强直性脊柱炎中医治疗方案优化研究

Optimized treatment program for ankylosing spondylitis by traditional Chinese Medicine

目的评价不同中医治疗方案对强直性脊柱炎的临床疗效。方法选取2015年1月～2018年2月江西中医药大学附属医院、南昌大学第一附属医院及南昌大学第二附属医院收治的200例AS患者,随机分为四组,每组50例。中药组给予健脾活血补肾汤,中药联合刮痧组给予健脾活血补肾汤和刮痧治疗,中药联合针灸组采用健脾活血补肾汤和针灸治疗;西药对照组给予柳氮磺胺吡啶治疗,四组疗程均为24周。比较治疗前后四组患者的中医证候积分、总体评价(PGA)、脊柱疼痛评分(VAS)、巴氏强直性脊柱炎病情活动指数(BASDAI)、巴氏强直性脊柱炎功能指数(BASFI)、血沉(ESR)、C-反应蛋白(CRP)水平,并进行临床疗效及安全性评价。结果共185例AS患者完成研究,中药组45例,中药联合刮痧组47例,中药联合针灸组47例,西药对照组46例。四组治疗后的PGA、VAS、BASDAI、BASFI、中医证候积分均较本组治疗前有改善,差异有统计学意义(P <0.05),且中药联合针灸组优于其他三组(P <0.01);治疗后的中药联合针灸组CRP、ESR数值较其他三组显著下降(P <0.05);中药联合针灸组的疗效(包括临床疗效和中医证候疗效)优于中药组、西药组(P <0.05),但与中药联合刮痧组比较无统计学差异(P> 0.05)。结论健脾活血补肾汤联合针灸治疗AS的疗效肯定,优于中药组、中药联合刮痧组及西药组,且无明显不良反应,适合AS患者临床推广应用。

Objective To evaluate the clinical efficacy of different traditional Chinese medicine(TCM)treatment schemes for ankylosing spondylitis(AS).Methods 200 patients with ankylosing spondylitis,who weretreated in the affiliated hospital of Jiangxi university of traditional Chinese medicine,the first affiliated hospital of Nanchang university and the second affiliated hospital of Nanchang University from January 2015 to February 2018,were randomly divided into 4 groups,with 50 cases in each group.Patients in TCM group were treated with Jianpi Huoxue Bushen decoction.Patients in TCM combined with scrapping group were given with Jianpi Huoxue Bushen decoction and scrapping.Patients in TCM combined with acupuncture group applied Jianpi Huoxue Bushen decoction and acupuncture.Patients in the western medicine control group received sulfasalazinetablets.Both groups were treated for24 weeks.Before and after treatment,the four groups of TCM syndrome score,overall evaluation of patients(PGA),spinal column pain(VAS),Bath Ankylosing Spondylitis Disease Activity Index(BASDAI),Bath Ankylosing Spondylitis Functional Index(BASFI),erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)levelswere compared.In addition,the clinical efficacy and safety were evaluated.Results A total of 185 AS patients completed the study,including 45 cases in the TCM group,47 casesin the TCM combined with scrapping group,47 cases in the TCM combined with acupuncture group,and 46 casesin the western medicine control group.Compared to before treatment,the PGA,VAS,BASDAI,BASFI and TCM syndrome scores of the four groups after treatmentwere improved(P<0.01),and the TCM combined acupuncture group were better than the other three groups(P<0.01).After treatment,CRP and ESR values of the TCM combined acupuncture group decreased significantly,compared to the other three groups(P<0.05).The curative effect(including clinical effect and TCM syndrome effect)of the TCM combined acupuncture group were better than the TCM group and the western medicine control group(P<0.05),but there was no statistical difference compared withthe TCM combined scrapping group(P>0.05).Conclusion The therapeutic effect of Jianpi Huoxue Bushen decoction combined with acupuncture in the treatment of AS is positive,superior to the TCM group,the TCM combined with scrapping groupand the western medicine group.This method has no obvious side effects in combination,and is suitable for the clinical application of AS patients.