【作者】 简任佑；

【导师】 陈纪藩；

【作者基本信息】 广州中医药大学 ， 中医临床基础， 2005， 博士

【摘要】 类风湿关节炎(RA)是一种常见的以关节组织慢性炎症性病变为主要表现的全身性自身免疫性疾病。侵犯多个关节,进展性的滑膜增生,不可逆的关节软骨的丢失并最终导致软骨下骨质的破坏,是类风湿关节炎发病的主要病理特征。根据统计,RA在我国的发病率约为0.3-0.6%。欧美国家发病率更高,根据国外统计,美国约有500-600万患者,日本约有1000万患者,且近年来该病呈上升趋势。本病任何年龄均可发病,多发于30～60岁之间,45岁左右最常见。随年龄增长,发病率也增高,在35岁以下成年人约0.3%发病,而65岁以上者发病率超过10%。男女发病比率为1:2～4。此外,本病还存在季节性高发现象,常在每年春季的春分及秋季的秋分前后或二、八月发病、加重或恶化。本病有较高的致残率,据统计在发病起计10年内约有60%的病人会致残。类风湿损害人类健康的同时也给国家及社会带来了巨大的经济负担。 类风湿性关节炎的治疗目的在于控制病情发展,减轻疼痛,阻止不可逆的骨破坏,保护关节及肌肉的功能,改善患者的生活质量。近年来西医学在RA发病机制及病理变化研究方面取得了明显进展,然而在治疗和药物上仍没有一种药物能够减慢或阻止类风湿关节炎骨质侵袭及关节破坏。缺乏有效真正控制病情发展的药物。故我们当前最紧迫的研究课题是,研究和寻找治疗RA的新途径、新药物。 中医对RA的认识和治疗积累了较为丰富的经验,具有方法多、疗效确切、毒副作用小的特点,在临床研究上,对RA的辨证分型仍存在诸多的分歧,各家分型不统一,不利于中医疾病的标准化与客观化的研究,制约了其在治疗学上的发展。近年来,中药复方和单味、单体中药制剂上市,成为我国治疗RA等难治性免疫性疾病的一大特色,受到国际抗风湿病学术界的关注。但在较多研究药物单一有效成分的研究及专病专方时,忽略了辨证论治方面的研究。所以中医在辨证分型治疗RA中的疗效成为我们研究所关注的焦点。 本研究分为临床观察与实验研究两个部分。临床观察中重点探讨症状与证型间的相关性及证型在临床患病人群中的分布情况,同时观察了中药复方通痹灵治疗RA的疗效。实验研究进一步观察通痹灵对AA大鼠急性关节炎症的影响作用。 为了探讨RA病症辨证分型的可行性,以进一步指导临床用药及治疗规范化的实施,我们进行了如下的临床调查研究。本研究基于导师多年临床实践经验的基础,结更多还原

【Abstract】 Rheumatoid arthritis (RA) is a common systematic autoimmune disease symbolized with chronic inflammation of joints and tissues. The main pathologic features include various joints invaded, evolving synovial hyperplasia, irreversible cartilage loss, resulting in sub-cartilaginous bone destruction. It shows that the incidence of RA is about 0.3-0.6% in China. That will still be higher abroad. RA not only impairs patients’ health but also brings heavy economic burden to the country and society.The objective of theraputics on RA is to control the process of the disease, . alleviate pain and prevent bones from irreversible destruction, as well as to protect the function of joints and muscles and improve the quality of patients’ lives. During these years, western medicine has made great process in the research of pathogenesis and pathology. But it is completely different in therapies and efficient medicines dealing on bones invasion and joints destruction. As a result, it becomes urgent and tough for us to explore and find out an effective method and drug in treating RA.There is plenty of experience on RA in traditional Chinese medicine (TCM). Holding divergences on syndrome differentiation in clinical research, compound and single Chinese medicine have been found in market recently, which becomes characteristic of TCM in dealing with refractory immuno-disease. In the same time, ignorance on syndrome differentiation appears. So we all focus on the curative effect of syndrome differentiation in TCM.This research is composed of two segments: Clinical observation and test section, discussing pertinence and subsection of syndrome and type, and observing curative effect of TBL on RA.更多还原