【摘要】：目的：總結(jié)導(dǎo)師臨床治療痹證的學(xué)術(shù)思想和經(jīng)驗(yàn)：探討清熱解毒、除濕通絡(luò)法治療活動(dòng)期類風(fēng)濕性關(guān)節(jié)炎的療效及安全性,并分析其辨治本病用藥規(guī)律。方法：1、理論研究：跟隨導(dǎo)師臨床診療、記錄筆記、收集整理導(dǎo)師相關(guān)臨證醫(yī)案、查閱檢索導(dǎo)師相關(guān)論文、著作及與導(dǎo)師探討等方式,梳理、總結(jié)導(dǎo)師治療痹證的經(jīng)驗(yàn),探討其治療痹證的學(xué)術(shù)思想。2、臨床研究：按照隨機(jī)、對(duì)照的臨床試驗(yàn)原則,入選60例符合西醫(yī)類風(fēng)濕性關(guān)節(jié)炎活動(dòng)期診斷標(biāo)準(zhǔn)及中醫(yī)辨證符合濕熱痹阻證候的病人。將病人分為治療組和對(duì)照組各30例,治療組每日以清熱治旭湯劑內(nèi)服治療,對(duì)照組以甲氨蝶呤片1Omg/周+雙氯芬酸鈉片75mg/日進(jìn)行治療,兩組療程均為4周。結(jié)果：理論研究：從理論上闡述導(dǎo)師治療痹證的學(xué)術(shù)思想及經(jīng)驗(yàn)。導(dǎo)師提對(duì)本病的治療當(dāng)從肝、脾、腎三臟辨治。影響痹證發(fā)生、發(fā)展、轉(zhuǎn)歸、預(yù)后最重要的在于此三臟。脾腎虧虛,正氣不足,肝失疏泄,情志過(guò)激極易致病。其臨床表現(xiàn)以正虛為本,感邪為標(biāo),邪毒內(nèi)伏,是導(dǎo)致本病反復(fù)發(fā)作、經(jīng)久不愈的根本原因,日久必當(dāng)氣血虧虛、痰瘀阻絡(luò),最終廢痿不用、致畸致殘。本病的治療分為急性期和緩解期進(jìn)行,急則治標(biāo),緩則治本。導(dǎo)師臨證時(shí)常靈活使用有毒藥物,以毒攻毒,從六經(jīng)辨治痹證,把握痹證發(fā)生、發(fā)展過(guò)程中的病機(jī)關(guān)鍵。對(duì)痹證的臨床用藥方面,擅用有毒藥物,祛除濕毒濁瘀,有效控制和緩解類風(fēng)濕性關(guān)節(jié)炎活動(dòng)期的疼痛癥狀,搭配藥對(duì)提高療效。臨床研究：經(jīng)對(duì)參與試驗(yàn)的60例患者臨床研究結(jié)果進(jìn)行統(tǒng)計(jì)學(xué)分析后顯示：1、兩組患者總療效比較,治療組總有效率為76.7%,對(duì)照組總有效率為83.3%,統(tǒng)計(jì)學(xué)分析,兩組患者疾病總療效無(wú)顯著性差異(P0.05)。2、中醫(yī)證候療效比較,治療組總有效率為86.7%,對(duì)照組總有效率為80.0%；統(tǒng)計(jì)學(xué)分析,兩組中醫(yī)證候療效比較,無(wú)顯著性差異(P0.05)。3、治療后兩組患者主要臨床癥狀比較,其關(guān)節(jié)疼痛個(gè)數(shù)、腫脹個(gè)數(shù)明顯減少,與治療前相比有非常顯著性差異(P0.01),治療后兩組平均握力均較治療前明顯增強(qiáng),有顯著性差異(P0.05)。兩組治療后主要臨床癥狀改善情況比較無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。4、治療組治療后中醫(yī)各項(xiàng)癥狀積分均減少,與治療前比較有統(tǒng)計(jì)學(xué)差異,其中在關(guān)節(jié)疼痛、關(guān)節(jié)壓痛方面有非常顯著性差異(P0.01)；在關(guān)節(jié)壓痛、屈伸不利、晨僵方面呈顯著性差異(P0.05)；對(duì)照組治療后中醫(yī)各項(xiàng)癥狀積分也均減少,均呈顯著性差異(P0.05)。5、實(shí)驗(yàn)室檢測(cè)指標(biāo)：兩組治療后RF有所下降,但均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)：兩組治療后ESR、CRP值均有下降,有非常顯著性差異(P0.01)；兩組治療后各實(shí)驗(yàn)室指標(biāo)變化均無(wú)統(tǒng)計(jì)學(xué)差異P0.05。結(jié)論：導(dǎo)師經(jīng)驗(yàn)方清熱治旭湯治療活動(dòng)期類風(fēng)濕性關(guān)節(jié)炎濕熱痹阻證總體治療效果及中醫(yī)證候療效確切。在改善關(guān)節(jié)疼痛、腫脹方面優(yōu)于甲氨蝶呤片聯(lián)合雙氯芬酸鈉緩釋片組。其安全性良好。
[Abstract]:Objective: to summarize the academic thoughts and experiences of tutor in the treatment of arthralgia syndrome: to explore the efficacy and safety of clearing heat and detoxifying toxin and removing dampness and dredging collaterals in the treatment of active rheumatoid arthritis, and to analyze the law of treating rheumatoid arthritis by differentiation and treatment. Methods: 1, theoretical research: follow the tutor's clinical diagnosis and treatment, record notes, collect and sort out the tutor's related clinical medical records, consult and search the tutor's related papers, books and discuss with the tutor, and summarize the tutor's experience in the treatment of arthralgia syndrome, so as to sum up the experience of the tutor's treatment of arthralgia syndrome. To discuss the academic thought of treating arthralgia syndrome. 2. Clinical study: according to the principle of randomized, controlled clinical trial, 60 patients who met the diagnostic criteria of active stage of rheumatoid arthritis in western medicine and syndrome differentiation of traditional Chinese medicine accorded with the syndrome of damp-heat arthralgia obstruction were selected. Patients were divided into treatment group (n = 30) and control group (n = 30). The treatment group was treated with Qingre Zhixu decoction daily, while the control group was treated with methotrexate tablet 1Omg/ weekly diclofenac sodium 75mg/ day. The course of treatment in both groups was 4 weeks. Results: theoretical study: the academic thought and experience of tutor treating arthralgia syndrome were expounded theoretically. The tutor raised the treatment of this disease from liver, spleen, kidney three viscera differentiation treatment. Arthralgia syndrome occurrence, development, outcome, prognosis is the most important three viscera. Deficiency of spleen and kidney, deficiency of qi, loss of liver, extreme emotion easily cause disease. Its clinical manifestations are based on positive deficiency, pathogenic as standard, pathogenic toxin is the underlying cause of repeated attacks of the disease, long unhealed, the long must be deficiency of qi and blood, phlegm stasis obstruction collaterals, the final waste of impotence need not, deformity. The treatment of this disease is divided into acute stage and remission stage, emergency treatment, slow cure. Mentor often flexibly use toxic drugs to attack poison, from the six meridians to treat arthralgia syndrome, grasp the arthralgia syndrome occurrence, development process of pathogenesis key. In the aspect of clinical medication of arthralgia syndrome, it is good to use toxic drugs, remove dampness and toxin turbid stasis, effectively control and relieve the pain symptoms of rheumatoid arthritis in active period, and improve the curative effect with medicine. Clinical study: after statistical analysis of the clinical study results of 60 patients who participated in the trial, we found that the total effective rate of the two groups was 76.77.The total effective rate of the control group was 83.3%, statistical analysis showed that the total effective rate of the two groups was 76.775, the total effective rate of the control group was 83.3%. There was no significant difference in the total curative effect between the two groups (P0.05). 2. The total effective rate of the treatment group was 86.7, and the total effective rate of the control group was 80.0. There was no significant difference (P0.05) .3After treatment, the number of joint pain and the number of swelling were significantly decreased in the two groups after treatment (P0.01). After treatment, the average grip strength of the two groups was significantly stronger than that before treatment. There was significant difference (P0.05). There was no significant difference in the improvement of major clinical symptoms between the two groups after treatment (P0.05). There was significant difference in joint tenderness (P0.01); in joint tenderness, flexion and extension unfavorable, morning stiffness showed significant difference (P0.05); the control group after treatment of TCM symptoms were also reduced, The results showed significant difference (P0.05). The laboratory test index: the RF of the two groups decreased after treatment, but there was no statistical difference (P0.05): after treatment, the CRP value of ESRN in the two groups were all decreased, there was a very significant difference (P0.01); There was no statistical difference between the two groups in the changes of laboratory indexes after treatment (P 0.05). Conclusion: the total therapeutic effect and TCM syndromes of active rheumatoid arthritis with Qingre Zhixu decoction are definite. It was superior to methotrexate combined with diclofenac sodium sustained-release tablets in improving joint pain and swelling. Its safety is good.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R259;R249

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10 李萍;類風(fēng)濕性關(guān)節(jié)炎腕關(guān)節(jié)病變的超聲顯像與MRI對(duì)照及血清VEGF表達(dá)的相關(guān)性研究[D];山東大學(xué);2011年

相關(guān)碩士學(xué)位論文 前10條

1 周宇子;類風(fēng)濕性關(guān)節(jié)炎合并冠心病患者的相關(guān)研究[D];北京協(xié)和醫(yī)學(xué)院;2015年

2 劉悅;商憲敏教授治療類風(fēng)濕性關(guān)節(jié)炎的經(jīng)驗(yàn)總結(jié)[D];北京中醫(yī)藥大學(xué);2016年

3 孫t爐，

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