中医辨证治疗强直性脊柱炎的临床疗效评价-冯兴华

2013103310CJITWMOctober2013Vol．33No.10·1309·“”(No.2006BAI04A10－3)1.(100053)2.(230038)3.(250014)4.(300192)5.(100091)6.(110032)7.(050082),Tel[phone],[e-mail]10.7661/CJIM.2013.10.1309··1111111123456711ankylosingspondylitisAS。、、、、354AS24asessmentsinankylosingspondylitisASASASAS20、BathBASDAI、BathBASFI、BathBASMI、、、PGA、CCＲPESＲAS。AS24ASAS2086.75%85.47%、BASDAI、BASFI、BASMI、、PGAP＜0.01。、AS。ClinicalEffectAnalysisofAnkylosingSpondylitisTreatedbyChineseMedicalSyndromeDifferentiationFENGXing-hua1,JIANGQuan1,LIUHong-xiao1,WANGHai-long1,HEXia-xiu1,ZHANGHua-dong1,TANGXiao-po1,XUFeng-quan1,LIUJian2,ZHOUCui-ying3,LIUWei4,ZHOUCai-yun5,GAOMing-li6,LIZhen-bin7,JIANGNan1,andCAOWei11Guang'anmenHospital,ChinaAcademyofChineseMedicalSci-ences,Beijing(100053),China2AffiliatedHospitalofAnhuiCollegeofTraditionalChineseMedicine,Hefei(230038),China3AffiliatedHospitalofShandongUniversityofTraditionalChineseMedicine,Jinan(250014),China4FirstTeachingHospital,TianjinUniversityofTraditionalChineseMedicine,Tianjin(300192),China5XiyuanHos-pital,ChinaAcademyofChineseMedicalSciences,Beijing(100091),China6AffiliatedHospitalofLiaoningUniver-sityofTraditionalChineseMedicine,Shenyang(110032),China7BethuneInternationalPeaceHospitalofthePeo-ple'sLiberationArmy,Shijiazhuang(050082),ChinaABSTRACTObjectiveToevaluatethecurativeeffectandsafetyofBushenQiangjiDecoction(BQD)andQingreQiangjiDecoction(QQD)intreatingankylosingspondylitis(AS)patients,andtoverifytheclinicalutilityofASsyndromedifferentiationandtreatmentschemeShen-deficiencyinducedstasisobstructionsyndrome(SDISOS)anddampness-heatobstructionsyndrome(DHOS)beingtwobasicsyndrometypes,Sheninvigoratingbloodactivatingmethod(SIBAM)andheatclearingdampnessresolvingmethod(HCDRM)beingtwobasictreatmentmethods．MethodsTotally354ASpatientsofSDISOSandDHOSwererandomlyassignedtothetreatmentgroupandthecontrolgroupusingamulti-centerrandomized,positivedrugparallel-controlledclinicaltrail.Patientsintreatment·1310·2013103310CJITWMOctober2013Vol．33No.10groupweretreatedbyBQDorQQDaccordingtosyndrometyping,whilethoseinthecontrolgrouptookSulfasalazineenteric-coatedtablet(SECT),24weeksasonetherapeuticcourse.Aftertreatment,theclinicalefficacywasevaluatedbyusingASAS20standard(setbyAsessmentinAnkylosingSpondylitisworkinggroup),Chinesemedicalefficacye-valuationstandards,andBASDAI,BASFI,BASMI,night-painindex,spinalpainindex,PGA,C-reactiveprotein(CRP),anderythrocytesedimentationrate(ESR).ResultsAfter24weeksoftreatmentbyBQDorQQD,ASAS20standardratewas86.75%inthetreatmentgroup,andthetotaleffectiverateofChinesemedicalsyndromewas85.47%.Theycouldsignificantlyreducepatients'integralsofChinesemedicalsyndrome,BASDAI,BASFI,BASMI,night-painindex,spinalpainindex,andPGA(allP0.01).ConclusionsQQDandBQDgotconfirmableclinicaleffectsintreatingAS,providingstrongevidenceofevidence-basedmedicineforsyndromedifferentiationandtreat-mentofAS.KEYWORDSankylosingspondylitisefficacyevaluationsyndromedifferentiationandtreatmentankylosingspondylitisAS、。AS0.35%1。。AS“”、“”2080AS、ASAS。AS、、、、354AS24asessmentinankylosingspondylitisASASASAS20。1AS1984213234Ⅱ～ⅣⅢ～Ⅳ。41～31AS。X0ⅠⅡ、、Ⅲ11、、Ⅳ。《》3AS2。、、、、、、。212318～5045BathBASDAI≥4≥46SASP、MTX、Lef13NSAIDs2。3123。412345、、。2013103310CJITWMOctober2013Vol．33No.10·1311·5123、。635420089—200912、、、、、、AS。2∶123611821181。、1P＞0.05。1x±s234117χ2/t/ZP/188/4697/201．6310．202%5．0970．16518～20239．831613．6820+～309138．895547．0130+～407130．343025．64＞404920．941613．68BASDAI5．52±0．975．40±0．841．9200．058BathBASFI4．56±1．614．26±1．491．6800．094BathBASMI3．11±1．713．18±1．550．3400．7376．65±1．446．59±1．342．0500．0526．22±1．606．06±1．451．8500．061PGA6．03±1．635．75±1．461．5800．11618．05±2．6717．99±2．591．8800．059CCＲPmg/L13．52±18．2614．50±19．950．5530．581ESＲmm/h24．76±22．8426．21±23．440．6470．5187。、15g10g10g10g10g10g10g15g15g15g15g10g10g3g。、10g30g10g10g15g15g15g15g10g15g15g10g。15g10g10g15g15g30g15g15g15g15g10g15g5g25g15g15g5g15g10g。1～2。1300mL1。250mg1.0g2。244、12、24。88.1。8.2、PGAvisualanaloguescaleVAS1。1001～34～67～9100。8.3BASDAI461、、、、。VAS0－10BASDAI=0.2×1+2+3+4+0.5×5+6。8.4BASFI51082VAS0－1010BASFI。8.5BASMI6、－cm、cm、cm、cm0－10BASMI=0.2×。8.6《》3。4、、0、2、4、60、1、2、33、0、1、2、33、·1312·2013103310CJITWMOctober2013Vol．33No.100、1、2、3。4、＞95%、70%～95%、30%～69%、＜30%。－/×100%。8.7ASASASAS20。ASAS20PGA、VAS、BASFI、443≥20%120%7。ASAS20。8.8ESＲCＲPELISA。8.9、ALTCr、BUN。9SAS。x±st。χ2χ2。P＜0.05。1351302352。24、12、24ASAS204720.09%、15566.24%、20386.75%97.69%、4135.04%、7866.67%。χ28.934、15.785、19.709P＜0.01。324、12、24P＜0.0112、24P＜0.01。2x±s23418．05±2．67415．64±3．13*1212．17±3．47＊△247．14±3．81＊△11717．99±2．59416．12±2．84*1213．95±2．91*2411．67±3．56**P＜0．01△P＜0．01434Z=2.245P＜0.0512Z=4.875P＜0.0124Z=7.823P＜0.01。5BASDAI、BASFI、BASMI、、、PGA44、12、24BASDAI、BASFI、、、PGABASMIP＜0.0112、24BASMIP＜0.05P＜0.0112、24BASDAI、BASFI、、、PGAP＜0.0124BAS-MIP＜0.05。3%234400．0000．004117．5219382．484117．521200．0072．9911750．0011047．0112452．9924114．706527．7812452．993414．5320085．47117400．0000．00108．5510791．45108．551200．0010．852924．798774．363025．642400．0021．716353．855244．446555．562013103310CJITWMOctober2013Vol．33No.10·1313·4BASDAI、BASFI、BASMI、、、PGAx±sBASDAIBASFIBASMIPGA234