自拟益肾通督汤结合柳氮磺胺吡啶与美洛昔康治疗强直性脊柱炎

Yishen-Tongdu decoction combined with sulfasalazine and meloxicam for ankylosing spondylitis

目的评价自拟益肾通督汤结合柳氮磺胺吡啶与美洛昔康治疗强直性脊柱炎（ankylosing spondylitis，AS）的临床疗效。方法纳入86例AS患者并按随机数字表法分观察组和对照组，每组各43例。对照组口服柳氮磺胺吡啶和美洛昔康；观察组在对照组基础上加服自拟益肾通督汤。分别采用Bath强直性脊柱炎功能指数（Bath Ankylosing Spondylitis Functional Index，BASFI）和Bath强直性脊柱炎疾病活动性指数（Bath Ankylosing Spondylitis Disease Activity Index，BASDAI）评价躯体功能和疾病活动性。并检测ESR和血清CRP。结果观察组治疗后BASFI[（3．25±1．18）分比（4．18±0．96）分：t=4．544，P〈0．01]、BASDAI[（2．33±1．46）分比（3．26±1．43）分；t=5．245，P〈0．01]均较对照组显著下降。观察组治疗后血清CRP水平[（8．62±14．71）mg／L比（12．57±16．32）mg／L；t=3．143，P〈0．05]和ESR[（14．93±17．15）mm／h比（18．61±20．98）mm/h；t=3．615，P〈0．05]显著低于对照组。观察组治疗后枕墙距[（2．07±0．59）cm比（2．68±0．69）cm；t=5．332，P〈0．01]、指地距[（12．88±1．92）cm比（13．26±1．71）cm;t=3．593，P〈0．05]、颌柄距[（1．58±0．63）cm比（2．43±0．64）cm；t=4．671，P〈0．01]较对照组显著缩短，胸廓活动度[（4．99±0．73）cm比（4．26±0．68）cm；t=4．226，P〈0．01]、Schober试验[（6．57±0．91）cm比（6．13±0．87）cm；t=3．733，P〈0．01]较对照组显著增大。结论自拟益肾通督汤结合柳氮磺胺吡啶与美洛昔康可改善AS患者的躯体功能和疾病活动性，其疗效优于柳氮磺胺吡啶和美洛昔康治疗。

Objective To evaluate the efficacy of Yishen-Tongdu decoction combined with sulfasalazine and meloxicamin for ankylosing spondylitis（AS）. Methods A total of 86 AS patients were recruited and randomized into an observation group and a control group, 43 in each group. The control group was treated by sulphasalazine and meloxicam, while the observation group was treated by Yishen-Tongdu decoction combined with sulfasalazine and meloxicam. The physical function and the disease activity were measured with the Bath Ankylosing Spondylitis Functional Index （BASFI） and the Bath Ankylosing Spondylitis Disease Activity Index （BASDAI）, respectively. The erythrocyte sedimentation rate （ESR） and serum C-reactive protein （CRP） were determined. Results The BASFI （3.25 1.18 vs. 4.18 ± 0.96; t=4.544, P〈0.01） and BASDAI （2.33 ± 1.46 vs. 3.26 ± 1.43; t=-5.245, P〈0.01） after treatment in the observation group were significantly decreased than those in the control group. Serum CRP level （8.62 ± 14.71 mg/L vs. 12.57 ± 16.32 mg,/L; t=3.143, P〈0.05） and ESR （14.93 ± 17.15 mm/h vs. 18.61 ± 20.98 mm/h; t=3.615, P〈0.05） in the observation group were significantly lower than those in the control group. The occiput-wall distance （2.07 ± 0.59 vs. 2.68 ± 0.69 cm; t=5.332, P〈0.01）, finger-floor distance （12.88 ± 1.92 vs. 13.26 ± 1.71 cm; t=3.593, P〈0.05）, and jaw-sternum distance （1.58 ± 0.63 vs. 2.43 ± 0.64 cm; t=4.671, P〈0.01） in the observation group were significantly decreased than those in the control group, while the chest expansion （4.99 ± 0.73 cm vs. 4.26 ± 0.68 cm; t=4.226, P〈0.01）, and Schober test （6.57 ± 0.91 vs. 6.13 ± 0.87cm; t=3.733, P〈0.01） in the observation group were significantly increased than those in the control group. Conclusion Yishen-Tongdu decoction combined with sulfasalazine and meloxicam can improve the physical function and the disease activity and tts effect is superior to sulfasalazine and meloxicam in patients with AS.