【作者】 刘丽娟；

【导师】 黄仰模；

【作者基本信息】 广州中医药大学 ， 中医临床基础， 2005， 硕士

【摘要】 强直性脊柱炎(Ankylosing Spondylitis,AS)是以中轴关节慢性炎症为主的全身性、免疫性、致残性疾病。目前无特效治疗。本病发病原因西医未明,中医则认为肝肾不足、督脉亏虚为本病发生的内在依据,感受外邪是形成本病的外在条件,此外,跌仆瘀血也是本病的成因之一。中医药疗效确切而毒副作用小,治疗方法丰富,有辨证治疗,分期治疗,专方治疗,中成药治疗,还有针灸治疗及中药理疗,其中辨证治疗是主要方法,但目前缺乏统一的辨证标准,不利于进一步提高中医药治疗本病的疗效。 目的:本课题旨在研究本病的辨证分型及证型与细胞因子白介素-6(IL-6)、肿瘤坏死因子(TNF-α)的关系。据此,在既往研究工作的基础上,根据风、寒、湿、热、痰、瘀的致病特点,运用脏腑、气血、八纲辨证的理论,通过临床病例的调查、统计和分析,总结AS的中医证型及其分布特点,分析细胞因子(IL-6、TNF-α)与AS病期、病程及中医证型的关系,为提高辨证论治水平提供实验依据。 方法:记录患者姓名、年龄、性别、诱因、遗传史等一般资料,对腰骶痛、发热、汗出、怕冷、胃纳、口味、腰酸腿软、头晕健忘、耳鸣耳聋、神疲乏力、舌脉等症状记录频数分布。每一病例由具有丰富临床经验的专科医生进行辨证分型。同时检测细胞因子(IL-6、TNF-α)。 结果:第一,本课题共收集病例139例,早期病例53例(38.2%)、中期病例43例(30.9%)、晚期病例43例(30.9%)。活动期病例76例(54.7%)、缓解期63例(45.3%)。 第二,AS中医证型分布特点,由高到低依次为湿热型59例(42.4%),肝肾阴虚型38例(27.3%),肝肾精亏型21例(15.1%),脾肾阳虚型14例(10.1%)和寒湿型7例(5%)。 第三,各证型证候特点如下: 湿热型:腰骶隐痛,伴外周关节炎,晨僵<30min,口干欲饮,腰酸腿软,舌质红或暗红,舌苔黄厚,脉弦。 肝肾阴虚型:腰骶酸硬,伴外周关节炎,晨僵<30min,口干欲饮,腰酸腿软,神疲乏力,舌红或暗红,苔薄黄,脉弦或细。 脾肾阳虚型:腰骶酸硬,外周关节炎,怕冷,腰酸腿软,自汗,神疲乏力,舌体胖,伴齿痕、舌淡红或暗淡,苔白,脉细。 肝肾精亏型:腰骶隐痛或酸硬,外周关节炎,腰酸腿软,神疲乏力,舌淡红或暗淡,苔白,脉细。 结论:第一,强直性脊柱炎多见于男性青壮年,发病与遗传、外伤有关。 第二,强直性脊柱炎中医证型分布,湿热型最常见,其次是肝肾阴虚型,寒湿型更多还原

【Abstract】 Ankylosing Spondylitis(AS) is a form of arthritis that involves primary the spine. It results in disability in severe cases. It is considered that AS’s etiology is deficiency of Kidney-Qi and invasion of wind, coldness and dampness. In addition to, blood statis is one of AS’s pathogenic factors. For this disease, the therapy of TCM not only is rich, such as according to differential diagnosis and period, acupuncture and moxibustion and so on , but also curative effect is sure and side effect little. According to differential diagnosis is the main therapy, but now AS is deficient of standard. It restricts curative effect of TCM.Objection:This subject is first to study the relationship of TCM syndrome type , second to study the relationship of syndrome-differential and cytokines (IL-6、 TNF-α ) .Methods:We have extracted 17 common clinical symptoms from some typical symptoms with each individual differential type, note each symptoms one by one. At the same time, test IL-6 and TNF-α. Results:Firstly, we collected 139 patients, in forepart stage 49(35. 2%), in metaphase stage 50(36%), in terminal stage 40(28. 8%). In acute stage 76(54. 7%), in chronic stage 63(45.3%).Secondly, AS’s syndrome classification includes the Damp-heat accumulation channel Du, hepatic and renal yin deficiency, hepatic and renal energy deficiency, asdthenic splenonephro-yang and cold-hampness accumulation channel Du. This order is formed from more to little.Thirdly, Damp-heat accumulation channel Du: lumbar vertebra pain, morning stiffness<30min, thirst and desire to drink, lassitude loin and legs, reddened更多还原