桂枝芍藥知母湯對(duì)陽(yáng)虛型干燥綜合征治療作用的臨床研究
發(fā)布時(shí)間：2019-05-15 13:45
【摘要】：干燥綜合征(Sj?gren’s syndrome;SS)是一種主要累及外分泌腺的慢性炎癥性自身免疫病,為第二常見(jiàn)的自身免疫性風(fēng)濕病,可累及多系統(tǒng)、多臟器,嚴(yán)重影響患者的生活質(zhì)量。本研究在臨床經(jīng)驗(yàn)的基礎(chǔ)上,以前瞻性對(duì)照研究的方法觀察桂枝芍藥知母湯治療陽(yáng)虛型SS的效果,為臨床提供有效的方法及理論依據(jù)。目的:通過(guò)與羥氯喹的對(duì)比研究,客觀評(píng)價(jià)桂枝芍藥知母湯治療陽(yáng)虛型SS的療效,驗(yàn)證陽(yáng)不化氣理論的正確性,探討溫陽(yáng)化氣法為主治療陽(yáng)虛型SS可能的機(jī)理。方法:采用隨機(jī)對(duì)照的方法,將符合標(biāo)準(zhǔn)的70例患者分為治療組和對(duì)照組,每組各35例,均給予硫酸羥氯喹片口服,治療組加桂枝芍藥知母湯辨證加減治療,按療程服用,觀察兩組患者中醫(yī)證候積分表癥狀評(píng)分,陽(yáng)虛證量化積分、疾病活動(dòng)度積分、實(shí)驗(yàn)室檢測(cè)指標(biāo)改善情況及安全性指標(biāo)。結(jié)果:(1)病例脫落3例,最終入組病例67例,治療組35例,對(duì)照組32例。(2)在總有效率方面,治療組臨床痊愈0例、顯效14例、有效17例、無(wú)效4例,總有效率88.57%,對(duì)照組臨床痊愈0例、顯效6例、有效13例、無(wú)效13例,總有效率59.37%,比較存在顯著統(tǒng)計(jì)學(xué)意義(P0.05)。(3)在中醫(yī)癥狀改善方面,兩組治療后均可降低中醫(yī)癥狀總積分及除腮部腫大外其余各個(gè)單項(xiàng)的中醫(yī)癥狀積分,且治療組優(yōu)于對(duì)照組(P0.05),其中在降低口干、眼干積分方面治療組明顯優(yōu)于對(duì)照組,具有顯著統(tǒng)計(jì)學(xué)意義(P0.01);在改善陽(yáng)虛證方面治療組能降低總評(píng)分(P0.01),對(duì)照組則無(wú)此作用(P0.05),兩組間治療后比較差異具有顯著統(tǒng)計(jì)學(xué)意義(P0.01)。(4)在改善ESSDAI方面,兩組治療前后比較差異存在顯著統(tǒng)計(jì)學(xué)意義(P0.01);治療后組間比較存在顯著統(tǒng)計(jì)學(xué)意義(P0.01)。(5)在物理及實(shí)驗(yàn)室檢查方面,兩組治療后均能降低ESR、CRP、IgG、IgM、IgA,并增加淚液、唾液分泌量,且治療組優(yōu)于對(duì)照組,以上均具有顯著統(tǒng)計(jì)學(xué)意義(P0.05)。(6)在各項(xiàng)安全指標(biāo)方面,與治療前相比,兩組治療后均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:桂枝芍藥知母湯可提高單純西藥治療SS的療效,增強(qiáng)羥氯喹調(diào)節(jié)機(jī)體免疫和抑制炎癥反應(yīng)的功能,改善陽(yáng)虛型SS的臨床癥狀和中醫(yī)證候;驗(yàn)證陽(yáng)氣不足,氣化失職是SS發(fā)生的重要機(jī)理,溫陽(yáng)化氣可做為本病治療的基本法則。
[Abstract]:Sjogren's syndrome (Sj?gren's syndrome;SS) is a chronic inflammatory autoimmune disease which mainly involves exocrine gland. Sjogren's syndrome (Sjogren's syndrome) is the second common autoimmune rheumatism, which can involve multiple systems and organs, and seriously affect the quality of life of patients. On the basis of clinical experience, this study observed the effect of Guizhi Shaoyao Zhimu decoction on Yang deficiency type SS by prospective controlled study, and provided effective method and theoretical basis for clinic. Objective: to objectively evaluate the efficacy of Guizhi Shaoyao Zhimu decoction in the treatment of yang deficiency type SS by comparing with hydroxychloroquine, to verify the correctness of Yang deficiency qi theory, and to explore the possible mechanism of warming yang and removing gas method in the treatment of yang deficiency type SS. Methods: 70 patients who met the standard were randomly divided into treatment group (n = 35) and control group (n = 35). All patients in each group were given hydroxychloroquine sulfate tablets by oral administration. The treatment group was treated with Guizhi Shaoyao Zhimu decoction according to the course of treatment. The symptom score of TCM syndrome table, the quantitative score of Yang deficiency syndrome, the score of disease activity, the improvement of laboratory test index and the safety index of the two groups were observed. Results: (1) there were 3 cases falling off, 67 cases in the final group, 35 cases in the treatment group and 32 cases in the control group. (2) in the total effective rate, 0 cases were cured, 14 cases were markedly effective, 17 cases were effective and 4 cases were ineffective. The total effective rate was 88.57%. In the control group, 0 cases were cured, 6 cases were markedly effective, 13 cases were effective and 13 cases were ineffective, the total effective rate was 59.37%. There was significant statistical significance (P 0.05). (3) in the improvement of TCM symptoms. After treatment, the total score of TCM symptoms and the score of other individual TCM symptoms in the treatment group were lower than those in the control group (P 0.05), and the treatment group was superior to the control group in reducing the score of dry mouth and eye stem, and the treatment group was obviously superior to the control group in reducing the score of dry mouth and eye. There was significant statistical significance (P01). In the improvement of yang deficiency syndrome, the treatment group could reduce the total score (P 0.01), while the control group had no such effect (P 0.05). There was significant difference between the two groups after treatment (P 0.01). (4) in improving ESSDAI. There was significant difference between the two groups before and after treatment (P 0.01). After treatment, there was significant difference between the two groups (P01). (5) in physical and laboratory examination. After treatment, both groups could decrease ESR,CRP,IgG,IgM,IgA, and increase the secretion of tears and saliva. The treatment group was superior to the control group, the above were statistically significant (P 0.05). (6) in terms of safety indicators, compared with before treatment, there was no significant difference between the two groups after treatment (P 0.05). Conclusion: Guizhi Shaoyao Zhimu decoction can improve the curative effect of western medicine alone in the treatment of SS, enhance the function of hydroxychloroquine in regulating immunity and inhibiting inflammatory reaction, and improve the clinical symptoms and TCM syndromes of yang deficiency type SS. It is proved that insufficient yang qi and gasification dereliction of duty are the important mechanism of SS. Wenyang Huaiqi can be used as the basic law of the treatment of this disease.
【學(xué)位授予單位】：河北大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R259
，
本文編號(hào)：2477547
[Abstract]:Sjogren's syndrome (Sj?gren's syndrome;SS) is a chronic inflammatory autoimmune disease which mainly involves exocrine gland. Sjogren's syndrome (Sjogren's syndrome) is the second common autoimmune rheumatism, which can involve multiple systems and organs, and seriously affect the quality of life of patients. On the basis of clinical experience, this study observed the effect of Guizhi Shaoyao Zhimu decoction on Yang deficiency type SS by prospective controlled study, and provided effective method and theoretical basis for clinic. Objective: to objectively evaluate the efficacy of Guizhi Shaoyao Zhimu decoction in the treatment of yang deficiency type SS by comparing with hydroxychloroquine, to verify the correctness of Yang deficiency qi theory, and to explore the possible mechanism of warming yang and removing gas method in the treatment of yang deficiency type SS. Methods: 70 patients who met the standard were randomly divided into treatment group (n = 35) and control group (n = 35). All patients in each group were given hydroxychloroquine sulfate tablets by oral administration. The treatment group was treated with Guizhi Shaoyao Zhimu decoction according to the course of treatment. The symptom score of TCM syndrome table, the quantitative score of Yang deficiency syndrome, the score of disease activity, the improvement of laboratory test index and the safety index of the two groups were observed. Results: (1) there were 3 cases falling off, 67 cases in the final group, 35 cases in the treatment group and 32 cases in the control group. (2) in the total effective rate, 0 cases were cured, 14 cases were markedly effective, 17 cases were effective and 4 cases were ineffective. The total effective rate was 88.57%. In the control group, 0 cases were cured, 6 cases were markedly effective, 13 cases were effective and 13 cases were ineffective, the total effective rate was 59.37%. There was significant statistical significance (P 0.05). (3) in the improvement of TCM symptoms. After treatment, the total score of TCM symptoms and the score of other individual TCM symptoms in the treatment group were lower than those in the control group (P 0.05), and the treatment group was superior to the control group in reducing the score of dry mouth and eye stem, and the treatment group was obviously superior to the control group in reducing the score of dry mouth and eye. There was significant statistical significance (P01). In the improvement of yang deficiency syndrome, the treatment group could reduce the total score (P 0.01), while the control group had no such effect (P 0.05). There was significant difference between the two groups after treatment (P 0.01). (4) in improving ESSDAI. There was significant difference between the two groups before and after treatment (P 0.01). After treatment, there was significant difference between the two groups (P01). (5) in physical and laboratory examination. After treatment, both groups could decrease ESR,CRP,IgG,IgM,IgA, and increase the secretion of tears and saliva. The treatment group was superior to the control group, the above were statistically significant (P 0.05). (6) in terms of safety indicators, compared with before treatment, there was no significant difference between the two groups after treatment (P 0.05). Conclusion: Guizhi Shaoyao Zhimu decoction can improve the curative effect of western medicine alone in the treatment of SS, enhance the function of hydroxychloroquine in regulating immunity and inhibiting inflammatory reaction, and improve the clinical symptoms and TCM syndromes of yang deficiency type SS. It is proved that insufficient yang qi and gasification dereliction of duty are the important mechanism of SS. Wenyang Huaiqi can be used as the basic law of the treatment of this disease.
【學(xué)位授予單位】：河北大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R259
，
本文編號(hào)：2477547
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