【作者】 王晶；

【导师】 张金波；

【作者基本信息】 山东中医药大学 ， 中医硕士（专业学位）， 2024， 硕士

【摘要】 目的观察分析加味宣痹汤治疗湿热痹阻型银屑病关节炎的有效性以及安全性,为临床治疗银屑病关节炎提供新思路。方法本研究采用随机对照的研究方法,将64例符合研究标准的银屑病关节炎(湿热痹阻型)患者分为两组,每组32人。对照组接受标准的西药治疗,治疗组接受加味宣痹汤与西药的联合治疗方案,两组的治疗周期统一设定为12周。采集治疗前后两组患者的中医证候积分、疼痛视觉模拟积分(VAS)、银屑病皮损面积和严重程度指数积分(PASI)、CRP及ESR水平等数据信息,通过SPSS27.0进行统计分析,评价临床疗效及安全性。结果1.疗效指标评估:(1)中医证候积分:治疗前,两组在中医证候积分方面展现出相似的基线水平,统计学分析无显著差异(P>0.05)。治疗后组内比较,两组患者的中医证候积分较治疗前均呈现下降趋势,具有统计学差异(P<0.05)。治疗后组间比较,治疗组在改善关节肿胀、皮疹单项症状积分方面,优于对照组(P<0.05);治疗组在改善中医证候总积分,发热、四肢困重、口干口苦、小便黄赤单项症状积分方面,显著优于对照组(P<0.01);治疗组在改善关节疼痛单项症状积分方面与对照组疗效相当,无统计学差异(P>0.05)。(2)PASI积分:治疗前,两组在PASI积分方面基线水平相似,统计学分析无显著差异(P>0.05)。治疗后组内比较,两组患者的PASI积分均有明显的下降,具有统计学差异(P<0.05)。治疗后组间比较,治疗组对PASI总分、PASI上肢、PASI躯干、PASI下肢积分的改善,优于对照组,统计学差异显著(P<0.01);两组对PASI头部积分的改善无统计学差异(P>0.05)。(3)VAS积分:治疗前,两组在VAS积分方面基线水平相似,统计学分析无显著差异(P>0.05)。治疗后组内比较,两组患者的VAS积分均有明显的下降,具有统计学差异(P<0.05)。治疗后组间比较,治疗组对VAS积分方面的改善与对照组相似,无统计学意义(P>0.05)。(4)实验室指标:治疗前,两组在CRP及ESR水平方面基线水平相似,统计学分析无显著差异(P>0.05)。治疗后组内比较,两组患者的CRP水平和ESR水平均有明显的下降,具有统计学差异(P<0.05)。治疗后组间比较,治疗组对CRP水平方面的改善,优于对照组,统计学差异显著(P<0.01);治疗组在ESR水平方面的改善,与对照组无明显区别,无统计学意义(P>0.05)。2.总体疗效:治疗组总有效率为86.67%,对照组总有效率为67.74%,治疗组疗效优于对照组,有统计学差异,P<0.05。3.安全性分析:治疗2周后,对照组1例患者转氨酶轻度升高,考虑患者作息、饮食不规律所致,改善作息规律并予短期对症治疗后好转。在治疗6周、10周以及治疗结束后,两组的肝功能、肾功能、血常规、尿常规等安全性指标均保持正常。治疗期间,对照组2例患者出现恶心、呕吐,停药后症状消失,为轻度不良反应。结论1.加味宣痹汤对改善湿热痹阻型银屑病关节炎的临床症状有明确效果,可以减少皮损面积、减轻皮损程度及改善关节红肿热痛症状,提高生活质量。2.加味宣痹汤联合甲氨蝶呤治疗湿热痹阻型银屑病关节炎的临床疗效优于单纯应用甲氨蝶呤治疗。3.加味宣痹汤联合甲氨蝶呤片在试验过程中没有发生严重不良反应,安全有效,疗效良好,值得推广。更多还原

【Abstract】 ObjectiveThe effectiveness and safety of Jiawei Xuan Bi decoction in the treatment of damp heat paralysis obstructive psoriatic arthritis were observed and analyzed,so as to provide new ideas for the clinical treatment of psoriatic arthritis.MethodsIn this study,64 patients with psoriatic arthritis(damp-heat paralysis type)who met the study criteria were divided into two groups of 32 people in each group.The control group received standard Western medicine,and the treatment group received a combination of Jiawei Xuanbi decoction and Western medicine,and the treatment period of the two groups was set at 12 weeks.The TCM syndrome score,psoriasis lesion area and severity index score(PASI),pain visual analogue score(VAS),CRP and ESR levels were collected and statistically analyzed by SPSS27.0 to evaluate the clinical efficacy and safety of the patients before and after treatment.Results1.Evaluation of efficacy indicators:(1)TCM pattern scores: Before treatment,the two groups showed similar baseline levels in TCM syndrome scores,and there was no significant difference in statistical analysis(P>0.05).After treatment,the TCM pattern scores of the two groups showed a downward trend compared with those before treatment,and there was a statistically significant difference(P<0.05).After treatment,the treatment group was better than the control group(P<0.05)in improving the individual symptom scores of joint swelling and rash,and the treatment group was significantly better than the control group(P<0.01)in improving the total score of TCM syndrome,fever,heavy limbs,dry mouth and bitter mouth,and yellow urine,and the treatment group was comparable to the control group in improving the individual symptom scores of joint pain(P>0.05).(2)PASI score: Before treatment,the baseline level of PASI scores was similar between the two groups,and there was no significant difference in statistical analysis(P>0.05).After treatment,the PASI scores of the two groups were significantly decreased(P<0.05).Compared with the treatment groups,the improvement of PASI total score,PASI upper limb,PASI trunk and PASI lower limb scores in the treatment group was better than that in the control group,with a significant difference(P<0.01),and there was no statistical difference in the improvement of PASI head score between the two groups(P>0.05).(3)VAS score: Before treatment,the baseline level of VAS scores was similar between the two groups,and there was no significant difference in statistical analysis(P>0.05).There was a significant decrease in VAS scores between the two groups(P<0.05).The VAS scores in the treatment group were similar to those in the control group and were not statistically significant(P>0.05).(4)Laboratory indicators: Before treatment,the baseline levels of CRP and ESR were similar between the two groups,and there was no significant difference in statistical analysis(P>0.05).After treatment,there was a significant decrease in CRP level and ESR level between the two groups(P<0.05).The improvement of CRP level in the treatment group was better than that in the control group(P<0.01),and the improvement in ESR level in the treatment group was not significantly different from that in the control group(P>0.05).2.Overall efficacy: The total effective rate of the treatment group was86.67%,and the total effective rate of the control group was 67.74%,and the treatment group was better than the control group,with a statistical difference,P<0.05.3.Safety analysis: After 2 weeks of treatment,one patient in the control group had a slight increase in aminotransferases,which was considered to be caused by irregular work and rest and diet,and improved after short-term symptomatic treatment.After 6 weeks of treatment,10 weeks of treatment,and after the completion of treatment,there were no abnormalities in liver function,renal function,blood routine,and urine routine in the two groups.Two patients in the control group developed nausea and vomiting,and the symptoms disappeared after drug withdrawal,which was a mild adverse reaction.Conclusion1.Jiawei Xuanbi Decoction has a clear effect on improving the clinical symptoms of psoriasis arthritis with damp-heat obstruction,which can reduce the area and degree of skin lesions,improve the symptoms of joint swelling and heat pain,and improve the quality of life.2.The clinical effect of Jiawei Xuanbi decoction combined with methotrexate tablets in the treatment of psoriasis arthritis with damp-heat obstruction is better than that of methotrexate tablets alone.3.Jiawei Xuanbi Decoction combined with methotrexate tablets has no serious adverse reactions during the experiment,which is safe,effective and has good curative effect,and is worth popularizing.更多还原