本文選題：急性痛風性關(guān)節(jié)炎 + 濕熱痹阻型　； 參考：《廣州中醫(yī)藥大學》2017年碩士論文

【摘要】：研究背景:痛風是代謝病中常見的一類疾病、癥狀總稱,不是一種單獨的疾病,隨著病程的進展,可隨之表現(xiàn)出高尿酸血癥、關(guān)節(jié)炎、痛風石及痛風腎等不同癥狀。隨著新時代人們飲食、生活水平的改變及提高,痛風已成為令全世界各國人民聞風喪膽的,除糖尿病外的第二號代謝性疾病。近十年來,不僅痛風患者人數(shù)呈攀升趨勢,其中青年患者比例也占據(jù)不小比例�，F(xiàn)代醫(yī)學對于痛風為什么發(fā)病、如何發(fā)病等都不清晰,治療上對痛風的根治暫也束手無策。西醫(yī)用藥上雖有多種能有效緩解痛風性關(guān)節(jié)炎急性發(fā)作癥狀的藥物,但其副作用大,患者不適感明顯,難以接受。相反,中藥方劑在患者耐受性及調(diào)節(jié)人體整體氣血方面有其優(yōu)勢,秉持中醫(yī)"整體觀"和"辨證論治""思想,各醫(yī)家有其治療上的一套經(jīng)驗治法方藥,療效顯著。本課題試驗組研究藥物為導師自擬方三四祛痹方,進行隨機對照試驗,進而探討三四祛痹方對于濕熱痹阻型急性痛風性關(guān)節(jié)炎的臨床效果,并與西醫(yī)用藥相對比,觀察其優(yōu)勢與不足,為臨床痛風的治療提供更多的思路與方向。研究目的:本臨床研究遵循DME的原則和方法,進行臨床隨機對照試驗,在日常生活基本治療的基礎(chǔ)上,對照組給以口服尼美舒利分散片,試驗組單純給予口服三四祛痹方,治療后通過對比患者的疼痛、腫脹緩解時間,治療1周后的疼痛程度、實驗室炎癥指標及中醫(yī)癥狀積分,評估三四祛痹方的臨床療效,并觀察三四祛痹方相對于尼美舒利分散片的優(yōu)劣勢,為中醫(yī)藥治療痛風提供更深入的醫(yī)療應用及根據(jù)。研究方法:通過臨床隨機對照的方式,選取本院導師門診中符合納入標準的患者,時間由2016年1月至2016年12月,患者發(fā)作時間需在48h以內(nèi),將其根據(jù)隨機數(shù)字表法以1:1的比例隨機分組,最終結(jié)果進入數(shù)據(jù)統(tǒng)計的患者共60人,對照組30人,試驗組30人。研究治療時間為1周,治療期間兩組均予日常生活基本治療,試驗組予三四祛痹方煎服,1劑/日,早晚飯后分服;對照組尼美舒利分散片口服,1片/1次,2次/1日。兩組患者于治療前、治療1周后予肝腎功能、C反應蛋白(CRP)、尿酸(UA)檢查,并實時詳確地記下患者癥狀、體征。記錄到的結(jié)果數(shù)據(jù)采用SPSS22.0進行分析。研究結(jié)果:1、兩組患者的年齡、性別、病程時間、治療前疼痛程度、CRP、UA及中醫(yī)癥狀積分等基線資料差異沒有統(tǒng)計學意義(P0.05)。2、兩組患者關(guān)節(jié)疼痛、腫脹緩解的時間,差異有統(tǒng)計學意義(P0.05),說明兩組治療的效果有可比性,對照組在緩解疼痛、腫脹上速度更快。3、兩組患者在疼痛分數(shù)(VAS評分)、CRP、UA、中醫(yī)癥狀積分方面,治療前后經(jīng)組內(nèi)對比,均有統(tǒng)計學意義(P0.05);治療后疼痛分數(shù)、UA組間比較無統(tǒng)計學意義(P0.05),CRP、中醫(yī)癥狀積分組間比較有統(tǒng)計學意義(P0.05)。兩組患者在疼痛、中醫(yī)癥狀積分、CRP、UA方面都有改善,對照組降低CRP更明顯,試驗組改善中醫(yī)癥狀體征更優(yōu)秀。4、對治療后兩組患者總有效率進行對照,經(jīng)卡方檢驗,無統(tǒng)計學意義(P0.05),兩組試驗對象臨床療效差不多。結(jié)論經(jīng)過嚴格的試驗及統(tǒng)計學分析,臨床辨證給予口服三四祛痹方治療急性痛風性關(guān)節(jié)炎,不僅可顯著緩解關(guān)節(jié)疼痛程度,而且能有效降低CRP、UA水平,改善患者中醫(yī)臨床癥狀體征,迅速減輕患者痛苦,恢復患者勞動、生活能力,試驗過程中無明顯不良反應,亦未見明顯肝腎功能損害指標,值得臨床應用推廣。
[Abstract]:Background: Gout is a common type of disease in metabolic diseases. Symptoms are generally called, not a single disease. With the progress of the course of disease, it can show hyperuricemia, arthritis, gout and gout kidney and other symptoms. With the change and improvement of people's diet and life water level in the new age, gout has become the people of the world. In the past ten years, not only the number of gout patients has been increasing, but the proportion of young patients has also occupied a small proportion in the past ten years. Modern medicine is not clear about why the gout is occurring, how to attack the disease and so on. The treatment of gout is also at a loss for the treatment of the gout. Although there are many kinds of medicine in western medicine, there are many kinds of drugs in the treatment of gout. It can effectively alleviate the symptoms of acute attack of gout arthritis, but its side effects are great, the patient's discomfort is obvious and it is difficult to accept. On the contrary, the prescription of traditional Chinese medicine has its advantages in the patient's tolerance and the regulation of the whole body and blood of the human body. The efficacy of the experiment group was studied in the study group. The drug was used as the three or four prescription of the tutor's self-made prescription. The randomized controlled trial was carried out to explore the clinical effect of the three or four expelling arthralgia syndrome on acute gouty arthritis of damp heat arthralgia type, and compared with the Western medicine, to observe its advantages and disadvantages, and to provide more ideas and directions for the treatment of clinical gout. Objective: This clinical study follows the principles and methods of DME and carries out clinical randomized controlled trials. On the basis of basic daily life treatment, the control group is given oral Nimesulide Dispersible Tablets, and the experimental group is given a simple oral administration of three or four expelling arthralgia. After treatment, the pain and swelling time of the patients are compared, and the pain degree after 1 weeks is treated. The index of laboratory inflammation and TCM symptom score were used to evaluate the clinical effect of three or four expelling Bi prescription, and to observe the advantages and disadvantages of three or four expelling Bi prescription relative to Nimesulide Dispersible Tablets, and provide more in-depth medical application and basis for the treatment of gout with traditional Chinese medicine. Standard patients, time from January 2016 to December 2016, patients need to be within 48h attack time, according to random numbers in the proportion of 1:1 in the proportion of random groups, the final results into the data of 60 patients, 30 in the control group, 30 in the experimental group. The treatment time for 1 weeks, during the treatment of two groups were given daily basic treatment, the basic treatment, during the treatment period, the basic treatment of daily life, two groups were given daily basic treatment, during the treatment period, The experimental group was given three or four decoction, 1 doses / day, after breakfast and dinner, and the control group was given Nimesulide Dispersible Tablets, 1 /1 times and 2 /1 days. Before the treatment, the liver and kidney function, the C reactive protein (CRP) and the uric acid (UA) were given for 1 weeks after treatment, and the symptoms and signs were recorded in real time. The recorded results were carried out by SPSS22.0. Analysis. Results: 1, two groups of patients of age, sex, course time, the degree of pain before treatment, CRP, UA and TCM symptom score of baseline data difference is not statistically significant (P0.05).2, two groups of patients with joint pain, swelling time, the difference is statistically significant (P0.05), indicating that the effect of the two groups is comparable, the control group is slow Pain, swelling speed.3 faster, two groups of patients in the pain score (VAS score), CRP, UA, traditional Chinese medicine symptom score, before and after the treatment, all were statistically significant (P0.05); after the treatment, there was no statistical significance (P0.05) between the UA group (P0.05), CRP, and the TCM symptom score group was statistically significant (P0.05). Two groups of patients were in the group (P0.05). Pain, TCM symptom score, CRP, UA were all improved, the control group reduced CRP more obvious, the experimental group improved the symptoms and signs of traditional Chinese medicine better.4, the total effective rate of the two groups of patients after treatment, after the chi square test, no statistical significance (P0.05), the two groups of subjects were similar in clinical efficacy. Conclusion after strict test and statistical credits conclusion The treatment of acute gouty arthritis by oral three or four prescription can not only significantly alleviate the degree of joint pain, but also effectively reduce the level of CRP, UA, improve the symptoms and signs of the clinical symptoms of the Chinese medicine, quickly reduce the pain of the patients, restore the patient's labor and life energy, and have no obvious adverse reactions in the test process, and no obvious liver is found. The index of renal function impairment is worthy of clinical application and promotion.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R259
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本文編號：1996898