薄氏腹针配合药物疗法治疗强直性脊柱炎的临床疗效评价
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摘要
背景
强直性脊柱炎(ankylosing spondylitis, AS)是一种原因不明的慢性炎性疾病,主要侵犯中轴骨,以骶髂关节炎和附着病为其特征。强直性脊柱炎虽大多不会对人的生命造成严重的威胁,但由于患病者可出现明显的腰背部僵硬、疼痛,晚期甚至可发生脊柱强直、畸形,造成严重的躯体功能活动障碍,故给患者带来很大的痛苦,严重影响患者的生存质量。目前尚无可完全治愈的理想方法,是国际上公认的一种难治疾病。
本文回顾了中西医在认识强直性脊柱炎方面的历程,总结了中西医对强直性脊柱炎病因、病机、诊断及药物、针灸作用机理等方面的相关认识及研究,归纳概括了现阶段治疗强直性脊柱炎的主要方法,论述了腹针治疗强直性脊柱炎的理论依据,通过对照实验分析,对腹针治疗强直性脊柱炎的临床疗效做出评价。对今后腹针治疗强直性脊柱炎的临床研究方面提出自己的一些观点和看法。
目的
本课题通过对口服柳氮磺胺吡啶片、双氯芬酸钠缓释片与腹针联合口服柳氮磺胺吡啶片、双氯芬酸钠缓释片这两种方法治疗强直性脊柱炎的临床疗效进行对照观察,应用多项量化指标对两者的疗效进行评价,为日后运用腹针治疗强直性脊柱炎方面的研究及疗效评价体系的建立提供一定的文献依据及数据支持。
研究对象与方法
对广东省中医院珠海医院门诊及住院部患者进行筛选,符合纳入标准的患者共计40名(针药组19名,药物组21名)进行随机对照研究。两组即针药组和药物组均接受西药治疗,即口服双氯芬酸钠缓释片75mg,每日1次；柳氮磺胺吡啶片第1周每次口服0.5g,每日3次,第2周每次口服0.75g,每日3次,第3周起每次口服1.0g,每日3次,维持至3个月治疗结束。针药组在此基础上,加用薄氏腹针进行治疗。基本处方：中脘(D)、下脘(D)、气海(D)、关元(D)、中极(D)、气穴(D)、大横双(M)、外陵双(M)、滑肉门双(M)。下腰椎及骶椎疼痛,根据部位高低加关元上或关元下。合并髋关节疼痛：下风湿内点M(患)。必要时并配合局部定位取穴。手法采用轻刺激,无酸麻胀痛感,但指下有如鱼吞饵之沉紧。施术后留针20-30分钟,针后10分钟左右调针一次。每周一至六连续治疗6天后休息1天,连续治疗3个月。两组的主要疗效观测指标包括疼痛评分、ESR、HSCRP、IgA、IgG、IgM水平、指地距、扩胸距和20m步行时间。将相关数据录入数据库,建立数据库系统,运用相关软件进行统计学分析,最后得出结论。
结果
本研究的数据结果显示：腹针配合药物治疗强直性脊柱炎3个月,对与强直性脊柱炎相关的主要症状、体征及指标,如：疼痛评分、ESR、HSCRP、IgA、IgG、IgM水平、指地距、扩胸距和20m步行时间,都有明显的改善作用,其中在疼痛评分、ESR、IgA水平、指地距、扩胸距及20m步行时间方面腹针配合药物治疗效果更优于单纯药物治疗。腹针配合药物与单纯药物治疗强直性脊柱炎其显著疗效差异有统计学意义。
结论
薄氏腹针配合柳氮磺胺吡啶片、双氯芬酸钠缓释片治疗强直性脊柱炎可以取得良好的疗效。
Background
Ankylosing spondylitis (ankylosing spondylitis, AS) is a chronic inflammatory disease of unknown cause, which mainly violates axial skeleton. It is characterized by sacroiliitis and disease attached. Although most of ankylosing spondylitis will not pose a serious threat to the human life, it brings great suffering to patients, and severe affection of the life quality of patients because of the stiffness, pain, and even spinal rigidity, deformity occurring in the waist and back. It makes serious body dysfunction. There is no satisfactory way to cure this disease completely which is internationally recognized as a refractory disease.
This paper reviewed the cause of Traditional Chinese and Western medicine in understanding AS, summing up the knowledge and research of the etiological factor, pathogenesis, diagnosis and mechanism of drug action. It also generalized the current treatment of AS and discussed the theory evidence of abdominal acupuncture in healing it. Through the analysis of the control experiment, abdominal acupuncture on the clinical effect of AS was evaluated. And I will propose my views and opinions on abdominal acupuncture for future clinical studies of AS in the following passages.
Objective
Through observing the comparison of clinic efficacy of two methods of treating ankylosing spondylitis with oral administration of sulfasalazine tablets, diclofenac sodium sustained-release tablets and abdominal acupuncture combined with oral administration of sulfasalazine tablets, diclofenac sodium tablets, and applying a number of quantizational index to evaluate the curative effect of the two ways mentioned above, this subject aimed to provide literature and data support to establish an efficacy evaluation system and further help the research of the future use of abdominal acupuncture treatment on AS.
Research and Methods
Among the outpatients and inpatients in Zhuhai Branch of Guangdong Provincial Traditional Chinese Medical Hospital,40 cases were selected who were in accord with the inclusion criteria and were divided randomly into two groups with 19 cases in acupuncture combined with drug group and 21 cases in drug group. Drug group were treated with sustained release tablets of diclofenac sodium 75mg, one time per day; sulfasalazine 0.5g per time and 3 times per day for the 1st week,0.75g per time and 3 times per day for the 2nd week,1.0g per time and 3 times per day for the 3rd week and the next three monthsthird week each oral 1.0g, three times a day, to maintain the end of therapy to three monthsthird week each oral 1.0g, three times a day, to maintain the end of therapy to three months until the therapy ends. Acupuncture combined with drug group were treated with Bo's abdominal acupuncture as well as tablets. Basic regimen:Zhongwan (D), Xiawan (D), Qihai (D), Guanyuan(D), Zhongji (D), Qixue (D),Daheng double (M), Wailing double (M), Huaroumen double(M). Pain in the lower lumbar and sacral vertebrae:added Guanyuanshang or Guanyuanxia according to the relevant parts. Pain in the hip:added Xiafengshinei (M). When necessary, treated with point-selection partly at the same time. The manipulation was of light stimulation but heavy and tense, without tingling and painful sensation. Needles were kept for 20-30 minutes and transferred after 10 minutes each time. After consecutive treatment of 6 days every week from Monday to Saturday for 3 months, the course of treatment finished. The main effect indicators used in the two groups included pain score, ESR, HSCRP, IgA, IgG, IgM levels, finger-ground distance, chest stretching distance and the time for 20m walking distance. The relevant data were selected into the database so as to establish a database system. And the statistical analysis software was used to come up with a conclusion.
Results
The data of this study showed that:after the abdominal acupuncture combined with drug treatment for 3 months, the related symptoms, signs and indicators of AS, such as pain score, ESR, HSCRP, IgA, IgG, IgM levels, finger-ground distance, chest stretching distance and the time for 20m walking distance have been improved visibly. From the.indicators of pain score, ESR, IgA levels, finger-ground distance, chest stretching distance and the time for 20m walking distance, we can see that abdominal acupuncture combined with drug treatment has better effect than drug treatment. The significant difference of clinical effect between abdominal acupuncture combined with drug treatment and drug treatment alone was statistically significant.
Conclusion
Bo's Abdominal Acupuncture combined with oral administration of sulfasalazine, diclofenac sodium sustained-release tablets in the treatment of ankylosing spondylitis can get a good effect.
强直性脊柱炎(ankylosing spondylitis, AS)是一种原因不明的慢性炎性疾病,主要侵犯中轴骨,以骶髂关节炎和附着病为其特征。强直性脊柱炎虽大多不会对人的生命造成严重的威胁,但由于患病者可出现明显的腰背部僵硬、疼痛,晚期甚至可发生脊柱强直、畸形,造成严重的躯体功能活动障碍,故给患者带来很大的痛苦,严重影响患者的生存质量。目前尚无可完全治愈的理想方法,是国际上公认的一种难治疾病。
本文回顾了中西医在认识强直性脊柱炎方面的历程,总结了中西医对强直性脊柱炎病因、病机、诊断及药物、针灸作用机理等方面的相关认识及研究,归纳概括了现阶段治疗强直性脊柱炎的主要方法,论述了腹针治疗强直性脊柱炎的理论依据,通过对照实验分析,对腹针治疗强直性脊柱炎的临床疗效做出评价。对今后腹针治疗强直性脊柱炎的临床研究方面提出自己的一些观点和看法。
目的
本课题通过对口服柳氮磺胺吡啶片、双氯芬酸钠缓释片与腹针联合口服柳氮磺胺吡啶片、双氯芬酸钠缓释片这两种方法治疗强直性脊柱炎的临床疗效进行对照观察,应用多项量化指标对两者的疗效进行评价,为日后运用腹针治疗强直性脊柱炎方面的研究及疗效评价体系的建立提供一定的文献依据及数据支持。
研究对象与方法
对广东省中医院珠海医院门诊及住院部患者进行筛选,符合纳入标准的患者共计40名(针药组19名,药物组21名)进行随机对照研究。两组即针药组和药物组均接受西药治疗,即口服双氯芬酸钠缓释片75mg,每日1次；柳氮磺胺吡啶片第1周每次口服0.5g,每日3次,第2周每次口服0.75g,每日3次,第3周起每次口服1.0g,每日3次,维持至3个月治疗结束。针药组在此基础上,加用薄氏腹针进行治疗。基本处方：中脘(D)、下脘(D)、气海(D)、关元(D)、中极(D)、气穴(D)、大横双(M)、外陵双(M)、滑肉门双(M)。下腰椎及骶椎疼痛,根据部位高低加关元上或关元下。合并髋关节疼痛：下风湿内点M(患)。必要时并配合局部定位取穴。手法采用轻刺激,无酸麻胀痛感,但指下有如鱼吞饵之沉紧。施术后留针20-30分钟,针后10分钟左右调针一次。每周一至六连续治疗6天后休息1天,连续治疗3个月。两组的主要疗效观测指标包括疼痛评分、ESR、HSCRP、IgA、IgG、IgM水平、指地距、扩胸距和20m步行时间。将相关数据录入数据库,建立数据库系统,运用相关软件进行统计学分析,最后得出结论。
结果
本研究的数据结果显示：腹针配合药物治疗强直性脊柱炎3个月,对与强直性脊柱炎相关的主要症状、体征及指标,如：疼痛评分、ESR、HSCRP、IgA、IgG、IgM水平、指地距、扩胸距和20m步行时间,都有明显的改善作用,其中在疼痛评分、ESR、IgA水平、指地距、扩胸距及20m步行时间方面腹针配合药物治疗效果更优于单纯药物治疗。腹针配合药物与单纯药物治疗强直性脊柱炎其显著疗效差异有统计学意义。
结论
薄氏腹针配合柳氮磺胺吡啶片、双氯芬酸钠缓释片治疗强直性脊柱炎可以取得良好的疗效。
Background
Ankylosing spondylitis (ankylosing spondylitis, AS) is a chronic inflammatory disease of unknown cause, which mainly violates axial skeleton. It is characterized by sacroiliitis and disease attached. Although most of ankylosing spondylitis will not pose a serious threat to the human life, it brings great suffering to patients, and severe affection of the life quality of patients because of the stiffness, pain, and even spinal rigidity, deformity occurring in the waist and back. It makes serious body dysfunction. There is no satisfactory way to cure this disease completely which is internationally recognized as a refractory disease.
This paper reviewed the cause of Traditional Chinese and Western medicine in understanding AS, summing up the knowledge and research of the etiological factor, pathogenesis, diagnosis and mechanism of drug action. It also generalized the current treatment of AS and discussed the theory evidence of abdominal acupuncture in healing it. Through the analysis of the control experiment, abdominal acupuncture on the clinical effect of AS was evaluated. And I will propose my views and opinions on abdominal acupuncture for future clinical studies of AS in the following passages.
Objective
Through observing the comparison of clinic efficacy of two methods of treating ankylosing spondylitis with oral administration of sulfasalazine tablets, diclofenac sodium sustained-release tablets and abdominal acupuncture combined with oral administration of sulfasalazine tablets, diclofenac sodium tablets, and applying a number of quantizational index to evaluate the curative effect of the two ways mentioned above, this subject aimed to provide literature and data support to establish an efficacy evaluation system and further help the research of the future use of abdominal acupuncture treatment on AS.
Research and Methods
Among the outpatients and inpatients in Zhuhai Branch of Guangdong Provincial Traditional Chinese Medical Hospital,40 cases were selected who were in accord with the inclusion criteria and were divided randomly into two groups with 19 cases in acupuncture combined with drug group and 21 cases in drug group. Drug group were treated with sustained release tablets of diclofenac sodium 75mg, one time per day; sulfasalazine 0.5g per time and 3 times per day for the 1st week,0.75g per time and 3 times per day for the 2nd week,1.0g per time and 3 times per day for the 3rd week and the next three monthsthird week each oral 1.0g, three times a day, to maintain the end of therapy to three monthsthird week each oral 1.0g, three times a day, to maintain the end of therapy to three months until the therapy ends. Acupuncture combined with drug group were treated with Bo's abdominal acupuncture as well as tablets. Basic regimen:Zhongwan (D), Xiawan (D), Qihai (D), Guanyuan(D), Zhongji (D), Qixue (D),Daheng double (M), Wailing double (M), Huaroumen double(M). Pain in the lower lumbar and sacral vertebrae:added Guanyuanshang or Guanyuanxia according to the relevant parts. Pain in the hip:added Xiafengshinei (M). When necessary, treated with point-selection partly at the same time. The manipulation was of light stimulation but heavy and tense, without tingling and painful sensation. Needles were kept for 20-30 minutes and transferred after 10 minutes each time. After consecutive treatment of 6 days every week from Monday to Saturday for 3 months, the course of treatment finished. The main effect indicators used in the two groups included pain score, ESR, HSCRP, IgA, IgG, IgM levels, finger-ground distance, chest stretching distance and the time for 20m walking distance. The relevant data were selected into the database so as to establish a database system. And the statistical analysis software was used to come up with a conclusion.
Results
The data of this study showed that:after the abdominal acupuncture combined with drug treatment for 3 months, the related symptoms, signs and indicators of AS, such as pain score, ESR, HSCRP, IgA, IgG, IgM levels, finger-ground distance, chest stretching distance and the time for 20m walking distance have been improved visibly. From the.indicators of pain score, ESR, IgA levels, finger-ground distance, chest stretching distance and the time for 20m walking distance, we can see that abdominal acupuncture combined with drug treatment has better effect than drug treatment. The significant difference of clinical effect between abdominal acupuncture combined with drug treatment and drug treatment alone was statistically significant.
Conclusion
Bo's Abdominal Acupuncture combined with oral administration of sulfasalazine, diclofenac sodium sustained-release tablets in the treatment of ankylosing spondylitis can get a good effect.
引文
[1]万学文.针罐结合治疗强直性脊柱炎临床观察[J].中国针灸,2005；25(8)：551-552.
[2]曾庆馀.关于强直性脊柱炎的早期诊断[J].中华风湿病学志,2000；4(2)：69-71.
[3]杨秀惠,郭向芳.强直性脊柱炎中医治疗进展[J].实用中医药杂志,2006；22(6)：386-387.
[4]卓鹰,黄泳.薄氏腹针配合药物治疗强直性脊柱炎32例[J].中国临床康复,2006；10(11)：140-141.
[5]Gu MM, Yuan WT, Yang JQ, et al. A genomewide scan for the susceptibility gene loci to ankylosing spondylitis in Chinese population. Acta Genetica Sinica,2004; 3:217-220.
[6]Brown MA, Kennedy LG, Macgtegor AJ, et o2. Susceptibility to ankylosing spo ndylitis in twins-The role of genes. HLA, and the envimnment. Arthritis Rheum,1997; 40:1823-1828.
[7]马海军,扈凤平.强直性脊柱炎遗传因素研究进展[J].中南大学学报学版.2005；30(3)：352-353.
[8]李维,昊强.HLA-B27亚型及其与强直性脊柱炎关系的研究进展[J].免疫学杂志.2002；18(3)：191-194.
[9]Liu Y, Li J, Chen B, et al. Familial aggregation ankylosing spondylitis in southern China [J]. J Rheumatol,2001; 28(3):550-553.
[10]Rubin LA et al. Arthritis Rheum,1994; 37:1212-1220.
[11]Brown M et al. Arthritis Rheum,1998; 41:588-595.
[12]Robinson WP, van der Linden SM, Rentsch HU, et al. HLA-B60 increases susceptibility to ankylosing spondylitis in HLA-B27+patients. Arthritis Rh eum,1991; 34:241-248.
[13]Wei JC, Tsai WC, Lin HS, et al. HLA-B60 and B61 are slronSly associated witll an kylosing spondylitis in HLA-B27-negive Taiwan Chinese patients. Rh eumatolohy,2004; 43:839-842.
[14]Brown M et al. Arthritis Rheum,1998; 41:460-465.
[15]Maksymowych WP, Tao S, Li Y, et al. Allelic variation at the TAP1 locus influences disease phenotype in HLA-B27 positive individuals with ankylosing spondylitis. Tissue Antigens,1995; 45:328-332.
[16]Vargas-Alarcon G, Gamboa R, Zuniga J, et al. Association study of LMP gene polymorphisms in Mexican patients wim spondyloarthritis. Hum Immunol, 2004; 65:1437-1442.
[17]Tsuchiya N et al. Arthritis Rheum,1998; 41:68-73.
[18]Yzbuki K et al. Hum Immunol,1999; 60:83-86.
[19]郭忠慧等.中华风湿病学杂志,1999；3(增刊)：4-7.
[20]Fraile A, Nieto A, Mataran L, et al. HSPTO gene polymorphisms in ankylosing spondylitis. Tissue Antigens,1998,51:382-385.
[21]De Juan MD et al. Tissue Antigens,1999; 53(2):161-166.
[22]蒋黎华等.中华风湿病学杂志,1998；2(4)：235-236.
[23]Brown M et al. Br J Rheumatol,1998; 37:454-458.
[24]Braunl J. Therapy for ankylosing spondylitis:new the rapeutic modalities [J]. BestPract Res Clin Rheunmtol,2002; 16(4):631-632.
[25]KHAN M. A current perspective on ankylosing spondylitis and related spondyloarthropathies[J]. IndRheum Asso,1999; 7(1):16.
[26]伊智雄.中西医结合治疗强直性脊柱炎[M].北京：人民卫生出版社,2008；90-91.
[27]Martinez Borrra J, Gonzaiez S, Lopez Vazquze A, et al. HLA-B27 alone rathar-than B27-related class I haplotypes contributes to ankyloseing spondylitis susceptibility[J]. Hum Immunol,2000; 61(2):131-139.
[28]Allen RL, Bowness P, McMicheal AJ. The role of HLA-B27 in spondyloarthritis [J]. Immunogenetics,1999; 50(3,4):220-227.
[29]Khare SD, Lee S, Bull MJ, et al. Peptide bingding a2 domain of HLA-B27 in contributes to the disease pathogenesis in tranagenic mice[J]. Hum Immunol, 1999; 60(2):116-126.
[30]Ebringer RW et al. Sequential studies in ankylosing spondylitis[J]. Association of Klebsiella pneumoniac with active disease, Ann Rheum Dis, 1978; 31:146.
[31]Yu DTY. Experimental sludies of infectious agents in reactive arthritis. In, Espiooza L, el al. edu. Infections in the rheumatic diseases. Orlando, Grnne & Stratton.1988; 287-302.
[32]Schwimmheck PL et al. Autoantibodies to HLA-B27 in the sera of HLA-B27 positive patients with ankylosing spondylitis and Reiter's syndrome [J]. Molecular mimiory with Klebsiella pneumoniac as potential mechanism of autoimmune disease. J Exp Med,1987; 166-173.
[33]Husby G. et al. Cross-reactive epitope with Klebsiella pneumoniae mtrogenase in articular tissue of HLA-B27+ patients with ankylosing spondylitis[J]. Arthritis Rheum,1989; 32-437.
[34]Ball J, Path FRC. Articular pathology of ankylosing spondylitis Clin3 Orthop,1979; 46:353.
[35]Kidd BL. Immunohistogical features of svnovins in ankylosing spondylitis camparison with rheumatoid arthritis. Ann Rheum Dis,1989; 48:92.
[36]Ball J. Enthesopathy of rheumatoid and ankylosing spondylitis. Ann Rheum Dis,1971; 30:213.
[37]崔儒涛.崔学增治疗强直性脊柱炎经验[J].中医杂志,1999；40(11)：655-656.
[38]随孝忠,于文青.补肾祛寒活络汤治疗早期强直性脊柱炎50例[J].新中医,1995：27(11)：362.
[39]刘继刚,焦树德.治疗强直性脊柱炎的经验介绍[J].贵阳中医学院学报,2002；24(3)： 14.
[40]姜萍.尹玉茹治疗强直性脊柱炎经验[J].河南中医,1998；18(3)：1.
[41]周正球.强直性脊柱炎辨治要法[J].江苏中医,1998；19(11)：436.
[42]朱辉,莫成荣.治疗强直性脊柱炎的经验[J].辽宁中医杂志,2004；3(10)：84.
[43]陆肇中.强直性脊柱炎辨证论治体会[J].天津中医,1996；13(3)：19.
[44]齐岩,王为兰.益肾通督方治疗强直性脊柱炎的临床与实验研究[J].北京中医,1995： (6)：12.
[45]陈肃标.强直性脊柱炎骶髂关节的应用解剖学[J].实用医学杂志,2002；18(2)：112-115.
[46]陈洁,许建荣,华小兰,等.强直性脊柱炎骶髂关节病变的CT特点[J].临床放射学杂志,2005；24(7)：621-623.
[47]盛华强,赵斌.强直性脊柱炎早期骶髂关节病变的MRI研究[J].医学影像学杂志,2007；17(2)：203-205.
[48]鲁琳,周伟生.强直性脊柱炎的影像学研究进展[J].医学影像学杂志,2005；15(4)：322-325.
[49]范仰刚,李国华.多个炎症指标在强直性脊柱炎活动性评价中的价值实用[J].实用临床医学,2006；7(1)：18-20.
[50]郝桂珍,自淑红.中西医结合治疗强直性脊柱炎45例[J].实用中西医结合杂志,1996；9(11)：677.
[51]林昌松,陈纪藩.治疗强直性脊柱炎经验[J].新中医,2001；33(2)：10.
[52]郭艳辛,郭维淮.治疗强直性脊柱炎经验[J].中国中医骨伤科杂志,1997；26 (7) ： 24.
[53]夏俊杰,朱晓鸣.治疗强直性脊柱炎经验[J].湖北中医杂志,1997；19(6)：10-11.
[54]袁福林.辨证治疗强直性脊柱炎20例报告[J].中医正骨,2001；13(3)：34.
[55]张思胜.中药辨证内服外用结合实际手法治疗强直性脊柱炎[J].安徽中医临床杂,2002；14(3)：195.
[56]陈丽华.强直性脊柱炎的中医辨证治疗及护理[J].河南中医药学刊,2001；16(4) ： 48.
[57]续青.强直性脊柱炎辨治体会[J].中国基层医药,2001；8(5)：441.
[58]姜泉.中医分期治疗强直性脊柱炎的临床研究[J].中医正骨,2001；13(12)：31.
[59]关彤.辨证分型治疗强直性脊炎热33例疗效观察[J].湖南中医杂志,2001；17(3) ： 14.
[60]潘中恒.中药配合手法治疗强直性脊柱炎76例[J].中医正骨,2001；13(3)：25.
[61]栾炯,李玮玮.强直性脊柱炎72例辨证论治[J].浙江中医杂志,1994；29(2)：65.
[62]邱志济,朱建平.朱良春治疗强直性脊柱炎用药特色选析—著名老中医学家朱良春教授临床经验系列之二十三[J].辽宁中医杂志,2001；28(11)：656-657.
[63]王政,陈湘君.治疗强直性脊柱炎经验[J].辽宁中医杂志,2000；27(5)：196.
[64]方汉文,柴良晖.中医药治疗强直性脊柱炎33例临床体会[J].中华现代中西医杂志,2004;2(9)：811-812.
[65]陈永斌.辨证论治AS21例疗效观察[J].广西医科大学学报,1997；14(1)：106-107.
[66]李和平.以痛为输报刺法治疗强直性脊柱炎[J].针灸临床杂志,2002；18(4)：37.
[67]勾祥辉,刘思明.银质针治疗强直性脊柱炎[J].中医骨伤,2000；13(5)：317.
[68]周燕媛.针刺治疗强直性脊柱炎15例[J].中国针灸,1999；3：166.
[69]佟琳娜,牛燕波.温针治疗强直性脊柱炎25例[J].中国民间疗法,1998；2：9.
[70]段莉,黎沛环,李鹏.手法大针中药外敷联合应用治疗强直性脊柱炎[J].包头医学,1999；23(3)：124.
[71]袁志太.针刺夹脊穴配合推拿治疗强直性脊柱炎23例[J].上海针灸杂志,2003；22(16)：35.
[72]李莉,易荣,姚岚.腹针配合隔药灸治疗强直性脊柱炎疗效观察[J].中国中医 药咨讯,2010;14(2)：123.
[73]胡军勇,陈金亮.从奇络治疗强直性脊柱炎60例临床观察[J].光明中医,2001；16(96) ： 26.
[74]高广忠,马小平.穴位埋线治疗强直性脊柱炎50例临床分析[J].四川中医,2003；21 (5) ： 78.
[75]伦新,李万瑶,林剑鸣.蜂针治疗强直性脊柱炎30例[J].四川中医,2000；18(2) ： 41.
[76]苏建业,张东安.小针刀治疗强直性脊柱炎[J].中医外治杂志,1995；4：31.
[77]李邦雷,李征.针刀与短波治疗强直性脊柱炎94例[J].中国针灸,2006；26(7)：501.
[78]罗健,孔令深,黄柳和等.挑筋疗法治疗强直性脊柱炎25例疗效观察[J].新中医,2000；32(4)：22.
[79]陈有国.重刺络放血为主治疗强直性脊柱炎50例[J].江苏中医药,2002；23(7)：35.
[80]高猛,刘源香.火针并电针治疗强直性脊柱炎117例[J].山东中医杂志,1997；16(7) ： 310.
[81]王秋云.火针为主治疗强直性脊柱炎外周关节肿12例[J].江苏中医药,2005；26(1) ： 20.
[82]马文龙,陈金亮,胡军勇.针药并用治疗强直性脊柱炎108例[J].针灸临床杂志,2000;16(9)：13.
[83]李熳,施静,刘晓春等.电针对大鼠针刺穴位穴旁和炎性痛病灶皮下肥大细胞数量的影响[J].中国针灸,2003；23(10)：597.
[84]方秀斌.神经肽和神经营养因子[M].人民卫生出版社,2000；1：9.
[85]赵仓焕,王虹英,杨介宾.电针对佐剂性关节炎大鼠脾细胞IL-1和IL-2活性的影响[J].上海针灸杂志,2001；2：34.
[86]曹东元,牛汉璋,赵曼.穴位刺激初级传入反射引起SP释放[J].中国针灸,2001；21 (10) ： 16.
[87]赵仓顺,杨介宾,宋开源.电针对佐剂性关节炎大鼠炎症局部EP LEK含量的影响[J].中国中医基础医学杂志,1999；5：58.
[88]朱月伟,陈肖燕,韩杭生等.铺灸对类风湿性关节炎患者免症功能的影响.上海针灸杂志,1991；10(1)：1.
[89]李世光,赵俊萍,岳目娥等.温针疗法对类风湿性关节炎患者免疫调节的影响.中国康复医学杂志,1994；9(5)：212.
[90]李世光,赵俊萍,岳片娥等.温针疗法对类风湿性关节炎患者免疫调节IL-2分泌细胞及NK细胞.中国康复医学杂志,1996；11(1)：30.
[91]孙丽琴,刘心莲等.针灸治疗类风湿关节炎434例疗效观察.中国针灸,1992；12 (1) ： 9.
[92]张金达,管遵惠,管遵信等.针灸调整体液免疫的实验研究.云南中医杂志,1993；13(5) ： 22.
[93]吴飞,纪青山,王庆等.针刺治疗类风湿关节炎105例临床观察.辽宁中医杂志,1990;14(9)：41.
[94]陈汉平,翟道荡.关于针灸免疫研究思路的探讨[J].上海针灸杂志,1991；10(1) ： 35.
[2]曾庆馀.关于强直性脊柱炎的早期诊断[J].中华风湿病学志,2000；4(2)：69-71.
[3]杨秀惠,郭向芳.强直性脊柱炎中医治疗进展[J].实用中医药杂志,2006；22(6)：386-387.
[4]卓鹰,黄泳.薄氏腹针配合药物治疗强直性脊柱炎32例[J].中国临床康复,2006；10(11)：140-141.
[5]Gu MM, Yuan WT, Yang JQ, et al. A genomewide scan for the susceptibility gene loci to ankylosing spondylitis in Chinese population. Acta Genetica Sinica,2004; 3:217-220.
[6]Brown MA, Kennedy LG, Macgtegor AJ, et o2. Susceptibility to ankylosing spo ndylitis in twins-The role of genes. HLA, and the envimnment. Arthritis Rheum,1997; 40:1823-1828.
[7]马海军,扈凤平.强直性脊柱炎遗传因素研究进展[J].中南大学学报学版.2005；30(3)：352-353.
[8]李维,昊强.HLA-B27亚型及其与强直性脊柱炎关系的研究进展[J].免疫学杂志.2002；18(3)：191-194.
[9]Liu Y, Li J, Chen B, et al. Familial aggregation ankylosing spondylitis in southern China [J]. J Rheumatol,2001; 28(3):550-553.
[10]Rubin LA et al. Arthritis Rheum,1994; 37:1212-1220.
[11]Brown M et al. Arthritis Rheum,1998; 41:588-595.
[12]Robinson WP, van der Linden SM, Rentsch HU, et al. HLA-B60 increases susceptibility to ankylosing spondylitis in HLA-B27+patients. Arthritis Rh eum,1991; 34:241-248.
[13]Wei JC, Tsai WC, Lin HS, et al. HLA-B60 and B61 are slronSly associated witll an kylosing spondylitis in HLA-B27-negive Taiwan Chinese patients. Rh eumatolohy,2004; 43:839-842.
[14]Brown M et al. Arthritis Rheum,1998; 41:460-465.
[15]Maksymowych WP, Tao S, Li Y, et al. Allelic variation at the TAP1 locus influences disease phenotype in HLA-B27 positive individuals with ankylosing spondylitis. Tissue Antigens,1995; 45:328-332.
[16]Vargas-Alarcon G, Gamboa R, Zuniga J, et al. Association study of LMP gene polymorphisms in Mexican patients wim spondyloarthritis. Hum Immunol, 2004; 65:1437-1442.
[17]Tsuchiya N et al. Arthritis Rheum,1998; 41:68-73.
[18]Yzbuki K et al. Hum Immunol,1999; 60:83-86.
[19]郭忠慧等.中华风湿病学杂志,1999；3(增刊)：4-7.
[20]Fraile A, Nieto A, Mataran L, et al. HSPTO gene polymorphisms in ankylosing spondylitis. Tissue Antigens,1998,51:382-385.
[21]De Juan MD et al. Tissue Antigens,1999; 53(2):161-166.
[22]蒋黎华等.中华风湿病学杂志,1998；2(4)：235-236.
[23]Brown M et al. Br J Rheumatol,1998; 37:454-458.
[24]Braunl J. Therapy for ankylosing spondylitis:new the rapeutic modalities [J]. BestPract Res Clin Rheunmtol,2002; 16(4):631-632.
[25]KHAN M. A current perspective on ankylosing spondylitis and related spondyloarthropathies[J]. IndRheum Asso,1999; 7(1):16.
[26]伊智雄.中西医结合治疗强直性脊柱炎[M].北京：人民卫生出版社,2008；90-91.
[27]Martinez Borrra J, Gonzaiez S, Lopez Vazquze A, et al. HLA-B27 alone rathar-than B27-related class I haplotypes contributes to ankyloseing spondylitis susceptibility[J]. Hum Immunol,2000; 61(2):131-139.
[28]Allen RL, Bowness P, McMicheal AJ. The role of HLA-B27 in spondyloarthritis [J]. Immunogenetics,1999; 50(3,4):220-227.
[29]Khare SD, Lee S, Bull MJ, et al. Peptide bingding a2 domain of HLA-B27 in contributes to the disease pathogenesis in tranagenic mice[J]. Hum Immunol, 1999; 60(2):116-126.
[30]Ebringer RW et al. Sequential studies in ankylosing spondylitis[J]. Association of Klebsiella pneumoniac with active disease, Ann Rheum Dis, 1978; 31:146.
[31]Yu DTY. Experimental sludies of infectious agents in reactive arthritis. In, Espiooza L, el al. edu. Infections in the rheumatic diseases. Orlando, Grnne & Stratton.1988; 287-302.
[32]Schwimmheck PL et al. Autoantibodies to HLA-B27 in the sera of HLA-B27 positive patients with ankylosing spondylitis and Reiter's syndrome [J]. Molecular mimiory with Klebsiella pneumoniac as potential mechanism of autoimmune disease. J Exp Med,1987; 166-173.
[33]Husby G. et al. Cross-reactive epitope with Klebsiella pneumoniae mtrogenase in articular tissue of HLA-B27+ patients with ankylosing spondylitis[J]. Arthritis Rheum,1989; 32-437.
[34]Ball J, Path FRC. Articular pathology of ankylosing spondylitis Clin3 Orthop,1979; 46:353.
[35]Kidd BL. Immunohistogical features of svnovins in ankylosing spondylitis camparison with rheumatoid arthritis. Ann Rheum Dis,1989; 48:92.
[36]Ball J. Enthesopathy of rheumatoid and ankylosing spondylitis. Ann Rheum Dis,1971; 30:213.
[37]崔儒涛.崔学增治疗强直性脊柱炎经验[J].中医杂志,1999；40(11)：655-656.
[38]随孝忠,于文青.补肾祛寒活络汤治疗早期强直性脊柱炎50例[J].新中医,1995：27(11)：362.
[39]刘继刚,焦树德.治疗强直性脊柱炎的经验介绍[J].贵阳中医学院学报,2002；24(3)： 14.
[40]姜萍.尹玉茹治疗强直性脊柱炎经验[J].河南中医,1998；18(3)：1.
[41]周正球.强直性脊柱炎辨治要法[J].江苏中医,1998；19(11)：436.
[42]朱辉,莫成荣.治疗强直性脊柱炎的经验[J].辽宁中医杂志,2004；3(10)：84.
[43]陆肇中.强直性脊柱炎辨证论治体会[J].天津中医,1996；13(3)：19.
[44]齐岩,王为兰.益肾通督方治疗强直性脊柱炎的临床与实验研究[J].北京中医,1995： (6)：12.
[45]陈肃标.强直性脊柱炎骶髂关节的应用解剖学[J].实用医学杂志,2002；18(2)：112-115.
[46]陈洁,许建荣,华小兰,等.强直性脊柱炎骶髂关节病变的CT特点[J].临床放射学杂志,2005；24(7)：621-623.
[47]盛华强,赵斌.强直性脊柱炎早期骶髂关节病变的MRI研究[J].医学影像学杂志,2007；17(2)：203-205.
[48]鲁琳,周伟生.强直性脊柱炎的影像学研究进展[J].医学影像学杂志,2005；15(4)：322-325.
[49]范仰刚,李国华.多个炎症指标在强直性脊柱炎活动性评价中的价值实用[J].实用临床医学,2006；7(1)：18-20.
[50]郝桂珍,自淑红.中西医结合治疗强直性脊柱炎45例[J].实用中西医结合杂志,1996；9(11)：677.
[51]林昌松,陈纪藩.治疗强直性脊柱炎经验[J].新中医,2001；33(2)：10.
[52]郭艳辛,郭维淮.治疗强直性脊柱炎经验[J].中国中医骨伤科杂志,1997；26 (7) ： 24.
[53]夏俊杰,朱晓鸣.治疗强直性脊柱炎经验[J].湖北中医杂志,1997；19(6)：10-11.
[54]袁福林.辨证治疗强直性脊柱炎20例报告[J].中医正骨,2001；13(3)：34.
[55]张思胜.中药辨证内服外用结合实际手法治疗强直性脊柱炎[J].安徽中医临床杂,2002；14(3)：195.
[56]陈丽华.强直性脊柱炎的中医辨证治疗及护理[J].河南中医药学刊,2001；16(4) ： 48.
[57]续青.强直性脊柱炎辨治体会[J].中国基层医药,2001；8(5)：441.
[58]姜泉.中医分期治疗强直性脊柱炎的临床研究[J].中医正骨,2001；13(12)：31.
[59]关彤.辨证分型治疗强直性脊炎热33例疗效观察[J].湖南中医杂志,2001；17(3) ： 14.
[60]潘中恒.中药配合手法治疗强直性脊柱炎76例[J].中医正骨,2001；13(3)：25.
[61]栾炯,李玮玮.强直性脊柱炎72例辨证论治[J].浙江中医杂志,1994；29(2)：65.
[62]邱志济,朱建平.朱良春治疗强直性脊柱炎用药特色选析—著名老中医学家朱良春教授临床经验系列之二十三[J].辽宁中医杂志,2001；28(11)：656-657.
[63]王政,陈湘君.治疗强直性脊柱炎经验[J].辽宁中医杂志,2000；27(5)：196.
[64]方汉文,柴良晖.中医药治疗强直性脊柱炎33例临床体会[J].中华现代中西医杂志,2004;2(9)：811-812.
[65]陈永斌.辨证论治AS21例疗效观察[J].广西医科大学学报,1997；14(1)：106-107.
[66]李和平.以痛为输报刺法治疗强直性脊柱炎[J].针灸临床杂志,2002；18(4)：37.
[67]勾祥辉,刘思明.银质针治疗强直性脊柱炎[J].中医骨伤,2000；13(5)：317.
[68]周燕媛.针刺治疗强直性脊柱炎15例[J].中国针灸,1999；3：166.
[69]佟琳娜,牛燕波.温针治疗强直性脊柱炎25例[J].中国民间疗法,1998；2：9.
[70]段莉,黎沛环,李鹏.手法大针中药外敷联合应用治疗强直性脊柱炎[J].包头医学,1999；23(3)：124.
[71]袁志太.针刺夹脊穴配合推拿治疗强直性脊柱炎23例[J].上海针灸杂志,2003；22(16)：35.
[72]李莉,易荣,姚岚.腹针配合隔药灸治疗强直性脊柱炎疗效观察[J].中国中医 药咨讯,2010;14(2)：123.
[73]胡军勇,陈金亮.从奇络治疗强直性脊柱炎60例临床观察[J].光明中医,2001；16(96) ： 26.
[74]高广忠,马小平.穴位埋线治疗强直性脊柱炎50例临床分析[J].四川中医,2003；21 (5) ： 78.
[75]伦新,李万瑶,林剑鸣.蜂针治疗强直性脊柱炎30例[J].四川中医,2000；18(2) ： 41.
[76]苏建业,张东安.小针刀治疗强直性脊柱炎[J].中医外治杂志,1995；4：31.
[77]李邦雷,李征.针刀与短波治疗强直性脊柱炎94例[J].中国针灸,2006；26(7)：501.
[78]罗健,孔令深,黄柳和等.挑筋疗法治疗强直性脊柱炎25例疗效观察[J].新中医,2000；32(4)：22.
[79]陈有国.重刺络放血为主治疗强直性脊柱炎50例[J].江苏中医药,2002；23(7)：35.
[80]高猛,刘源香.火针并电针治疗强直性脊柱炎117例[J].山东中医杂志,1997；16(7) ： 310.
[81]王秋云.火针为主治疗强直性脊柱炎外周关节肿12例[J].江苏中医药,2005；26(1) ： 20.
[82]马文龙,陈金亮,胡军勇.针药并用治疗强直性脊柱炎108例[J].针灸临床杂志,2000;16(9)：13.
[83]李熳,施静,刘晓春等.电针对大鼠针刺穴位穴旁和炎性痛病灶皮下肥大细胞数量的影响[J].中国针灸,2003；23(10)：597.
[84]方秀斌.神经肽和神经营养因子[M].人民卫生出版社,2000；1：9.
[85]赵仓焕,王虹英,杨介宾.电针对佐剂性关节炎大鼠脾细胞IL-1和IL-2活性的影响[J].上海针灸杂志,2001；2：34.
[86]曹东元,牛汉璋,赵曼.穴位刺激初级传入反射引起SP释放[J].中国针灸,2001；21 (10) ： 16.
[87]赵仓顺,杨介宾,宋开源.电针对佐剂性关节炎大鼠炎症局部EP LEK含量的影响[J].中国中医基础医学杂志,1999；5：58.
[88]朱月伟,陈肖燕,韩杭生等.铺灸对类风湿性关节炎患者免症功能的影响.上海针灸杂志,1991；10(1)：1.
[89]李世光,赵俊萍,岳目娥等.温针疗法对类风湿性关节炎患者免疫调节的影响.中国康复医学杂志,1994；9(5)：212.
[90]李世光,赵俊萍,岳片娥等.温针疗法对类风湿性关节炎患者免疫调节IL-2分泌细胞及NK细胞.中国康复医学杂志,1996；11(1)：30.
[91]孙丽琴,刘心莲等.针灸治疗类风湿关节炎434例疗效观察.中国针灸,1992；12 (1) ： 9.
[92]张金达,管遵惠,管遵信等.针灸调整体液免疫的实验研究.云南中医杂志,1993；13(5) ： 22.
[93]吴飞,纪青山,王庆等.针刺治疗类风湿关节炎105例临床观察.辽宁中医杂志,1990;14(9)：41.
[94]陈汉平,翟道荡.关于针灸免疫研究思路的探讨[J].上海针灸杂志,1991；10(1) ： 35.