右归汤加减治疗肾虚督寒型强直性脊柱炎临床观察

目的:观察右归汤加减治疗肾虚督寒型强直性脊柱炎的疗效及安全性,并探讨其作用机制。方法:将165例肾虚督寒型强直性脊柱炎患者随机分为中药组(52例)、西药组(53例)和中西药组(60例)。中药组给予右归汤加减,西药组给予双氯芬酸钠缓释片,中西药组同时给予右归汤加减和双氯芬酸钠缓释片,疗程均为56 d。观察各组治疗前后活动度衡量指数(BASMI),疾病功能指数(BASFI),放射学指数(BASRI)和中医辨证肾虚督寒型强直性脊柱炎中医证候评分;检测治疗前后血沉(ESR),C-反应蛋白(CRP)和甲状旁腺激素(PHI)的变化;比较各组有效率及不良反应发生率。结果:治疗后中西药组总有效率87.7%,优于中药组的76.5%和西药组的73.5%(P0.05);中药组和西药组比较无统计学差异;中西药组和中药组中医证候评分较西药组改善更为明显(P0.05);中西药组其他临床症状评分均较中药组和西药组改善明显(P0.05),中药组和西药组比较无统计学差异;不良反应的发生率中药组(1.9%)小于中西药组(17.5%),中西药组(17.5%)小于西药组(30.6%)(P0.05)。结论:右归汤加减治疗肾虚督寒型强直性脊柱炎的疗效与西药双氯芬酸钠缓释片无明显差异,具有有效性,且不良反应发生率较双氯芬酸钠缓释片低;右归汤加减结合双氯芬酸钠缓释片治疗肾虚督寒型强直性脊柱炎疗效优于双氯芬酸钠缓释片。

Clinical Effect of Youguitang for Kidney Deficiency and Cold Type Ankylosing Spondylitis

Objective: To explore the therapeutic effect and security of Youguitang in treatment of kidney deficiency cold type ankylosing spondylitis, and investigate its possible mechanism. Method: A total 165 cases with kidney deficiency cold type ankylosing spondylitis were randomly divided into the Chinese medicine group, western medicine group and integrated Chinese and western medicine group. The patients in Chinese medicine group (52 case) were treated with Youguitang; the patients in western medicine group (53 case) were treated with Diclofenac Sodium Sustained Release tablets; and the patients in integrated Chinese and western medicine group (60 cases) received Youguitang and Diclofenac Sodium Sustained Release tablets, with a treatment course of 56 d in all groups. The bath ankylosing spondylitis metroloty index (BASMI), the bath ankylosing spondylitis functional index (BASFI), the bath ankylosing spondylitis irradiation index (BASRI), and traditional Chinese medicine (TCM) syndrome differentiation scores for kidney deficiency cold type ankylosing spondylitis were observed in three groups before and after treatment. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and parathyroid hormone (PHI) were detected before and after treatment; and the effective rate and incidence of adverse reactions were compared in the 3 groups. Result: The total effective rate was 87.7% in integrated Chinese and western medicine group, better than 76.5% in Chinese medicine group and 73.5% in western medicine group (P<0.05), with no statistically significant difference between Chinese medicine group and western medicine group. After treatment, the TCM syndrome scores in integrated Chinese and western medicine group and Chinese medicine group were better than those in western medicine group (P<0.05); the improvement in other clinical symptoms scores in integrated Chinese and western medicine group was better than that in Chinese medicine group and western medicine group (P<0.05), but with no statistically significant difference between Chinese medicine group and western medicine group. In addition, the incidence of adverse reactions in the Chinese medicine group (1.9%)P<0.05). Conclusion: Youguitang treatment had no significant difference with Diclofenac Sodium Sustained Release tablets in the efficacy for kidney deficiency cold type ankylosing spondylitis, and the incidence of adverse reactions in Youguitang recipe treatment was lower than that of Diclofenac Sodium Sustained Release tablets; the combined use of Youoguitang and Diclofenac Sodium Sustained Release tablets had better efficacy than Diclofenac Sodium Sustained Release tablets alone in the treatment of kidney deficiency cold type ankylosing spondylitis.