摘要
目的:观察独活寄生汤加减治疗强直性脊柱炎(AS)肾虚督寒证的临床疗效及对骨代谢指标和肿瘤坏死因子-α(TNF-α),白细胞介素-6(IL-6)等炎症因子的影响。方法:将120例AS患者随机按数字表法分为对照组和观察组各60例。对照组采用美洛昔康片+柳氮磺胺吡啶片治疗。观察组采用独活寄生汤加减内服。两组疗程均为4个月。评价治疗前后脊柱疼痛视觉模拟评分(VAS),巴氏强直性脊柱炎功能指数(BASFI),炎症病情活动指数(BASDAI),胸廓活动度,腰椎活动度(Schober)试验,枕-墙距、臀-地距、"4"字试验和患者整体评分(PGA)和肾虚督寒证评分等指标;检测治疗前后血沉(ESR),C反应蛋白(CRP),TNF-α,IL-6,降钙素(HCT),甲状旁腺激素(PTH),骨碱性磷酸酶(BALP)和骨钙素(BGP)等指标;进行安全性评价。结果:观察组达到AS疗效评价标准20反应(ASAS20)达标率为70.91%,高于对照组的51.79%(χ~2=4.275,P<0.05);观察组ASAS50达标率为54.54%,高于对照组的19.64%(χ~2=14.513,P<0.01);观察组ASAS70达标率为32.72%,高于对照组的8.93%(χ~2=9.566,P<0.01);观察组BASDAI50达标率为50.91%,高于对照组的16.07%(χ~2=15.156,P<0.01);治疗后观察组患者疼痛VAS,BASFI,BASDAI,PGA,"4"字试验评分均低于对照组,枕-墙距、指-地距均短于对照组,胸廓活动度和腰椎活动度均大于对照组(P<0.05,P<0.01);观察组肾虚督寒证评分低于对照组(P<0.01);观察组患者ESR,CRP,TNF-α,IL-6水平均低于对照组(P<0.01);治疗后两组患者PTH水平均下降(P<0.01),组间PTH水平差异无统计学意义;治疗后观察组患者BGP水平高于对照组(P<0.05);观察组的不良反应发生情况少于对照组。结论:采用独活寄生汤加减内服治疗AS肾虚督寒证患者能缓解症状,提高运动活动能力,降低疾病活动度,并能下调炎症因子,防止骨量丢失,临床疗效优于对照组,且副作用少。
Objective： To observe the clinical efficacy of addition and subtraction treatment of Duhuo Jisheng Tang on ankylosing spondylitis（ AS） with kidney deficiency,and investigate its effect on levels of bone metabolism and tumor necrosis factor-α（ TNF-α）,interleukin-6（ IL-6） and inflammatory mediators. Method：One hundred and twenty patients with AS were randomly divided into control group（ 60 cases） and observation group（ 60 cases） by random number table. Patients in control group got meloxicam tablets and sulfasalazine tablets,and the patients in observation group received addition and subtraction treatment of Duhuo Jisheng Tang.The treatment course was 4 months in both groups. Scores of visual analogue scale（ VAS） for spinal pain,bath AS function index（ BASFI）,bath ankylosing spondylitis disease activity index（ BASDAI）,thoracic activity,lumbar vertebra activity（ Schober test）,pillow-wall distance,buttocks-ground distance,＂4 ＂figure test and physicians global assessment（ PGA）,as well as kidney deficiency scores were evaluated and recorded before and after treatment. Before and after treatment,levels of erythrocyte sedimentation rate（ ESR）,C-reactive protein（ CRP）,TNF-α,IL-6,human calcitonin（ HCT）,parathyroid hormone（ PTH）,bone alkaline phosphatase（ BALP） and osteocalcin were detected, and safety was evaluated. Result： The compliance rate of assessment in ankylosingspondylitis 20（ ASAS20） was 70. 91% in observation group,higher than 51. 79% in control group（ χ~2= 4. 275,P〈0. 05）. The compliance rate of ASAS50 was 54. 54% in observation group,higher than 19. 64%in control group（ χ~2= 14. 513,P〈0. 01）. The compliance rate of ASAS70 was 32. 72% in observation group,higher than 8. 93% in control group（ χ~2= 9. 566,P〈0. 01）. The compliance rate of BASDAI50 was 50. 91% in observation group,higher than 16. 07% in control group（ χ~2= 15. 156,P〈0. 01）. Scores of VAS of pain,and BASFI,BASDAI,PGA,＂4＂figure test and physicians global assessment were lower than those in control group,and pillow-wall distance,finger-ground distance were shorter than those in control group,thoracic activity and lumbar activity were larger than those in control group after treatment（ P〈0. 05,P〈0. 01）. Score of kidney deficiency and levels of ESR,CRP,TNF-α,IL-6 in observation group were lower than those in control group（ P〈0. 01）. PTH levels were decreased in two groups（ P〈0. 01）,and there was no statistical significance between two groups. Level of BGP in observation group was higher than that in control group（ P〈0. 01）. Adverse reactions in observation group were less than those in control group. Conclusion： Addition and subtraction treatment of Duhuo Jisheng Tang can relieve symptoms,improve athletic ability,reduce disease activity,downgrade inflammatory factors and prevent loss of bone mass for ankylosing spondylitis. The clinical efficacy was better than that in western medicine treatment,with less side effects.
出处
《中国实验方剂学杂志》
CAS
CSCD
北大核心
2017年第24期202-207,共6页
Chinese Journal of Experimental Traditional Medical Formulae
基金
天津市科学技术研究计划项目(2015JQ4014G)
关键词
强直性脊柱炎
肾虚督寒证
独活寄生汤
骨代谢
炎症因子
ankylosing spondylitis
kidney deficiency
Duhuo Jisheng Tang
bone metabolism
inflammatory factor
