【作者】 艾瑞可；

【导师】 王玲玲；

【作者基本信息】 南京中医药大学 ， 中医学， 2012， 博士

【摘要】 研究背景：类风湿关节炎是一种自身免疫性疾病,会导致关节炎症进而导致关节破坏。中医归类此疾病为“痹证”,而艾灸亦对此疾病表现出了临床治疗效果。本研究项目旨在对风湿关节患者的关节功能采用临床和基本实验指标数据进行不同灸法的治疗。研究方法：本研究中的102类风湿性关节炎患者,从2010年03月至2011年08在江苏省中医院,收到了治疗月随机抽样四组风湿性关节炎患者,对其关节功能的临床结果进行比较,其中三组患者在中西药物治疗(24患者)的基础上,分别施以麦粒灸加药物治疗(30患者)、温和灸加药物治疗(30患者)或温针灸法加药物治疗(18患者)。使用方差分析、t-检验和卡方检验的统计方法来确定结果的统计意义。研究结果：采用临床特征症状指标值和实验“6项免疫指标”,根据治疗计划表现出不同的治疗结果。在本研究中每个独立治疗组合的全部临床特征症状评价指标均达到或超过统计要求的显著差异标准(P<0.05)。麦粒灸加药物治疗对类风湿关节炎患者在改善“双手握力”与“晨僵”方面的结果表现出显著差异的统计结果。据实验治疗结果,本研究中麦粒灸加药物治疗与其他三个治疗方案相比,对血沉与C-反应蛋白(CRP)最有改善的结果和统计意义。温针灸加药物治疗在主观疼痛感知和类风湿性因子(RF)与其他二组治疗方案相比,显示出更有效的治疗结果。本研究表现温和灸合药物治疗方案,明显能改善类风湿性关节炎患者的日常生活能力(HAQ指数),同时具有调理免疫球蛋白(IgG)实验水平。研究结论：1、本研究中的每单个治疗组合对类风湿关节炎患者的各项指标都有良好的改善效果。2、在三组灸法治疗和药物治疗下,三组灸法治疗的“双手握力”、“晨僵”、“HAQ指数”结果均比单一药物治疗表现出显著地统计意义3、在本研究中,麦粒灸加药物的治疗在改善“握力”、“晨僵”方面更优于其他三个治疗组合的疗效。这组的治疗方案在改善本病患者的关节肿胀数,也出现更明显的疗效。4、温和灸加药物治疗方案与单一药物治疗方案与麦粒灸加药物治疗方案(P<0.05)相比,温和灸合药物治疗方案对患者病情评估和HAQ指数的影响表现得更为显著得疗效(P<0.01)。5、采用麦粒灸加药物治疗方案对类风湿关节炎患者,其疗效在改善血沉ESR与C-反应蛋白方面,比其他三组更为有效(P<0.05)。6、在本研究中温针灸加药物治疗组,在改善类风湿关节炎患者的主观疼痛感知与类风湿因子(RF)实验水平方面比其他三组更为有效(P<0.01)。经常采用艾灸疗法的类风湿关节炎患者,其治疗效果表现出对症状渐进性的快速改善。这些患者也表现出普遍的身体体质增强。上述各组合方案对病房不同中医证型疗效区别有待于更进一步的研究。更多还原

【Abstract】 Background:Rheumatoid arthritis (RA) is an autoimmune disease leading to chronic inflammation in the joints and subsequent destruction of the affected joint. Chinese Medicine categorizes this as a "Bi-syndrome", of which moxibustion has expressed clinical treatment results. This project aimed to collect clinical and basic laboratory index-data for joint-functions of RA-patients, treated with different moxibustion-methods.Method:A total of102RA-patients was included and treated from2010.03-2011.08. Comparing clinical results of joint functions and general health-condition, from four randomized groups. Three groups treated with either "maili-moxa"(30patients),"Wenhe-moxa"(30patients) or "Wenzhen-acupuncture"(18patients) in addition to conventional western and Chinese medicinal treatments, while one group was treated with singular pharmaceutical treatment (24patients). Statistical analysis was conducted through ANOVA, t-test and Chi-square/X2to determine significance of findings.Result:Collected index-values of both Clinical signs&symptoms and laboratory "6items immunology index", expressed different treatment-results according to treatment scheme. All the clinical signs&symptoms evaluation-indexes within each individual treatment-regime in this research, reached a statistical difference of P<0.05or higher."Maili-moxa"+pharmaceutical gave statistically significant results to improved "Grip strength","Morning stiffness" and "HAQ" results in RA-patients."Wenhe-moxa"+pharmaceutical treatment improved RA-patients subjective pain-sensation with statistical significance. Concerning laboratory treatment-results,"Maili-moxa"+Pharmaceutical treatment for ESR/CRP expressed superior results compared to all three other treatment-regimes in this study."Wenzhen-acupuncture"+Pharmaceutical treatment expressed superior treatment results for VAS-scores and Rheumatoid Factor (RF) compared to the other three treatment-schemes included in this research. Statistical differences in Lab-levels of IgG, and of HAQ-scores was expressed for the "Wenhe-moxa"+Pharmaceutical treatment scheme.Conclusions:1. Each individual treatment-regime in this research, gave adequate treatment-results of before/after index-values for treatment of RA. 2. All three moxa-methods in combination with pharmaceutical treatment, expressed statistically significant superior results to that of singular pharmaceutical treatment, in improving "Grip strength","Mornin stiffness" and "HAQ" results.3. Maili-moxa+Pharmaceutical treatment is favorable to all three other treatment-regimes in this study, for improvement of "Grip strength" and "Morning stiffness". This treatment scheme, also expressed superior results for improving edema in and n/swollen joints.4."Wenhe-moxa"+pharmaceutical treatment is superior in treatment-results for "Patient’s health assessment" and "Health Assessment Questionnaire (HAQ)", compared to singular pharmaceutical treatment (P<0.01) and "Maili-moxa"+pharmaceutical treatment (P<0.05)5."Maili-moxa"+Pharmaceutical treatment is superior to all other three treatment-regimes for improving ESR/CRP-factors in RA patients.6."Wenzhen-acupuncture"+Pharmaceutical treatment is favorable to all three other treatment-regimes i this study, in improving RF-levels and VAS-score for subjective pain-sensation in RA-patients.Frequent moxibustion of RA-patient, gives progressively a quicker expression of the immediate improvin; effect of joints. These patients also express enhanced general physical condition. Further and more detailed observations of differences between in-/out-patients and Chinese Medicine’s diagnostic sub-patterns should be made.更多还原