中药蒸气浴联合药物口服治疗寒湿痹阻型强直性脊柱炎疗效观察

Clinical Observation on Treatment of Ankylosing Spondylitis with Cold and dampness stagnation type with Chinese medicine steam bath combined with Chinese and Western medicine

目的：通过治疗寒湿痹阻型强直性脊柱炎患者,探究中药蒸气浴联合中西医结合药物治疗的临床疗效与机制,并检测观察血清中程序性死亡受体l（PD-1）、人类白细胞抗原B27（HLA-B27）水平的变化及意义。方法：采用随机对照方法收集2015年3月—2018年3月期间于医院风湿科诊治的寒湿痹阻型强直性脊柱炎患者60例,采用随机数表法将其随机分成对照、观察两组,各30例。对照组患者采用常规中西医结合药物治疗;观察组在对照组治疗基础上联合应用中药蒸气浴进行治疗,治疗两个月后进行临床疗效评估,观察两组患者的治疗有效率、基础实验室指标、中医症状积分、总体疼痛VAS评分、BASDAI、BASFI、BASMI、BAS—G指数改善情况,并检测患者外周血清中HLA-B27、PD-1的水平并比较检测结果的差异情况与病情及疗效的关系。结果：治疗后观察组的总有效率（86.7%）显著高于对照组（63.3%）（P〈0.05）,提示中药蒸气浴联合中西医结合药物治疗可显著提高临床疗效;与治疗前组内及治疗后组间比较,观察组晨僵时间、Schober试验、指地距、疼痛、ESR、CRP等临床基础实验室指标均有显著改善且优于对照组,差异具有统计学意义（P〈0.05）;观察组中医症状积分改善情况明显优于对照组,差异具有统计学意义（P〈0.05）;与治疗前组内及治疗后组间比较,观察组总体疼痛VAS评分、BAS-G、BASMI、BASFI、BASDAI指数等指标均有显著改善且优于对照组,差异具有统计学意义（P〈0.05）;治疗后两组患者血清中PD-1、HLA-B27水平均明显下降,组内及组间比较差异均具有统计学意义（P〈0.05）。结论：运用中药蒸气浴联合中西医结合药物治疗寒湿痹阻型强直性脊柱炎患者可明显提高临床疗效,有效促进中医症状改善及促进临床基础实验室指标、总体疼痛VAS评分、BAS-G、BASMI、BASFI、BASDAI指数的改善,并且临床工作中可以通过血清中HLA-B27、PD-1水平联合检测值的异常变化来预测寒湿痹阻型强直性脊柱炎的病情严重程度与治疗效果,应在临床诊疗中广泛应用。

Objective： To investigate the clinical efficacy and mechanism of traditional Chinese medicine steam bath combined with traditional Chinese and western medicine treatment in patients with ankylosing spondylitis treated by cold-swelling and spasticity,and to detect and detect the programmed death receptor（ PD-1） in human serum. Leukocyte antige The change of B27（ HLA-B27） level and its significance. Methods： Randomized control was used to collect 60 cases of cold-swelling ankylosing spondylitis diagnosed and treated in our department from March 2015 to March 2018. The randomized table was used to randomly divide them into controls and observe. Two groups,each 30 patients. The patients in the control group were treated with traditional Chinese and Western medicines; the observation group was treated with a steam bath of traditional Chinese medicine on the basis of the control group; the clinical curative effect was evaluated after two months of treatment,and the treatment efficiency and basic laboratory indicators of the two groups were observed,TCM symptom scores,overall pain VAS score,BASDAI,BASFI,BASMI,BAS-G index improvement,and detection of HLA-B27,PD-1 levels in peripheral blood of patients and comparison of test results of the difference in condition and efficacy relationship. Results： After treatment,the total effective rate of the observation group（ 86. 7%） was significantly higher than that of the control group（ 63. 3%）（ P 〈0. 05）,suggesting that traditional Chinese medicine steam bath combined with traditional Chinese and Western medicine treatment can significantly improve the clinical efficacy; and before treatment within the group After treatment and between groups,the clinical lab indexes such as morning stiffness,Schober＇s test,finger-pitch,pain,ESR,and CRP were significantly improved in the observation group and were better than those in the control group（ P 〈0. 05）. The improvement of symptoms scores in the observation group was obviously better than that in the control group,and the difference was statistically significant（ P 〈0. 05）. Compared with before and after treatment in the treatment group,the VAS score,BAS-G,BASMI,BASFI,BASDAI index and other indicators of the observation group were significantly improved and better than the control group,the difference was statistically significant（ P 〈0. 05）. After treatment,the levels of PD-1 and HLA-B27 in the serum of the two groups were significantly decreased,and there were significant differences between the two groups（ P 〈0. 05）. Conclusion： The use of traditional Chinese medicine steam bath combined with traditional Chinese and Western medicine treatment of patients with cold spastic ankylosing spondylitis can significantly improve the clinical efficacy,effectively promote the improvement of TCM symptoms and promote the basic clinical laboratory indicators,the overall pain VAS score,BAS-G,The improvement of BASMI,BASFI and BASDAI indices,and the severity of clinical conditions and therapeutic effects of sphincteric spondylitis can be predicted by abnormal changes in serum HLA-B27 and PD-1 levels. Should be widely used in clinical diagnosis and treatment.