益元祛浊法治疗类风湿关节炎的临床研究

【作者】 柴铁玲；

【导师】 何厚夫；

【作者基本信息】 北京中医药大学 ， 中医内科临床， 2006， 硕士

【摘要】 类风湿关节炎rheumatoid arthritis RA是一种慢性炎症性疾病,是以对称性多关节炎病变为主要临床表现的全身性自身免疫性疾病。其特点是关节滑膜的慢性炎症、软骨吸收、骨质破坏和骨质纤维化。本病为慢性、进行性、侵袭性疾病,失治误治,病情逐渐加重,造成骨关节的破坏,直致关节强直、畸形、功能丧失。严重影响了患者的工作和生活质量。由于现代医学对本病的病因和发病机理尚未完全清楚,故在治疗上缺乏具有针对性的措施和药物。类风湿性关节炎属中医“痹证”范畴,中医对本病强调个性化治疗,疗效肯定、副作用较小,越来越受到重视。目前中成药种类繁多,但疗效并不确切。内服中药汤剂可因人而异,分类、分型、分期辨证施治,对缓解症状、减轻疼痛、改善体征,恢复功能和改善相关检验指标,均有良好作用。进一步展示了中医药治疗本病的光明前景。本研究分为文献综述和临床研究两部分。文献综述:包括西医综述、中医综述,西医综述讨论了类风湿关节炎的病因、发病机理、诊断、治疗和研究新近展;中医综述对类风湿关节炎的中医病名,历代文献观点、病因病机,因理演变、辨证分型治疗及其它治疗方法作了系统分析总结。临床研究:根据中医理论为指导,根据辨证分型,自拟经验方通用蠲痹汤及益元蠲痹汤方作为治疗组用药。根据早期类风湿关节炎及中晚期类风湿关节炎各证型的证候积分标准,对80例类风湿关节炎患者采用随机开放,平行对照的方法进行分组。早期类风湿关节炎治疗组及对照组各20例,治疗组采用自拟通用蠲痹汤,对照组采用风湿液治疗,中晚期类风湿关节炎治疗组及对照组各20例,治疗组采用益元蠲痹汤,对照组采用尪痹冲剂治疗；分别通过对各期的两组病例一般情况进行统计分析,发现各期两组病例在一般情况上不存在差异性(P>0.05)。分别对治疗四周、八周后四组病例的临床症状、体征及实验室指标进行观察对比,记录结果,并进行统计学分析。统计结果显示:RA早期、RA中晚期治疗组与对照组在治疗后,关节疼痛、关节肿胀、晨僵等主要症状的缓解及压痛、功能活动度等主要体征的改善上均有明显差异(P<0.05)。同时对RF、ESR、CRP指标,免疫球蛋白IgG、IgM、IgA,补体C3、C4进行观察,研究结果表明,RA早期治疗组与对照组在治疗后RF, IgG, IgA, C3水平的改善有明显差异(P<0.05); RA中晚期治疗组与对照组在治疗后RF, IgG水平的改善有明显差异(P<0.05);各治疗组在治疗后八周时ESR、CRP水平的改善有明显差异(P<0.05)。临床研究更多还原

【Abstract】 Rheumatoid arthritis(RA) is belonged to chronic systematic autoimmune disease which is charactered by multiple symmetric arthritis . Its main pathologic mechanism include chronic inflammation of arthral synovium , absorption of cartilaginous tissue, destruction and fibrosis of sclerotin.Because of chronicity,progression and dimolition of Rheumatoid arthritis, incorrect or postponed treatment often happens and RA patients have to suffer arthrocleisis, malformation and dysfunction of joints, all those of forementioned complications severely affect work ability and life quality of RA patients. More worsely, by so far concrete etiological factors and pathogenic mechanism of Rheumatoid arthritis is still unknown and consequently, more efficacious therapy or drugs to RA is insufficient in clinical medicine.In Tradtional Chinese medicine,RA belongs to the range of arthromyodynia. Because of individual treatment, affirmatively curative effect and more fewer side effect than pharmaceutical chemicals, TCM therphy for arthromyodynia is now more and more thought highly of. Though Chinese formulated products have a great variety of kinds,their precise effect is still not yet known .Comparing to Chinese formulated products, using Chinese medicinal decotion has predominance of individualization, classification, grouping and staging differentiation and corresp treatment in TCM clinical practice. And datas also haven shown that the former can relieve pain, restore articular function and ameliorate pertinently laboratory RA marker.As to this research ,it can be divided into two parts: literature summarization, and clinical study. The former is consisted of modern medicine and TCM summary.In modern medicine summary, etiopathogenisis, pathogenesis, diagnosis, treatment and preclinical progression of RA is mentioned.In TCM summary,TCM name to RA,different viewpoint in successive dynasties, etiologicalfactors, pathogenesis, variation, treatment by syndrome differentiation and other TCM therapy for arthromyodynia are comprehensively summed up. Within clinical study,80 RA patients are erolled and divided into four groups openly, randomly and controlly. Among them , 20 early stage RA patients are treated更多还原