【作者】 林青；

【导师】 严道南；

【作者基本信息】 南京中医药大学 ， 中医五官科学， 2009， 博士

【摘要】 研究背景变应性鼻炎,是以鼻痒、鼻塞、喷嚏和鼻流清涕为主要症状的疾病,其症状具有发作突然、反复发作、迁延难愈的特点。中医根据其临床症状,将其归属于“鼻鼽”范畴。中医理论认为,变应性鼻炎的病位在于肺、脾、肾,内因是肺气虚弱则鼻窍不利,且脾、肾虚均会导致肺气虚,外因是风寒和异气袭肺。对变应性鼻炎治疗,西医着重于减轻肌体对过敏原的敏感性,而不能彻底改变变态反应体质,抗过敏及激素治疗的效果亦不够明显。中药在治疗与预防变应性鼻炎的方面具有非常独特优势,且药性温和,无不良方应,加之新加坡广泛采用科学浓缩中药,为推广中医药治疗提供了极大方便。新加坡地区变应性鼻炎患病率高,且发病率有逐年上升的趋势,其中肺气虚寒证最为常见,这与新加坡地区环境因素变化有关。新加坡地区常年为夏,“夏月发泄”,人体皮毛开泄,腠理易疏松,体质易感外邪;由于空调使用率很高,室外“盛夏”室内“深秋”,人们进出室内外时,冷热交替,容易形成寒邪入侵;新加坡地区四季如夏,阳热亢盛,人们消耗能量多,新陈代谢快,故人群体质多瘦薄细弱,多为气虚体质;新加坡饮食业发达,多数民众一日三餐在外就餐,脂肪、糖、盐份的摄入多,且食物辛辣为多,又喜冷饮以消暑气。由于工业化的发展,汽车尾气和化学气体、微粒也有一定影响。这些因素使得人体容易出现肺气虚寒型变应性鼻炎。目的本文的临床研究包括两个部分:(1)证候调查;(2)临床治疗。证候调查的目的是确定新加坡地区变应性鼻炎的主要临床辨证分型及其他证候特征;临床治疗研究的目的是对肺气虚寒型变应性鼻炎的不同治疗方法进行分析。方法证候调查本文共收集变应性鼻炎症状调查病例250例,从5个方面调查新加坡地区变应性鼻炎的证候学特征,包括辨证分型构成、性别年龄比较、并发症、病情和病程分布、家族史影响。临床治疗本文将肺气虚寒型变应性鼻炎患者91人分为3组:A针药组35人、B中药组32人和C辛夷片组24人;分别采用不同治疗方法:A组-中药结合针刺、B组-中药和C组-口服片剂。采用医学统计学方法,对临床数据进行统计学处理,包括平均数、标准差、百分比、独立样本t检验等等,进行疗效统计分析。结论(A)证候调查1.变应性鼻炎患者以肺气虚寒型居多,占64.8%;其次是脾气虚弱,占23.2%。因此,本文以肺气虚寒型变应性鼻炎作为治疗研究对象。2.年龄小于19岁的患者所占比例最大,达50.4%。随着年龄增加,患者所占比例减小。男女性别比例为1.1∶1。3.变应性鼻炎多数无并发症,达71.1%。在有合并并发症时,合并哮喘的患者较多,合并湿疹及同时合并哮喘和湿疹的患者极少。4.病情和病程分布情况有共同特征:中等病情所占比例最高,为46%,轻病和重病比例越低;1-5年病程的病患比例最高,占40.0%;1年以下病程与5年以上病程比例越低。5.变应性鼻炎患者大多有家族史,占73.2%。(B)临床治疗1.A针药组的总有效率为94.3%(显效率68.6%),B中药组的总有效率为81.3%(显效率34.4%),C辛夷片组的总有效率为50.0%(显效率8.3%)。Ridit统计分析表明,疗效具有显著性差异。因此,在综合疗效方面,治疗组A和B远高于辛夷片组C,A针药组略高于B中药组。2.治疗前后临床症状体征总积分差值t检验的结果表明:(1)A针药组、B中药组对C辛夷片组,体征总积分差值具有显著性差异。因此,A针药组、B中药组的疗效显著高于C辛夷片组。(2)A针药组对B中药组,体征总积分差值有显著性差异。因此,A针药组的疗效高于B中药组。3.治疗前后单个临床症状体征积分差值t检验的结果表明:(1)对任何单个临床症状体征,A或B治疗组的疗效显著地优于C辛夷片组。(2)A针药组对B中药组,在鼻痒、喷嚏、流涕3个症状方面,A针药组的疗效显著高于B中药组;在鼻塞、鼻甲肿大2个症状方面,A针药组与B中药组的疗效一样。4.病程越短,治疗效果越好;病情越轻,治疗效果越好。疗效与年龄和性别的相关性不显著。更多还原

【Abstract】 BackgroundAllergic rhinitis is a disease with rhinocnesmus, nasal obstruction, sneezing and turbid nasal discharge as main symptoms, and has sudden onset, recurrent, persistent and refractory characteristics. According to its clinical symptoms, the allergic rhinitis is attributed to the areas of "Bi Qiu " , in the theory of Chinese medicine, which believes that allergic rhinitis is the disease due to the deficiency of lung, spleen and kidney. The internal causes are the deficiency of lung, spleen and kidney inducing weakness of nose and eyes, and the external causes are cold or odor air passing through the lung to induce the disease. For the treatment of allergic rhinitis, Western medicine focuses on alleviating the body’s sensitivity to allergens, and can not change radically the physical allergy, anti-allergy and the effect of hormone therapy is also far from obvious. Chinese medicine in the treatment and prevention of allergic rhinitis has a very unique advantages, and mild in nature but should be all good, plus the Singapore Chinese medicine widely used in scientific enrichment, in order to promote Chinese medicine treatment provided a great convenience.Prevalence rate of allergic rhinitis in Singapore is high and has an increasing tendency, in which the cases with deficiency of Lung and cold syndrome are most common. This is closely related to the environmental factors of Singapore and the region. Singapore is an area in summer all the year round. The high temperature in summer release and open on human’s skin and fur, which is susceptible of exogenous evil. Due to the high usage of air conditioning in Singapore, it is summer outdoor and "late autumn" in the room. When people are in and out of air-condition rooms, alternating hot and cold air, it is easy to cause invasion of exogenous evil. Since Singapore is a four-season summer area, people consume more energy and experience faster metabolism. Therefore, the crowd physique in Singapore is generally thin and weaken in Qi. In addition, the people in Singapore usually have daily meals outside most of time. This makes them have more fat, sugar and salt intake than normal. Due to heat and wetting weather, the people also like spicy food and cold drinks. Therefore, Singapore’s geographical location, population health and eating habits make the people in the region with the characteristics of lung weak and vulnerable, and being sense of cold-induced allergic rhinitis.PurposeIn this paper, the clinical study has two parts: (1) syndrome investigation and (2) clinical treatment. The aim of the syndrome investigation is to determine the major clinical syndrome type and other characteristics of the allergic rhinitis in the area of Singapore; and the aim ofthe clinical study is to analyses different treatment methods for lung-cold allergic rhinitis.MethodsSyndrome investigation A total of 250 cases of allergic rhinitis symptoms have been collected,and the investigations have been made from 5 aspects, including syndrome type, age and sexcomparison, complications, distribution of illness-condition and course of disease etc.Clinical treatment Choosing 91 patients with lung-cold allergic rhinitis which are divided into 3 groups: group A (medicine and acupuncture group) - 35 patients, treated with combining traditional Chinese medicine and acupuncture; group B (medicine group) - 32 patients, treated with traditional Chinese medicine; group C (control group) - 24 patients, treated with oral tablets. The clinical data are analyzed with medical statistical methods, including average, standard deviation, percentage, independent samples t test and so on, to carry out statistical analysis of the effect.Results(A) Syndrome investigation1. In the investigation, it is found that the patients with the lung-cold type allergic rhinitis are majority, accounting for 64.8%; followed by the spleen-weak type allergic rhinitis, accounting for 23.2%. Therefore, the lung-cold allergic rhinitis is selected as the object of study and treatment.2. The patients younger than 19-year-old are the largest proportion, reaching 50.4%. With the increase of age, the proportion of the patients with the allergic rhinitis is reduced. The ratio of the male and female sex patients is 1.1:1.3. The majority of the patients with allergic rhinitis have no complications, reaching 71.1 %. In the cases of the allergic rhinitis patients with complications, more patients are allergic rhinitis with asthma. The cases of the allergic rhinitis with eczema and the allergic rhinitis with asthma and eczema are very few.4. The patients’ illness conditions and courses have similar distributions. The patients with medium illness-condition are in the highest proportion, reaching 34.4%, and the patients with light or serious disease are in lower ratio. The patients with 1-5 years of the disease are in the highest proportion, accounting for 40.0%; and the patients with the disease more than 5 years or lower than one year are in lower ratio.5. Most patients with allergic rhinitis have a family history, accounting for 73.2%. (B) Clinical treatment1. The total treatment rate of the group A is 94.3% (effective rate 68.6%), the total treatment rate of the group B is 81.3 % (effective rate 34.4%), and the total treatment rate of the group C is 50.0% (effective rate 8.3%). Ridit statistical analysis showed that the effect has a significant difference. As a result, the comprehensive treatment effect of the groups A and B is far higher than group C, and the treatment effect of the group A is slightly higher than that of the group B.2. The statisticalμtest results for the total clinical symptoms score differences before and after the treatments show that: (i) the statistical results for group A and group C and for group B and group C all statistically show significant difference. Therefore, the treatment efficacies of the groups A and B are significantly higher than that of the group C. (ii) the statistical results for group A and group B also show statistical difference. Therefore, the treatment efficacy of the groups A is higher than that of the group B.3. The statisticalμtest results for individual clinical symptom score differences before and after the treatments show that: (i) for any individual clinical symptom, the statistical results for group A and group C and for group B and group C all show significant difference. Therefore, the treatment efficacies of the groups A and B are significantly higher than that of the group C. (ii) the statistical results for group A and group B show that for the symptoms of nasal itching, sneezing and runny nose, the treatment efficacy of the groups A is higher than that of the group B, and for the symptoms of stuffy nose, swollen turbinate, the treatment effect of the groups A and B is same.4. The shorter the course of disease is, the better the treatment effect is and the lighter the illness condition is, the better the treatment effect is. And the relevance between the treatment effects and the age and gender are not significant.更多还原