【作者】 郭壁周；

【导师】 刘晓玲；

【作者基本信息】 广州中医药大学 ， 中医临床基础， 2012， 硕士

【摘要】 目的：客观评价昆断蝎子汤合薏鲫汤治疗活动期类风湿关节炎的临床疗效方法：选择60例符合纳入标准的类风湿关节炎患者随机分为治疗组与对照组。治疗组：昆明山海棠45克、全蝎5克、川断15克,煎服法：昆明山海棠、全蝎加水500m1先煎三个半小时,再加入川断同煎半小时,一共煎四小时,煎至150m1,分三次饭后温服,日一剂；薏苡仁50克、鲫鱼500克、猪脊骨250克,加水500m1煮至150m1,分两次服用,共服六周。对照组：昆明山海棠45克、全蝎5克、川断15克,煎服法同上,共服六周。观察治疗后六周关节压痛数、关节压痛指数、关节肿胀数、关节肿胀指数、晨僵时间、平均握力、VAS评分、HAQ指数等临床症状、体征；观察类风湿因子、C反应蛋白及血沉等实验室指标：监测血常规、肝肾功能；同时详细记录治疗过程中出现的不良反应。结果：治疗六周后,治疗组总有效率为86.7%,对照组总有效率为76.7%,治疗组的疗效与对照组比较有统计学差异(P<0.05),治疗组优于对照组。临床研究结果显示,治疗组与对照组的DAS28评分改善情况与治疗前比较均有统计学意义(P<0.05)：组间比较：治疗组与对照组相比有统计学意义(P<0.05),治疗组优于对照组。说明昆断蝎子汤合薏鲫汤和单用昆断蝎子汤均能明显降低活动期类风湿关节炎患者的疾病活动度,而且联合应用方案优于单用。在症状体征改善方面,治疗组：关节压痛总数、关节压痛指数、关节肿胀总数、关节肿胀指数、晨僵时间、平均握力、患者对疼痛的VAS评分及HAQ与治疗前比较均有统计学意义(P<0.05)。对照组：关节压痛总数、关节压痛指数、关节肿胀总数、关节肿胀指数及患者对疼痛的VAS评分与治疗前比较均有统计学意义(P<0.05),晨僵时间、平均握力及HAQ与治疗前比较无统计学意义(P>0.05)。治疗组与对照组对比：两组间关节压痛总数、关节压痛指数、关节肿胀总数及关节肿胀指数比较有统计学意义(P<0.05),治疗组优于对照组。两组问患者对疼痛的VAS评分比较无统计学意义(P>0.05)。在实验室指标方面,治疗组与对照组的RF、CRP及ESR与治疗前比较均有统计学意义(P<0.05),治疗组的CRP与对照组相比有统计学意义(P<0.05),治疗组优于对照组。在治疗过程中,共出现药物副反应7例。其中治疗组3例,有1例患者出现恶心呕吐、暖气返酸、腹胀腹泻等消化系统症状,经服用制酸护胃药后症状可以缓解；有1例患者肝转氨酶升高,经护肝治疗后,肝功能基本恢复正常：有1例女性患者出现月经紊乱：余未见明显不良反应。对照组4例,有1例患者服药后出现呃逆的消化道不适反应,后自行好转。有1例患者肝转氨酶升高,经护肝治疗后,肝功能基本恢复正常；有2例女性患者出现月经紊乱；余未见明显不良反应。两组患者均未出现严重不良反应。结论：昆断蝎子汤合薏鲫汤和单用昆断蝎子汤对活动期类风湿关节炎的疗效是肯定的,而且联合应用能更好地控制病情,可以作为中药联合食疗模式应用于临床。短期用药不良反应无明显差异。更多还原

【Abstract】 Object i veTo evaluate the therapeutic effect of Himalayan Teasel Root Radix seu Caul is Celastri Orbiculati Scorpion decoction and Semen Coicis Carassius Auratus decoction in the therapy of rheumatoid arthritis (RA).MethodSixty RA patients fulfilling including criteria were randomly dividing into therapeutic group and control group. Patients in therapeutic group were administrated decoctions as follow:(1) to decoct Radix seu Caul is Celastri Orbiculati45g and Scorpion5g for3.5hours, then plus Himalayan Teasel Root15g and decoct for0.5hours, this decoction was taken once per day;(2) to decoct Semen Coicis50g, Carassius Auratus500g, porcine vertebral column500g from4bowls of water to1bowl of decoction, this decoction was taken twice per day, half bowl of decoction per time. Patients in control group were just administrated decoction (1) of therapeutic group. Course of treatment in both groups was6weeks. Total number of articular tenderness, articular tenderness index, number of joint swelling, joint swelling index, time of morning stiffness, average hand strength, VAS score, HAQ index, RF, CRP, ESR, were observed after6weeks after therapy. Blood routine test, hepatic renal test, and side effects were monitored during therapy.ResuleTotal effective rate was86.7%and76.7%in therapeutic group and control group respectively. Total effective rate in therapeutic group was significantly higher than control group (P<0.05).DAS28score in both therapeutic group and control group were improved significantly after therapy (P<0.05). DAS28score in therapeutic group was significantly higher than control group after therapy (P<0.05). Both combinative therapy and Himalayan Teasel Root Radix seu Caul is Celastri Orbiculati Scorpion decoction can decrease activity in acute phase of RA. Combinative therapy had better effect than Himalayan Teasel Root Radix seu Caulis Celastri Orbiculati Scorpion decoction alone.Total number of articular tenderness, articular tenderness index, number of joint swelling, joint swelling index, time of morning stiffness, average hand strength, VAS score and HAQ index significantly improved after therapy in therapeutic group (P<0.05). Total number of articular tenderness, articular tenderness index, number of joint swelling, joint swelling index and VAS score in control group significantly improved after therapy (P<0.05). Time of morning stiffness, average hand strength and HAQ index didn’t have significant improvement after therapy in control group. Total number of articular tenderness, articular tenderness index, number of joint swelling, joint swelling index in therapeutic group improved significantly than control group after therapy (P<0.05). There was no statistical significance in VAS score between two groups.RF, CRP, ESR levels in both groups decreased after therapy. CRP levels in therapeutic group were significantly decreased in therapeutic group than control group.There were3patients in therapeutic group and4patients in control group had side effect during therapy. In therapeutic group, one patient had digestive symptoms of nausea and vomiting, epigastic upset and eructation, abdominal distension and diarrhea, these symptoms were relieved after antacid agent administration; one patient had increased transaminase level, and relieved after hepatic protective agent administration; one female patient had amenorrhea. In control group, one patient had singultous and recovered automatically; one patient had increased transaminase level, and relieved after hepatic protective agent administration; two female patients had amenorrhea. All patients did not have server side effect.Conclusion Himalayan Teasel Root Radix seu Caulis Celastri Orbiculati Scorpion decoction and combinative therapy with Semen Coicis Carassius Auratus decoction had pronounced therapeutic effect to RA. Combinative therapy has better effect to RA and can be applied to clinical treatment in the mode of Chinese medicine combine with dietary therapy. Side effects between two groups had no statistically significant difference.更多还原