干燥综合征中医辨证治疗36例分析(英文)

Analysis of Chinese medicine on differentiation of symptoms and treatment of 36 cases of Sjgre’s syndrome

背景:干燥综合征是老年人常见多发病,由于口干、咽干而影响咀嚼、吞咽和语言等功能,严重影响患者的生活质量。目的:探讨中医辨证施治对干燥综合征患者口腔功能的改善作用。设计:病例回顾分析。单位:解放军第四军医大学口腔医学院牙黏膜病科。对象:选择2000-05/2004-02在解放军第四军医大学口腔医学院牙周黏膜病科门诊就诊的干燥综合征患者36例,均知情同意。男5例,女3例,年龄27～70岁,病程0.5～10年。方法:①在沾润燥热、生津止渴的基础上加活血化瘀、清热解毒的药物方剂:沙参、麦冬、石斛、玉竹、花粉、玄参、生地、陈皮、丹参、半枝莲、白花蛇舌草等。②结合维生素、转移因子治疗。③局部应用人工唾液,防止继发感染。④进行99锝m腮腺功能试验(从肘静脉注入99锝m后即刻描记腮腺摄取和浓集99锝m的曲线,当放射性强度升到最高值时,请患者咀嚼维生素C片剂200mg,继续描记99锝m放射性下降曲线的最低值。正常图像显示清晰,维生素C刺激后显影消退迅速,时间-放射性曲线有明显的摄取及排泄段。阳性结果为腮腺显影模糊,或维生素C刺激后显影消退不明显,时间-放射性曲线呈水平型、低水平型、抛物线型或持续上升型)、血沉(正常值:成年男性0～15mm/h;成年女性0～20mm/h)及部分免疫学检查,如类风湿因子、免疫球蛋白(IgG正常值:7.6～16.6g/L)、免疫复合物等。有效为唾液分泌增加,口腔功能改善。主要观察指标:以99锝m腮腺功能试验、类风湿因子、血沉、IgG、免疫复合物检测中药治疗效果。结果:36例患者全部进入结果分析。①治疗后类风湿因子的阳性率显著低于治疗前犤36.7%,73.3%,(χ2=6.796,P<0.01)犦;血沉及IgG、免疫复合物水平均较治疗前显著降低犤(35.50±5.65)mm/h,(13.47±1.58)g/L(8.30±1.24)mg/L;(55.20±8.85)mm/h,(23.57±2.37)g/L,(14.96±2.21)mg/L(t=3.549～4.962,P<0.01)犦,99锝m腮腺功能试验结果及主要检测指标均有所好转。②治疗后患者口干、眼干及全身症状均有不同程度的改善,唾液分泌增加。总有效率达80.7%。结论:采用中医辨证治疗,在沾润燥热、生津止渴的基础上加用活血化瘀、清热解毒的药物,能够有效地促进干燥综合征患者咀嚼、吞咽和语言等口腔功能的康复。

BACKGROUND： Sjogre＇s syndrome is a common disease of aged people, in which, dry mouth and throat have disturbed thawing, swallowing and speech and have seriously affected living quality of patients. OBJECTIVE： To probe into the improvement of oral function treated with Chinese medicine based on differentiation of symptoms. DESIGN： Retrospective analysis on cases was designed. SETTING： Department of Periodontal Disease, College of Stomatology, Fourth Military Medical University of Chinese PLA. PARTICIPANTS： Thirty-six cases of Sjogre＇s syndrome were selected from clinic of Department of Periodontal Disease of Stomatology College of Fourth Military Medical University of Chinese PLA from May 2000 to February 2004, with agreement and in the know of patients. Of those, 5 cases were male, 31 cases were female, aged varied from 27 to 70 years, with duration of sickness in range from 0.5 to 10 years. METHODS： ① On basis of moistening, drying up heat, producing fluid and stopping thirst, the drugs for activating blood circulation, resolving stasis, clearing away heat and detoxification were supplemented. Formula： shashen （Radix Glehniae）, maidong （Radix Ophiopogonis）, shihu （Herba Dendrobii）, yuzhu （Rhizome Polygonati Odorati）, hugfen （Radix Trichosanthis）, xuanshen （Radix Scrophulariae）, shengdi （Radix Rehmanniae）, chenpi （Pericarpium Citri Reticulatae）, danshen （Radix Salviae Mihiorrhizae）, banzhilian （herba Scutellariae Barbatae）, bahuasheshecao （Herba Hedyotis Dissusae）, etc. ②Treatment of vitamins and transfer factor were associated. ③ Artificial saliva in local was applied to prevent from secondary infection. ④ It was to test ^99Tc^m parotid function （After ^99Tc^m was injected intravenously on elbow, the parotid uptaking and concentrated ^99Tc^m curve were traced immediately. When radioactivity intensity was increased to maximum, the patients were required to chaw Vit. C tablet, 200 mg. In following, it was to trace the minimum of ^99Tc^m radioactivity on decreased curve. Normal imaging was illustrated clearly, the development after Vit. C stimulationwas declined swiftly. Time-radioactivity curve illustrated obvious uptaking and excreting segments. Positive results were unclear parotid development or the development after Vit. C stimulation was not declined obviously. Time-radioactivity curve was of horizontal type, low-horizontal type, parabola type or persistent rising type）, erythrneyte sedimentation （ERS） （Normal value： 0-15 mm/h for male adult, 0-20 mm/h for female adult） and a part of immunology, such as rheumatoid factor, immunoglobulin （IgG normal value： 7.6-16.6 g/L）, immune complex, etc. The effect was determined as increased saliva secretion and improved oral function. MAIN OUTCOME MEASURES： ^99Tc^m parotid function test, rheumatoid factor, ELLS, IgG and immune complex were applied to determine the therapeutic effects of Chinese herbs. RESULTS：Thirty-six cases all entered resuh analysis. ① After treatment, the positive rate of rheumatoid factor was lower significantly compared with that before treatment [36.7%, 73.3%,（X^2=6.796, P 〈 0.01 ）]. The levels of ERS, IgG and immune complex were all decreased significantly compared with those before treatment [（35.50±5.65） mm/h,（13.47±l.58） g/L,（8.30±1.24） mg/L;（55.20±8.85）mm/h,（23.57±2.37） g/L,（14.96±2.21） mg/L; （t=3.549-4.962, P 〈 0.01 ）]. The result of ^99Tcm parotid function test and main determinedindexes had been improved for all. ② After treatment, dry mouth, dry eye and general symptoms were all improved of various degrees and saliva secretion was increased. Total effective rate reached 80.7%. CONCLUSION： Treatment based on differentiation of symptoms is applied in Chinese medicine. On basis of moistening, drying up heat, producing fluid and stopping thirst, the drugs for activating blood circulation, resolving stasis, clearing away heat and detoxification are supplemented and effectively promote rehabilitation of oral function in Sjogre＇s syndrome, such as chawing, swallowing, speech, etc.