中医内外合治法治疗强直性脊柱炎的临床疗效分析

Therapeutic Effect of Traditional Chinese Medicine Internal and External Therapies for Ankylosing Spondylitis

【目的】研究中医内外合治法与中医内治法治疗强直性脊柱炎(AS)的临床疗效。【方法】将70例AS患者随机分为观察组和对照组各35例。对照组给予中医辨证法指导中药内治治疗(肾虚瘀阻者口服补肾强脊加减汤,湿热瘀阻者口服清热强脊加减汤),观察组给予中医内外合治法治疗,即在中医辨证指导中药内服治疗的同时,给予中医外治穴位敷贴治疗。观察2组中医主要症状疗效及中医证候总疗效,采用Bath强直性脊柱炎测量指数(BASMI)评估各项指标改善情况,采用生活质量表(HAQ)评价治疗前后2组患者生活质量。【结果】(1)BASMI指标改善情况:除腰椎侧弯改善及腰椎前屈改善与对照组改善差异不大外,观察组的BASMI其他指标改善程度均显著大于对照组(P<0.001)。(2)中医证候总疗效:观察组的总有效率为62.86%,优于对照组的34.29%(P<0.001)。(3)中医主要症状疗效:观察组对晨僵、疼痛夜甚及颈部、胸背、腰骶痛等的改善作用优于对照组(P<0.05)。(4)HAQ量表评估:治疗后4周,2组HAQ分值均显著降低(P<0.001),且观察组的降低作用优于对照组(P<0.05)。【结论】与中医内治法相比,中医内外合治法治疗强直性脊柱炎具有一定优势,能明显缓解颈椎、胸背、腰骶疼痛、疼痛夜甚、晨僵等症状,改善踝间距、颈椎旋转,提高活动能力,改善患者生活质量。

Objective To compare the clinical efficacy of traditional Chinese medicine（TCM）internal and external therapies and TCM internal therapy for ankylosing spondylitis（AS）. Methods A total of 70 AS patients were evenly randomized into observation group and control group. The control group was given TCM internal therapy based on syndrome differentiation：modified Bushen Qiangji Decoction was used for patients with kidney deficiency and blood stasis, and modified Qingre Qiangji Decoction was used for patients with blockage of damp-heat and blood stasis. The observation group was given acupoint application of Chinese medicine on the basis of treatment for the control group. The total effective rate for TCM symptoms and syndromes was investigated in both groups, and we also used the Bath Ankylosing Spondylitis Metrology Index（BASMI）to assess the improvement of indicators, and evaluated the quality of life of two groups before and after treatment with Health Assessment Questionnaire（HAQ）. Results（1）Except for the lumbar scoliosis improvement and lumbar flexion improvement, the observation group had better effect on improving the BASMI than the control group（P〈0.001）.（2）The total effective rate for TCM syndromes was 62.86% in the observation group, and was34.29% in the control group, the difference being significant（P〈0.001）.（3）The observation group had better effect on relieving the main symptoms of morning stiffness,severer pain at night, and pain in the neck,chest and back and lumbosacral region than the control group（P〈0.05）.（4）After treatment for 4 weeks, HAQ scores were decreased in the observation group（P0.001 compared with those before treatment）,and the decrease was superior to that of the control group（P〈0.05）. Conclusion TCM internal and external therapies exert better effect on relieving the main symptoms of morning stiffness, severer pain in the night, and pain in the neck,chest and back and lumbosacral region,and on improving intermalleolar distance,cervical rotation,mobility as well as the quality of life of patients than TCM internal therapy.