本文關鍵詞： 烏龍丹 來氟米特 痰瘀痹阻 類風濕關節(jié)炎　出處：《黑龍江中醫(yī)藥大學》2016年碩士論文　論文類型：學位論文

【摘要】：目的：通過對比烏龍丹聯(lián)合來氟米特與旭痹片聯(lián)合來氟米特兩種治療方案治療痰瘀痹阻型類風濕關節(jié)炎的療效差異,從而評價烏龍丹聯(lián)合來氟米特對痰瘀痹阻型類風濕關節(jié)炎的治療效果。方法：篩選60例符合本課題研究方案的痰瘀痹阻型類風濕關節(jié)炎患者,經(jīng)醫(yī)院倫理委員會批準,按照1：1比例,隨機分為治療組(烏龍丹聯(lián)合來氟米特)30例,與對照組(旭痹片聯(lián)合來氟米特)30例,兩組治療周期均為12周。治療前,經(jīng)統(tǒng)計學分析,兩組患者在性別、年齡、病程等方面具有可比性。觀察并記錄第0、12周患者疼痛評價、關節(jié)評價(壓痛數(shù)與腫脹數(shù))、患者對疾病活動性評價、醫(yī)生對疾病活動性評價、體力功能的評價、急性期反應物水平等指標,用以評價ACR20標準的達標情況；觀察并記錄第0、12周患者關節(jié)疼痛程度、關節(jié)腫脹程度、關節(jié)壓痛程度、屈伸不利、汗出、畏惡風寒、腰膝酸軟、晨僵時間等指標,用以評價中醫(yī)證候療效情況；監(jiān)測第0、4、8、12周時血、尿常規(guī),肝、腎功能等安全性指標及可能出現(xiàn)的不良反應。采用ACR20、50、70標準及中醫(yī)證候療效判定標準作為療效評價標準。用以評價烏龍丹聯(lián)合來氟米特對痰瘀痹阻型類風濕關節(jié)炎的治療效果。結果：1疾病療效評價：治療組ACR70達標1例、ACR50達標10例、ACR20達標15例,ACR20未達標4例,總有效率為86.67%；對照組ACR70達標0例、ACR50達標6例、ACR20達標13例,ACR20未達標11例,總有效率為63.33%。治療組優(yōu)于對照組。2中醫(yī)證候療效評價：治療組臨床控制2例、顯效11例、有效15例、無效2例,總有效率為93.33%；對照組臨床控制0例、顯效6例、有效16例、無效8例,總有效率73.33%。治療組優(yōu)于對照組。3 ACR20標準各項指標比較：在改善患者疼痛評價(VAS-1)、關節(jié)評價(壓痛數(shù)與腫脹數(shù))、患者對疾病活動性評價(VAS-2)、醫(yī)生對疾病活動性評價(VAS-3)、體力功能的評價(HAQ)、急性期反應物水平(ESR/CRP)等指標方面,治療組優(yōu)于對照組。4中醫(yī)各癥候評分比較：在改善關節(jié)疼痛程度、關節(jié)腫脹程度、關節(jié)壓痛程度、關節(jié)屈伸不利、汗出、畏惡風寒、腰膝酸軟、晨僵時間等指標方面,治療組優(yōu)于對照組。結論：烏龍丹聯(lián)合來氟米特治療痰瘀痹阻型類風濕關節(jié)炎,在臨床總體療效,改善患者癥狀、體征及急性期反應物水平(ESR/CRP)等方面效果顯著,優(yōu)于旭痹片聯(lián)合來氟米特。
[Abstract]:Objective: to compare the therapeutic effects of Wulongdan combined with leflunomide and Xubi tablet in the treatment of phlegm and stasis obstruction rheumatoid arthritis. To evaluate the therapeutic effect of Wulong Dan combined with leflunomide on rheumatoid arthritis of phlegm and stasis obstruction. Methods: 60 cases of rheumatoid arthritis with phlegm and stasis obstruction were selected. According to the proportion of 1: 1, the patients were randomly divided into treatment group (30 cases with Wulongdan combined with leflunomide) and control group (30 cases with Xubi tablet combined with leflunomide). Before treatment, the two groups were comparable in sex, age, course of disease and so on. The pain evaluation of patients at week 0 was observed and recorded. Evaluation of joint (tenderness and swelling), patients' evaluation of disease activity, doctors' evaluation of disease activity, physical function evaluation, acute reaction level and other indicators. To evaluate the standard of ACR20; To observe and record the degree of joint pain, joint swelling, joint tenderness, unfavorable flexion and extension, perspiration, dread of wind and cold, weakness of waist and knee, time of morning stiffness and so on. To evaluate the curative effect of TCM syndrome; Blood, urine routine, liver and kidney function and possible adverse reactions were monitored at the 12th week of the 4th week. ACR2050 was used. To evaluate the therapeutic effect of Wulong Dan combined with leflunomide in treating rheumatoid arthritis of phlegm and stasis obstruction type. Results the curative effect of Wulong Dan combined with leflunomide on rheumatoid arthritis of phlegm and stasis obstruction type was evaluated. In the treatment group, ACR70 reached the standard in 1 case. The total effective rate of ACR50 was 86.67 with 10 cases of ACR20 meeting the standard of 15 cases of ACR20 and 4 cases of failing to reach the standard of ACR20. In the control group, 0 cases of ACR70 were up to standard and 6 cases of ACR50 were up to standard. 13 cases of ACR20 failed to reach the standard of ACR20 in 11 cases. The total effective rate was 63.33. The therapeutic effect of the treatment group was better than that of the control group (2 cases, 11 cases, 15 cases, 2 cases), and the total effective rate was 93.33%. In the control group, there were 0 cases of clinical control, 6 cases of remarkable effect, 16 cases of effective and 8 cases of ineffective. The total effective rate was 73.33.The treatment group was superior to the control group in the comparison of ACR20 criteria: in improving the pain evaluation of patients with VAS-1, the joint evaluation (number of tenderness and swelling). Patients were evaluated for disease activity (VAS-2), doctors for disease activity (VAS-3) and physical function (HAQ). The treatment group was superior to the control group in comparing the scores of TCM symptoms in improving the degree of joint pain, joint swelling and joint tenderness. The treatment group was superior to the control group in terms of joint flexion and extension, perspiration, dread of evil wind and cold, sore waist and knee, time of morning stiffness and so on. Conclusion: Wulong Dan combined with leflunomide in treating rheumatoid arthritis of phlegm and stasis obstruction type. It was better than Xubi tablet combined with leflunomide in general clinical efficacy, improving symptoms, signs and levels of ESR-CRP in acute phase.
【學位授予單位】：黑龍江中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R593.22

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