唾液腺核素动态显象评估益阴活血汤治疗原发性干燥综合征的临床研究

Salivary Gland Radionuclide Dynamic Imaging Used in Efficacy Assessments of Yiyin Huoxue Tang for Primary Sjogren's Syndrome Patients

目的:研究益阴活血汤治疗原发性干燥综合征的安全性和有效性,分析唾液腺核素动态显象技术评估其疗效的临床价值。方法:将筛选得到的原发性干燥综合征患者60例根据病程分层随机化平均分组,对照组(CG)30例患者给予白芍总苷(0.3 g/粒)2粒/次口服,每日2次。试验组(TG)30例患者给予同CG患者相同的白芍总苷治疗,同时联合益阴活血汤每次250 m L,每日2次。治疗3个月后从临床症状评分、实验室检查、唾液腺核素动态显象评估三方面比较评价两组患者的有效率、治愈率、血沉(ESR)、C反应蛋白(CRP)、免疫球蛋白(Ig G、Ig M、Ig A)、抗SSA、抗SSB、类风湿因子(RF)、核抗体(ANA)、Schirmer试验、角膜染色指数,并计算唾液腺相对摄入比(S/T)、腺体摄入率(UR)、酸刺激放射排泄的时间(Tmin)及排泄率(MSR)进行比较。结果 TG有效率为63.33%,CG为30%(P<0.01)。TG患者的口干、眼干等症状积分及实验室检查结果、唾液腺核素动态显象指标显著优于CG患者。TG患者的S/T、UR、MSR显著低于CG患者(P<0.001),Tmin显著长于CG患者,均为(P<0.001)。S/T、UR、MSR、Tmin在腮腺中的灵敏度依次为90%、93.33%、86.66%、83.33%,在颌下腺中的灵敏度依次为90%、90%、80%、83.33%。结论:益阴活血汤能改善原发性干燥综合征患者的主观不适和客观指标,是一种安全且有效的治疗方案,唾液腺核素动态显象评价干燥综合征的治疗效及病情有可靠价值。

Objective： To study the safety and effectiveness of Yiyin Huoxue Tang for primary sjogren＇s syndrome patients and to assess clinical efficacy of salivary gland radionuclide dynamic imaging（SDRDI） used in the disease. Method：60 cases of patients with primary sjogren＇s syndrome screened out were average packed randomly according to stratified disease duration. The control group（CG） 30 patients were given total glucosides of paeony（0. 3 g/tablets） 2 tablets each time orally,twice a day. Test group（TG） 30 patients were given the same treatment and added Yiyin Huoxue Tang250 mL each time,twice a day. After three months,based on clinical symptom scores,laboratory tests and SDRDI,the efficient rate,the cure rate,erythrocyte sedimentation rate（ESR）,C-reactive protein（CRP）,immunoglobulin（IgG,IgM,IgA）,anti-SSA,anti-SSB,rheumatoid factor（RF）,nuclear antibodies（ANA）,Schirmer test and corneal staining index were compared and the relative uptake ratio salivary（S/T）,gland uptake rate（UR）,the acid-sensitive radiation excretion time（Tmin） and the excretion rate（MSR） were calculated. Results： Efficient rate in TG was 63. 33% and in CG was 30%（P〈 0. 01）. Symptom score of dry mouth and dry eyes,laboratory test results and indicators of SDRDI in TG were significantly better than those of CG patients. Values of S/T,UR,MSR in TG were significantly lower than those in CG（P〈 0. 001） while value of Tmin in TG significantly was longer than that in CG（P〈 0. 001）. Sensitivities of S/T,UR,MSR,Tmin of the parotid gland were 90%,93. 33%,86. 66%,83. 33%,and those in the submandibular glands in the order were 90%,90%,80%,83. 33%. Conclusion： The subjective discomfort and objective indicators of primary sjogren＇s syndrome patients can be improved by Yiyin Huoxue Tang,which is a safe and effective treatment option and the effect can be evaluated by SDRDI. It is a reliable and appropriate technology.