补肾强督方辨证配合西医治疗脊柱关节病30例

Bushen Qiangdu Decoction Combined Western Medicine Treatment on Spinal Joint Disease with 30 Cases

目的:观察补肾强督方辨证配合西医治疗脊柱关节病(SpA)的临床疗效及对血清白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)影响。方法:58例SpA患者根据不同的治疗方式分为西药组28例和观察组30例。西药组服用塞来昔布胶囊,0.2 g/次,1次/d,疼痛控制后停用;来氟米特片,20 mg/次,1次/d;柳氮磺吡啶肠溶片,1.0 g/次,2次/d。观察组在西药组治疗的基础上采用补肾强督方进行辨证治疗。两组疗程均为4个月。进行治疗前后巴氏病情活动指数(BASDAI)、巴氏功能活动指数(BASFI)、脊柱痛Likert四级评分及医生的总体评价四级评分;治疗前后关节痛、关节肿胀、附着点痛评分;治疗前后血沉(ESR)、C-反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)检测。结果:观察组治疗后BASDAI,BASFI,Likert和医生的总体评价评分均低于西药组(P<0.01);观察组治疗后关节痛、关节肿胀、附着点痛评分低于西药组(P<0.01);治疗后观察组ESR,CRP,IL-6及TNF-α水平低于西药组(P<0.01);治疗后西药组14例(50%)患者达到强直性脊柱炎评估指标,观察组有19例(63.3%),观察组ASAS50高于西药组,但差异无统计学意义。结论:补肾强督方辨证配合西医治疗脊柱关节病能进一步改善疼痛、肿胀等急性期症状,改善关节和脊柱功能障碍,并具有抗炎和免疫调节作用,能控制疾病活动。

Objective：Observe the clinical effects of Bushen Qiangdu decoction on cure of spinal joint disease （SPA） added western medicine treatment and the serum interleukin-6 （IL-6） and tumor necrosis factor-α （TNF-α）.Method：Fifty-eight patients were divided into western medicine group for （28 cases） and observation group for （30 cases）.For patients in control group took celecoxib capsules,0.2 g/time,1 does/day,stopped as the pain control.Besides they took leflunomide tablets,20 mg/time,1 does/day,sulfasalazine enteric-coated tablets,1.0 g/time,2 does/day.On the basis of western medicine group treatment,observation group used Bushen Qiangdu decoction for dialectical add and subtract treatment.Both groups＇ treatment courses were four months.Conducted PAP disease activity index （BASDAI） Bath ankylosing spondylitis functional index （BASFI）,spinal pain Likert four level score and overall assessment four level score from doctor before and after treatment.Graded joint pain,joint swelling and attachment points pain for pre-therapy and post-treatment.Test erythrocyte sedimentation rate （ESR）,C-reactive protein （CRP）,interleukins-6 （IL-6） and tumor necrosis factor （TNF-α）.Result：After treatment,BASDAI,BASFI,Likert and doctor＇s overall assessment score for observation group were lower than those data in western medicine group （P ＜ 0.01）.Patients in observation group＇ scores of joint pain,joint swelling and attachment points pain were inferior to those data in western medicine group （P ＜0.01）.The level of ESR,CRP,IL-6 and TNF-α for observation group were below to the level in western medicine group after treatment （P ＜ 0.01）.There were 14 patients （50％） reached ankylosing spondylitis activity score-50 （ASAS50） in western medicine group and 19 patients （63.3％） in observation group.ASAS50 in observation group was higher than that in western medicine group.But there was no obvious statistically difference.Conclusion：Syndrome differentiation treatment of Bushen Qiangdu decoction combined with western medicine in treating spondyloarthropathy can ameliorate pain,swelling et acute symptoms.It was able to improve joint and spine dysfunction and had function of anti-inflammatory and immunoregulation.It can western medicine the disease activity.