补肾通痹汤联合西药治疗气滞血瘀与肝肾阴虚强直性脊柱炎随机平行对照研究

The Clinical Effect of Bu-shen Tong-pi Tang combined with Western Medicine in Treatment of Ankylosing Spondylitis

[目的]观察补肾通痹汤联合西药治疗气滞血瘀与肝肾阴虚强直性脊柱炎疗效。[方法]使用随机平行对照方法,将80例住院患者按病志号抽签方法分为两组。对照组40例,基础治疗,膳食、运动指导及心理辅导,氮磺胺吡啶,第1周0.25g/次,3次/d,每周递增0.25g,直至1g/次,2次/d;甲氨蝶呤,第1周7.5 mg,第2周10mg,1次/周,口服六个月;叶酸,5mg/次,3次/d(甲氨蝶呤12h后服用);双氯芬酸钠缓释片,75mg/次,2次/d,至症状控制,逐渐减量。治疗组40例补肾通痹汤(熟地、枸杞各30g,桑寄生、当归、威灵仙、桑葚各15g,甘草炙、白芥子、独活、川弓、鸡血藤、牛膝、续断、制川乌各10g,蜈蚣2条;湿热、关节红肿减蜈蚣和川乌,加忍冬藤、银花各30g,黄柏炒10g,防己6g),水煎200m L;第1疗程,1剂/d,早晚温服;第2疗程,隔天1剂;第3疗程,隔两天1剂;西药治疗同对照组。连续治疗60d为1疗程。观测临床症状、腰背部酸痛、晨僵、肌腱及韧带附着痛、肿胀、关节压痛、ESR、CRP、Schober、不良反应。连续治疗3疗程,随访180d,判定疗效。[结果]治疗组临床缓解15例,显效25例,有效8例,无效2例,总有效率96.0%。对照组临床缓解5例,显效15例,有效16例,无效12例,总有效率75.0%。治疗组疗效优于对照组(P<0.05)。ESR、CRP、Schober两组均有改善(P<0.01),治疗组改善优于对照组(P<0.01)。[结论]补肾通痹汤联合西药治疗气滞血瘀与肝肾阴虚强直性脊柱炎,疗效满意,无严重不良反应,值得推广。

[Objective]To observe the clinical effect of Bu-shen Tong-pi Tang combined with western medicine in treatment of ankylosing spondylitis.[Methods]Using random parallel controlled multicenter equivalence method,80 cases of ankylosing spondylitis diagnosed in our hospital were randomly or voluntarily divided into research group（40） and control group（40）.The control group was given foundation treatment,diet,exercise guidance and counseling,nitrogen sulfanilamide pyridine,0.25g/1 time in first time,3 times/d,increasing 0.25 g per week,until 1 g/time,2 times/d;methotrexate,7.5 mg 1 week,2 weeks 10 rag,1 time per week,oral six months;Folic aeid,5mg/second,3b/d（12h after taking methotrexate）;Diclofenac sodium zyban,75 mg/times,2 times/d,to control symptoms,gradually reduced.The treatment group was given kidney tong bi soup（30 g,prepared rhizome of rehmannia,wolfberry fruit,the mulberry parasitism,angelica,radix clematidis,mulberry each 15 g,main licorice root,white mustard,live alone,sichuan bow,caulis spatholobi,twotooth achyranthes root,radix dipsaci,radix aconiti 10 g each,the centipede 2;hot and humid,joint swelling,decrease the centipede and radix aconiti,eaeh 30 g plus honeysuckle stem,honeysuckle,fry cortex phellodendri 10 g,acutum（6g）,200 ml water decoction;1 course of treatment, ltime/d,morning and evening temperature suit;2 period of treatment,the next day 1 agent;3 period of treatment,1 agent every two days;the two group was given continuous treatment of 60d/course of treatment.The clinical symptoms,lower back pain,morning stiffness,tendon and ligament pain,swelling,joint ten derness,ESR,CRP,Schober,adverse reactions were observed.[Result]the treatment group 25 cases were markedly effective,8 cases effective,ineffective in 2 cases,total effective rate was 96.0%.Control group 15 cases were markedly effective,16 8 cases effective,12 cases of invalid,the total effective rate was 75.0%.The effective rate of the research group was significantly higher than those of the control group（P〈0.05）;The biochemical indicators of the research group was significantly better than that of the control group（P〈O.OS）.[Conclusion]The application of Bu-shen Tong-pi Tang combined with western medicine in treatment of ankylosing spondylitis is safe and effective,worthy of clinical promotion.