中医辨证论治联合柳氮磺胺吡啶治疗强直性脊柱炎

摘要

目的：研究中医辨证论治联合柳氮磺胺吡啶治疗强直性脊柱炎（AS ）的效果，探讨中医治疗AS的优势。方法选取2011年8月至2013年8月湖北医药学院附属人民医院收治的AS患者96例，采用随机数字表法将患者分为对照组和试验组，各48例，对照组予柳氮磺胺吡啶治疗，试验组在此基础上予中医辨证论治，4周1个疗程，持续3个疗程。评估临床疗效，行主症状量化评分评估临床症状，Bath 强直性脊柱炎病情活动指数（BASDAI）评估炎性活动，Barh强直性脊柱炎功能指数（BASFI）评估病情，记录临床观察指标，检测红细胞沉积率（ESR）、C反应蛋白（CRP）、肿瘤坏死因子α（TNF‐α）、白介素‐27（IL‐27）的水平。随访患者至2015年8月，中位随访时间为43个月，计算两组复发率。结果试验组治疗总有效率为85.42％，明显高于对照组（64.58％）（ P＜0.05），复发率为4．17％，明显低于对照组（16.67％）（ P＜0.05）；试验组治疗后中医主要症状评分、晨僵时间、指地距、枕墙距、BASDAI、BASFI及ESR、CRP、TNF‐α、IL‐27水平均低于对照组（P＜0.05）。结论中医辨证论治联合柳氮磺胺吡啶治疗AS可减轻自身炎症，缓解临床症状，降低疾病复发率。%Objective To study the effects of syndrome differentiation and treatment of traditional Chinese medicine combined with sulfasalazine in the treatment of ankylosing spondylitis (AS) and to explore the advantages of traditional Chinese medicine in treating AS .Methods Ninety‐six patients with AS admitted to People′s Hospital Affiliated to Hubei University of Medicine between August of 2011 and August of 2013 were selected and divided into the control group and the experiment group by means of random number table ,and each group consisted of 48 cases . The control group was treated with sulfasalazine , while the experiment group was given syndrome differentiation and treatment of Chinese medicine as well as sulfasalazine .4 weeks comprised 1 course of treatment and the treatment consisted of 3 courses of treatment .Then ,the clinical curative effects were evaluated .The main symptoms were quantified and scored to evaluate clinical symptoms .Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was used to evaluate inflammatory activities and Bath Ankylosing Spondylitis Functional Index (BASFI) was used to evaluate the pathogenetic condition .The clinical observation indexes including erythrocyte sedimentation rate (ESR) ,C‐reactive protein (CRP) ,tumor necrosis factor alpha (TNF‐α) ,interleukin‐27 (IL‐27) were recorded .The patients were followed up until August of 2015 and the median time of follow‐ups was 43 months .The recurrence rates in the two groups were recorded .Results The total response rate of the experiment group (84.42% ) was significantly higher than that of the control group (64.48% ) (P<0.05) ,but the recurrence rate of the experiment group (4.17% ) was significantly lower than that of the control group (16.67% ) (P<0.05) .The experiment group was significantly better than the control group after treatment in lumbar and sacral pain ,low back pain ,hypnalgia ,joint function limitation ,degree of morning stiffness ,time of morning stiffness ,finger‐ground distance , occiput‐to‐wall distance , BASDAI , BASFI , ESR , CRP , TNF‐α, and IL‐27 ( P < 0.05 ) . Conclusion The syndrome differentiation and treatment of traditional Chinese medicine combined with sulfasalazine is effective in alleviating inflammation ,relieving clinical symptoms and reducing recurrence rates in the treatment of AS .