【作者】 唐长华；

【导师】 李富玉；

【作者基本信息】 中国人民解放军军医进修学院 ， 中医师承制， 2008， 硕士

【摘要】 本课题分为李富玉教授学术经验总结以及解毒益肾法治疗膝骨性关节炎临床研究两部分。学术经验总结:从学术思想、临床经验两方面进行阐述。学术思想总结:包括整体恒动、天人相应;调理气化、行滞补虚;疑难重症,从毒论治;衷中参西,病证结合四方面;临床经验总结:通过对病因病机、辨证论治、临床心得的总结,阐明了导师关于肝肾亏虚、瘀毒痹阻是骨痹根本病机的理论观点,系统展现了导师治疗骨痹(骨性关节炎)的临证思路及用药特点。临床研究:围绕导师临床经验,进行解毒益肾法治疗膝骨性关节炎临床研究。目的:观察中药解毒益肾丸对膝骨性关节炎的疗效及作用机理。方法:自拟活血解毒、补益肝肾的解毒益肾丸与维骨力比较。将辨证为肝肾亏虚、瘀毒痹阻型膝骨性关节炎患者随机分两组治疗,观察组28例,口服解毒益肾丸,对照组29例,口服维骨力胶囊,8周为一疗程,采用国际通用的WOMAC问卷评估、疼痛视觉模拟量表、中医证候量化评价、测定血清MMP-3和TIMP-1含量等指标客观评价解毒益肾丸临床疗效。结果:观察组治疗后能明显降低WOMAC指数、下蹲痛评分、中医症状积分,能降低血清中MMP-3含量,调高TIMP-1含量,但与对照组相比无显著性差异。对中医证侯的改善情况观察组与对照组相比有显著性差异。两组安全性指标无显著性差异。结论:解毒益肾丸和维骨力胶囊均能有效改善膝关节骨关节炎症状,两药疗效相当。但就改善中医证侯而言,解毒益肾丸优于维骨力胶囊。调节血清MMP-3和TIMP-1的水平可能是其发挥疗效的作用机理之一。更多还原

【Abstract】 The research is devided into two parts: summing-up of Prof. Li Fuyu’s clinical experiences in treating knee osteoarthritis and treating osteoarthritis with the method of Detoxificating and Invigorating the Kidney.Summing-up of Prof. Li Fuyu’s clinical experiences: the academic thoughts includes four aspects: correspondence principle of nature and human being, focusing on integrated and lasting motivation; weakness benefiting, being good at geriatric medicine; set forth his views based on toxin, being good at difficulties and vital diseases; stick to traditional Chinese medicine and reference to Western medicine.The clinic experiences: by summing-up the etiology and pathogenesis, differentiation of syndromes and the clinlical thoughts, the author explained the tutor’s viewpoint that deficiency of liver and kidney and congestion of toxin and blood is the basic pathogenesis of osteoarthritis, and displayed completed the tutor’s clinical thoughtsand drug administering characteristics.The clinical research: treating osteoarthritis with the method of Detoxificatingand Invigorating the Kidney is based on the clinical experiences of Prof. Li Fuyu. The purpose is to observe the curative effects and the functional mechanism of Detoxificating and Kidney-Invigorating Pill. The method is to compare the Detoxificating and Kidney-Invigorating Pill improving blood circulation and detoxicating, and liver & kidney benefiting with Viartril-S. 60 osteoarthritis patients recognized as deficiency of liver and kidney and congestion of toxin and blood were divided randomly into two groups. The test group took orally Detoxificating and Kidney-Invigorating Pill the control group took Viartril-S Capsule, both for 8 weeks. The therapeutic and security effects were observed through the international WOMAC questionnaire, visual analogue scale (VAS), traditional Chinese medicine symptoms quantitative evaluation, the serum level of MMP-3 and TIMP-1, and so on. The results reveal that in the test group, the treatment shall decrease the WOMAC index, squat pain score and score of Traditional Chinese medicine symptoms evidently, lower the MMP-3 level in serum while increase the TIMP-1 level, with no distinctive differences contrast to the control group; however, there are distinctive differences on the improvement of the Traditional Chinese medicine symptoms between the test group and the control group. There’s no distinctive difference between the tow groups in security indexes. The results reveal that both the Detoxificating and Kidney-Invigorating Pill and Viartril-S Capsule can improve the symptoms of osteoarthritis effectively, and two kinds of medicine have equal therapeutic effects. But as far as the improvement of Traditional Chinese medicine symptoms are concerned, the Detoxificating and Kidney-Invigorating Pill is superior to Viartril-S Capsule. The regulation of the serum level of MMP-3 and TIMP-1 may be one of the mechanisms of therapeutic effects.更多还原