红外热像图与强直性脊柱炎辨证分型及疗效观察的关系探讨

【作者】 解国华；

【导师】 阎小萍；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2003， 硕士

【摘要】 强直性脊柱炎（anklosing spondylitis,简称AS）是现代医学病名，祖国医学无此病名。焦树德教授和导师阎小萍教授提出将“大”作为强直性脊柱炎的中医病名。AS早期特征性病理变化为肌腱、韧带、附着点炎症，属于软组织炎症，脊背是其重要累及部位，如能直接、准确观测AS患者脊背的软组织情况，对于早期诊治AS将会起到重要作用。本课题就是对红外热成像这项无创功能性检测技术用于AS的检测进行了初步观察，并对AS患者的红外热成像表现与其中医辨证分型及疗效观察的关系进行了初步探讨。本实验结果显示：实验中AS患者的红外热像图表现大致分为三种类型。一种为暖色热区和冷色寒区相间出现，成片状，大小不等，热区和寒区的中心温度的温差较大，在3.9～6.4℃之间。此种表现为多数，主要见于肾虚督寒证患者。第二种表现为大片暖色热区，兼见小片状次热区或次冷色寒区，热区和寒区的中心温度的温差较小，在0.8～3.0℃之间。见于邪痹肢节证和3例邪郁化热证患者。第三种为大部分呈冷色寒区，兼见小片状次寒区或次热区，热区和寒区的中心温度的温差亦较小，在0.8～2.9℃之间。见于邪痹肢节证和7例邪及肝肺证患者。邪痹肢节证患者的红外热像图有两种不同的表现。将肾虚督寒证和邪痹肢节证的红外热像图的高温区与低温区的面积之差和高温区与周围组织之间的温差进行统计学处理有显著性差异（P＜0.01）。本实验还将AS患者的红外热像图温差ΔT与其中医症状、体征、实验室指标作了相关性研究发现：温差ΔT可以反映躯体瘀血程度，很直观地反映出疼痛部位，从另一角度反映了脊柱的活动情况，温差变化还可以象血沉、C反应蛋白一样反映疾病的活动情况。补肾强督治尫汤是导师阎小萍教授经多年临床实践总结而成。实验中观察到30例肾虚督寒证AS患者治疗前后红外热像图表现明显不同，治疗后面积差和温差均明显降低，经统计学处理有显著性差异（P＜0.01）。补肾强督治尫汤对中医症状、体征及实验室指标有显著作用。治疗总有效率为90.00％。更多还原

【Abstract】 Ankylosing spondylitis (AS) is a form of chronic inflammation of the spine and the sacroiliac joints. Chronic inflammation in these areas causes pain and stiffness in and around the spine.AS is a name of the disease in modern medicine.There isn’t exact name in Chinese Medicine. Professor Jiao shu-de and professor Yan xiao-ping consider that AS belongs to the "DALU". The hallmark of pathologic change is the inflammation of tendon , ligament, the drop of adhesion. It is a inflammation of soft tissue. Ankylosing spondylitis is characteristically a chronic inflammation of the spine, particularly of the lower back. It is important to make a diagnosis and give treatment in initial AS if the soft tissue on the back of AS patients can be observed nicetyly and directly. This research studied effect of Medical thermography that is no hurt and functional check technique is used in the observation of AS, and observed the relationship between Medical thermography and the Chinese Traditional Medicine identify classifications of AS.The result shows: Medical thermography of AS patients display three types. One type is shows that hot section alternate with cold section ，the size is different. The difference in temperature of center temperature betweens hot section and cold section is 3.9～6.4℃.This type appears to kidney-asthenia and Du-cold patients. The second type shows big patch hot section and small patch cold section. The difference in temperature of center temperature betweens hot section and cold section is 0.8～3.0℃. This type appears to evils intrude extrarthron patients and three evils luxuryite and turn into heat patients.The third type shows big patch cold section and small patch hot section. The difference in temperature of center temperature is 0.8～2.9℃. This type appears to evils intrude extrarthron patients and seven evils intrude liver and lung patients. The difference in temperature and area of kidney-asthenia and Du-cold patients is very obvious compared with evils intrude extrarthron patients.(P<0.01). The difference in temperature represents body blood stasis dgree, pain position, function of vertebral column and disease activity like ESR、CRP.Bushenqiangduzhiwangtang (BSQDZWT) is a available prescription created by professor Yan xiao-ping. The Medical thermography of 30 AS patients with <WP=5>kidney-asthenia and Du-cold are very obvious difference after curing with BSQDZWT. The difference in temperature and area arevery obviously decreased. (P<0.01). Laboratory research revealed that BSQDZWT has good effect to clinical symptom,joint activity function,immunity inflammation. The overall effective rate is 90.00%.更多还原