本文選題：清熱利濕方　切入點：急性痛風性關節(jié)炎　出處：《南京中醫(yī)藥大學》2017年碩士論文

【摘要】：目的:通過文獻研究,探討中醫(yī)學對急性痛風性關節(jié)炎的認識;通過臨床研究觀察清熱利濕方治療急性痛風性關節(jié)炎的濕熱痹阻證患者在中醫(yī)臨床癥狀、證候積分、血沉(ESR)、C反應蛋白(CRP)、血尿酸(UA)等指標的影響,為急性痛風性關節(jié)炎的中醫(yī)藥治療提供有效方藥。方法:本研究采用隨機對照的原則,將符合急性痛風性關節(jié)炎濕熱痹阻證診斷標準的60例患者,隨機分為對照組和治療組各30例。其中,對照組給予基礎治療(生活方式干預、低嘌呤飲食、適當運動)加扶他林治療。扶他林劑量每次75mg,每日2次,疼痛緩解后每日1次。治療組在對照組基礎上加清熱利濕方干預,每日1劑。1周為一療程,觀察2個療程。分別評價兩組治療前后臨床癥狀、血尿酸、血沉、C反應蛋白、中醫(yī)證候療效評分、關節(jié)癥狀相關評價等指標,以及安全性。結果:經過SPSS19.0軟件對兩組患者數(shù)據(jù)進行統(tǒng)計學分析:①總有效率:治療組30例,總有效率96.7%。對照組30例,總有效率70.00%,兩組的比較差異有統(tǒng)計學意義(P0.05)。②在中醫(yī)臨床表現(xiàn)方面,治療組患者治療后與治療前相比都有一定的改善(P0.05或P0.01),說明差異具有統(tǒng)計學意義。組間比較,治療組對中醫(yī)證候的改善顯著優(yōu)于對照組(P0.05)。③對于關節(jié)癥狀相關評價(關節(jié)疼痛VAS評分、關節(jié)腫脹程度評價、關節(jié)活動能力評價、關節(jié)壓痛評分),治療后兩組對關節(jié)癥狀的改善較治療前有顯著差異(P0.05);組間比較,治療組的改善顯著優(yōu)于對照組(P0.05)。④對血尿酸、血沉、C反應蛋白的監(jiān)測,治療后兩組患者血尿酸、血沉、C反應蛋白均明顯降低(P0.05);組間比較,治療組的控制效果明顯優(yōu)于對照組(P0.05)。⑤安全性方面,治療組在研究期間,通過對血尿糞常規(guī),肝腎功能的統(tǒng)計分析,無統(tǒng)計學差異(P0.05),并在治療期間未出現(xiàn)惡心、嘔吐等胃腸道反應,以及皮疹等不良反應。結論:經過本次臨床研究提示清熱利濕方聯(lián)合西藥常規(guī)治療治療急性痛風性關節(jié)炎濕熱痹阻證患者的效果優(yōu)于單純西藥治療,既可改善急性痛風性關節(jié)炎的濕熱痹阻證患者的中醫(yī)臨床癥狀,又可改善關節(jié)相關癥狀,降低了血尿酸、血沉,具有安全,可靠的特點,值得我們臨床中廣泛推廣,并進行下一步深入研究。
[Abstract]:Objective: to explore the understanding of acute gouty arthritis in traditional Chinese medicine (TCM) through literature study, and to observe the clinical symptoms and syndromes of the patients with damp-heat arthralgia syndrome of acute gouty arthritis treated by Qingre Li-shen recipe in traditional Chinese medicine.The effect of erythrocyte sedimentation rate (ESR) C-reactive protein (CRP) and hematuria (UAA) on the treatment of acute gouty arthritis by traditional Chinese medicine (TCM) provides an effective prescription for the treatment of acute gouty arthritis.Methods: 60 patients with acute gouty arthritis were randomly divided into control group (n = 30) and treatment group (n = 30).The control group was treated with basic therapy (lifestyle intervention, low purine diet, appropriate exercise) and Fentalin.The dosage was 75 mg, twice a day, once a day after pain relief.The treatment group in the control group on the basis of Qingre and dampness prescription intervention, 1 dose per day for a course of treatment, observation of two courses.The clinical symptoms, serum uric acid, erythrocyte sedimentation rate C reactive protein (ESR C reactive protein), curative effect score of TCM syndromes, related evaluation of joint symptoms, and safety were evaluated before and after treatment.Results: the total effective rate of the two groups was statistically analyzed by SPSS19.0 software: 30 cases in the treatment group and 96. 7% in the treatment group.There were 30 cases in the control group, the total effective rate was 70.00g. The difference between the two groups was statistically significant in the clinical manifestation of traditional Chinese medicine (TCM). After treatment, the patients in the treatment group improved to a certain extent compared with before treatment (P0.05 or P0.01), which indicated that the difference was statistically significant.There was no significant difference (P 0.05) and no gastrointestinal reactions, such as nausea, vomiting, and rash, were observed during the treatment.Conclusion: after this clinical study, the effect of Qingre Li-li Fang combined with western medicine in the treatment of acute gouty arthritis with damp-heat obstruction syndrome is better than that of western medicine alone.It can not only improve the clinical symptoms of the patients with damp-heat arthralgia and obstruction syndrome of acute gouty arthritis, but also improve the symptoms related to joints, reduce the blood uric acid and erythrocyte sedimentation rate, and have the characteristics of safety and reliability, so it is worth widely popularizing in our clinical practice.And carries on the next step thorough research.
【學位授予單位】：南京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R259

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