發(fā)布時(shí)間：2018-06-04 00:48

  本文選題：路志正 + 針刺療法�。� 參考：《安徽中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：自身免疫性疾病原發(fā)性干燥綜合征(PSS,Primary Sjogren’s syndrome)臨床上侵犯唾液腺、淚腺,同時(shí)也伴隨其他外分泌腺體的損害�？诟伞⒀鄹墒瞧渑R床的主要典型表現(xiàn),此外腮腺的反復(fù)腫大、關(guān)節(jié)痛、齲齒、紫癜、多尿也是其臨床的特征性表現(xiàn)。若病情繼續(xù)進(jìn)展,可以造成患者的多器官、多系統(tǒng)的損害,如肺間質(zhì)性纖維化、萎縮性胃炎、慢性胰腺損害、腎功能不全等并發(fā)癥。當(dāng)前現(xiàn)代醫(yī)學(xué)對(duì)于PSS的研究正處在開(kāi)始階段,其病因以及發(fā)病機(jī)制并不十分清楚,故而對(duì)于該病的治療臨床上缺乏有效性和針對(duì)性強(qiáng)的治療藥物和措施。臨床上常用的藥物多是作用于全身的糖皮質(zhì)激素、免疫抑制劑等藥物,對(duì)于局部癥狀如口干、眼干有一定的緩解作用,但是長(zhǎng)期療效不佳,而且長(zhǎng)期作用于全身的副作用大,治療效果也并不理想。因此運(yùn)用中醫(yī)中藥聯(lián)合針刺治療此病,其臨床有顯著的優(yōu)勢(shì),癥狀緩解顯著、安全、副作用小等。從事臨床科研70余載的國(guó)醫(yī)大師路志正教授,是中醫(yī)現(xiàn)代風(fēng)濕病學(xué)科開(kāi)創(chuàng)者,首創(chuàng)“燥痹”病名。原發(fā)性干燥綜合征也被路老納入“燥痹”中,路志正教授結(jié)合自己對(duì)于干燥綜合征幾十年的從醫(yī)用藥經(jīng)驗(yàn),創(chuàng)造了“益氣養(yǎng)陰”的基本大法,并且創(chuàng)造“路氏潤(rùn)燥湯”來(lái)治療此病。1目的評(píng)價(jià)路氏潤(rùn)燥湯聯(lián)合針刺療法治療氣陰兩虛型的原發(fā)性干燥綜合征口干癥狀的臨床增效療效及其臨床價(jià)值。2方法本次臨床試驗(yàn)研究是基于“首都臨床特色應(yīng)用研究”項(xiàng)目課題:“路氏潤(rùn)燥湯聯(lián)合針刺療法治療原發(fā)性干燥綜合征增效研究”,共收入62例(由于本次課題未完全結(jié)束,所以62例是按順序截取已經(jīng)完成數(shù)據(jù)統(tǒng)計(jì)的受試者)符合燥痹氣陰兩虛型的原發(fā)性干燥綜合征患者,采用隨機(jī)、對(duì)照、單盲(評(píng)價(jià)者盲)的研究方法,進(jìn)行臨床服用中藥聯(lián)合針刺療法組(每周針刺兩次以下穴位:三陰交、足三里、公孫、照海、中脘、合谷、內(nèi)關(guān)、外關(guān)、廉泉等穴位)和服用中藥的分組,即治療組和對(duì)照組。治療觀察是四個(gè)月,在每個(gè)時(shí)間點(diǎn)進(jìn)行評(píng)價(jià)隨訪,設(shè)置評(píng)價(jià)時(shí)間點(diǎn),即分別均于治療前以及試驗(yàn)開(kāi)始后1、2、3、4、6、8、10、12、14、16周,進(jìn)行中醫(yī)口干癥狀、口干VAS(目視模擬尺)評(píng)分,中醫(yī)證候評(píng)分,關(guān)節(jié)疼痛和夜尿多等癥狀進(jìn)行觀察對(duì)比,并且進(jìn)行臨床實(shí)驗(yàn)室檢查,即分別在治療0、3月,同時(shí)檢查包括口腔的非刺激唾液流率試驗(yàn)、血尿常規(guī)、肝腎功能、類風(fēng)濕因子RF、血沉、免疫球蛋白電泳、ANA抗體譜,從各個(gè)節(jié)點(diǎn)所得到的隨訪治療數(shù)據(jù)及治療前后的實(shí)驗(yàn)室檢查數(shù)據(jù)進(jìn)行統(tǒng)計(jì)、分析,以此來(lái)評(píng)價(jià)路氏潤(rùn)燥湯聯(lián)合針刺療法治療氣陰兩虛型的PSS口干癥狀的臨床增效療效及其安全性。3結(jié)果:針刺對(duì)于干燥綜合征口干癥狀的增效改善上沒(méi)有顯著的統(tǒng)計(jì)學(xué)差異,但是有改善的趨勢(shì),兩組總有效率達(dá)84.1%。治療組口干癥狀VAS評(píng)分較對(duì)照組均有統(tǒng)計(jì)學(xué)顯著性差異(P0.01),安全性指標(biāo)較療前均無(wú)統(tǒng)計(jì)學(xué)顯著性差異(P0.05)4結(jié)論:針刺針刺對(duì)于治療原發(fā)性干燥綜合征受試者口干癥和降低血清免疫學(xué)指標(biāo)增效治療,在統(tǒng)計(jì)學(xué)上雖不具有顯著差異,但是對(duì)于對(duì)于干燥綜合征的治療有改善的趨勢(shì)和態(tài)勢(shì)。下一步研究打算延長(zhǎng)療程、增加刺治療頻率,擴(kuò)大樣本量。
[Abstract]:The autoimmune disease PSS (Primary Sjogren 's syndrome) clinically infringes the salivary glands and lacrimal glands, and also is accompanied by other exocrine glands. Dry mouth and dry eye are the main typical manifestations of its clinical manifestations. The recurrent swelling of the parotid gland, joint pain, caries, purpura and polyuria are also the characteristic manifestations of the clinical. The continuous progress of the disease can cause multiple organs and multiple system damage, such as interstitial fibrosis of the lung, atrophic gastritis, chronic pancreatic damage, and renal dysfunction. The current research on PSS is in the beginning stage, its etiology and pathogenesis are not very clear, so the treatment of the disease is clinical Lack of effective and pertinent therapeutic drugs and measures. Most commonly used drugs are systemic glucocorticoids, immunosuppressants, such as immunosuppressive drugs, for local symptoms such as dry mouth, eye dry, but the long-term effect is not good, and long term side effects are large, the treatment effect is not ideal. Therefore, the use of traditional Chinese medicine and acupuncture in the treatment of this disease has remarkable advantages, significant relief, safety and minor side effects. Professor Lu Zhizheng, a master of Chinese medicine who has been engaged in clinical scientific research for more than 70 years, is the pioneer of modern rheumatism in traditional Chinese medicine, the first "dryness arthralgia", and the primary dry syndrome is also included in the "dryness Bi" by Lu Lao. Professor Lu Zhizheng created the basic law of "Nourishing Qi and nourishing Yin" with his experience in medical medicine for several decades, and created "Lu Shi run dryness soup" to treat the.1 in order to evaluate the effect of Lu Shi's moistening dryness soup combined with acupuncture on the symptoms of dry mouth dry syndrome. And its clinical value.2 method this clinical trial is based on the project of "clinical characteristic application research of capital" project: "Lu Shi run dryness soup combined acupuncture treatment for primary Sjogren syndrome synergy", a total of 62 cases (because the subject is not completely finished, so 62 cases are sequentially intercepted data statistics have been completed. " A randomized, controlled, single blind (evaluator blindness) study of patients with dryness Qi and yin deficiency type of primary Sjogren syndrome was used to carry out clinical use of traditional Chinese medicine combined acupuncture therapy group (acupuncture points below two times a week: Three Yin, Zusanli, Kung sun, sham Hai, Zhong Wan, Hegu, Neiguan, Wai Guan, Lian Quan and other acupoints) and Chinese Medicine The treatment group and the control group were divided into groups. The treatment observation was four months. At each time point, the evaluation was followed up and the time points were set. The symptoms of dry mouth, dry mouth VAS (visual analogue ruler) score, TCM syndrome score, joint pain and night urination, etc. were carried out before the treatment and 1,2,3,4,6,8,10,12,14,16 weeks after the start of the experiment. Clinical laboratory tests were performed, and the non irritating saliva flow rate test including oral cavity, hematuria routine, liver and kidney function, rheumatoid factor RF, erythrocyte sedimentation, immunoglobulin electrophoresis, ANA antibody spectrum, follow-up treatment data from each node and laboratory examination before and after treatment were examined at 0,3 month, respectively. Statistics, analysis, in order to evaluate the effect of Lu Shi Runzao Decoction Combined Acupuncture Therapy on the symptoms of Qi and yin deficiency of PSS on the clinical effect and safety of.3 results: there is no significant difference in the effect of acupuncture on dry syndrome, but there is a trend of improvement, the total effective rate of the two groups is up to 84.1%. The VAS score of dry mouth symptoms in the treatment group was significantly different than that in the control group (P0.01), and there was no significant difference in safety index (P0.05) 4 Conclusion: acupuncture was not statistically significant in the treatment of dry mouth syndrome of primary Sjogren syndrome and reducing serum immunological index. However, for the treatment of Sjogren's syndrome, the trend and trend of improvement will be improved. The next step is to extend the course of treatment, increase the frequency of acupuncture treatment and enlarge the sample size.
【學(xué)位授予單位】：安徽中醫(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)】：R259

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