and joint pain were also improved. The Michel Lequesen index of the treatment group was significantly better than that of the control group (P 0.01); the joint swelling and morning stiffness time were not significantly different between the two groups (P 0.05); in the course of the study, there was no significant difference between the two groups. The dosage and number of acaclofenac tablets in the treatment group were lower than those in the control group, and the difference was statistically significant (P 0.05). Before and after treatment, the grade of joint function in the two groups was significantly improved after treatment compared with before treatment, the difference was statistically significant (P 0.05), and there was no significant difference between the two groups after treatment. Before and after treatment, there was no statistical significance of ESR-CRP in both groups. In the course of the study, there were no obvious side effects and adverse reactions in the treatment group and the control group. During the study, no adverse effects were found in blood test, liver function, renal function, electrocardiogram, stool routine and urine routine. Conclusion 1. Astragalus parasitic decoction is an effective prescription for osteoarthritis. Astragalus parasitic decoction can improve pain, swelling, joint activity, morning stiffness time, Lequesen index of articular function and so on in patients with KOAA (liver and kidney, deficiency of qi and blood). It is a safe and effective method for clinical treatment of OA. It is worth further popularizing and studying.
【學位授予單位】：云南中醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R274.9

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