针药并用治疗原发性干燥综合征临床观察
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摘要
目的观察针药并用治疗原发性干燥综合征患者的临床疗效。方法将100例原发性干燥综合征患者随机分为4组,每组25例,针灸组予以针刺治疗,中药组予以深圳市中医院院内制剂祛斑养阴颗粒治疗,针药组予以针刺和中药并用治疗,西药组予以常规西医治疗。4周为1个疗程,治疗3个疗程后判定总体临床疗效。观察中医证候临床疗效、干燥综合征患者报告指数(ESSPRI)、干燥综合征疾病活动指数(ESSDAI)评分、唾液流率、Schirmer试验、血清免疫球蛋白(Ig G)、血沉(ESR)、C反应蛋白(CRP)。结果针药组总有效率为92.0%,中药组总有效率为76.0%,针灸组总有效率为68.0%,西药组总有效率56.0%,针药组优于针灸组、中药组、西药组(P<0.05)。针药组在ESSPRI评分、中医证候积分、唾液流率、IgG、ESR、CRP改善方面明显优于其他组,差异有统计学意义(P<0.05)。结论针刺和中药并用可以有效改善患者临床疗效及相关指标,提高患者生活质量,是原发性干燥综合征患者安全有效的治疗方法。
Objective To investigate the clinical efficacy of combined acupuncture and medicine in treating primary Sjogren syndrome. Method One hundred patients with primary Sjogren syndrome were randomized to 4 groups, 25 cases each. The acupuncture group was treated with acupuncture; the Chinese herbal medicine group, with freckle-removing and yin-nourishing granules prepared by Shenzhen hospital of traditional Chinese medicin; the acupuncture and medicine group, with combined acupuncture and medicine; the Western medication group with conventional Western drugs. One course of treatment consisted of four weeks. The overall clinical effectswere evaluate after three courses of treatment. The clinical therapeutic effects on TCM syndrome were observed. The EULAR Sj?gren's Syndrome Patient Reported Index(ESSPRI) score and the EULAR Sj?gren's Syndrome Disease Activity Index(ESSDAI) score were recorded. Schirmer's test was carried out. The salivary flow rate, serum immunoglobulin(IgG), erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) were measured. Result The total efficacy rate was 92.0% in the acupuncture and medicine group, 76.0% in the Chinese herbal medicine group, 68.0% in the acupuncture group and 56.0% in the Western medication group. The therapeutic effect was better in the acupuncture and medicine group than in the acupuncture, Chinese herbal medicine and Western medication groups(P<0.05). The ESSPRI score, the TCM syndrome score, the salivary flow rate, IgG, ESR and CRP improved more in the acupuncture and medicine group compared with the acupuncture, Chinese herbal medicine and Western medication groups. The differences had statistical significance(P<0.05). Conclusion Combined use of acupuncture and medicine can effectively improve the clinical therapeutic effect, related indicators and quality of life in the patients. It is an effective and safe way to treat primary Sjogren syndrome.
Objective To investigate the clinical efficacy of combined acupuncture and medicine in treating primary Sjogren syndrome. Method One hundred patients with primary Sjogren syndrome were randomized to 4 groups, 25 cases each. The acupuncture group was treated with acupuncture; the Chinese herbal medicine group, with freckle-removing and yin-nourishing granules prepared by Shenzhen hospital of traditional Chinese medicin; the acupuncture and medicine group, with combined acupuncture and medicine; the Western medication group with conventional Western drugs. One course of treatment consisted of four weeks. The overall clinical effectswere evaluate after three courses of treatment. The clinical therapeutic effects on TCM syndrome were observed. The EULAR Sj?gren's Syndrome Patient Reported Index(ESSPRI) score and the EULAR Sj?gren's Syndrome Disease Activity Index(ESSDAI) score were recorded. Schirmer's test was carried out. The salivary flow rate, serum immunoglobulin(IgG), erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) were measured. Result The total efficacy rate was 92.0% in the acupuncture and medicine group, 76.0% in the Chinese herbal medicine group, 68.0% in the acupuncture group and 56.0% in the Western medication group. The therapeutic effect was better in the acupuncture and medicine group than in the acupuncture, Chinese herbal medicine and Western medication groups(P<0.05). The ESSPRI score, the TCM syndrome score, the salivary flow rate, IgG, ESR and CRP improved more in the acupuncture and medicine group compared with the acupuncture, Chinese herbal medicine and Western medication groups. The differences had statistical significance(P<0.05). Conclusion Combined use of acupuncture and medicine can effectively improve the clinical therapeutic effect, related indicators and quality of life in the patients. It is an effective and safe way to treat primary Sjogren syndrome.
引文
[1]陈战瑞.原发性干燥综合征系统表现及治疗进展[J].中国医学创新,2013,10(24):153-156.
[2]陈秀芳,范永升.干燥综合征的中医药研究进展[J].中医药导报,2011,17(3):115-117.
[3]何慧珍,金桂兰.干燥综合征的中医论治近况[J].环球中医药,2011,(6):486-489.
[4]雷玲,赵铖,米存东,等.原发性和继发性干燥综合征患者的临床及实验室特征分析[J].军医进修学院学报,2008,(5):371-373.
[5]谭飞,赖维,王海俊,等.原发性和继发性干燥综合征67例临床分析[J].临床皮肤科杂志,2010,39(2):80-82.
[6]梁红,汪元,刘佳佳,等.干燥综合征的中医药治疗进展[J].风湿病与关节炎,2018,7(5):77-80.
[7]李飞燕,吴绍萍.中医外治法治疗干燥综合征研究进展[J].风湿病与关节炎,2018,7(2):72-73,80.
[8]韦尼,范鸿儒,丁明辉,等.中医慢病管理对干燥综合征患者疾病控制及生活质量的影响[J].中医杂志,2017,(4):316-320.
[9]中华医学会风湿病学分会.干燥综合征诊断及治疗指南[J].中华风湿病学杂志,2010,14(11):766-768.
[10]中华人民共和国卫生部.中药新药临床研究指导原则[S].北京:人民卫生出版社,1993:210-213.
[11]冯海霞.针刺结合温润附葛汤治疗阳虚型干燥综合征的临床疗效观察[D].黑龙江中医药大学硕士论文,2017:1-53.
[12]李奔,薛鸾,朴雪梅,等.针药结合对原发性干燥综合征疾病相关指数影响的临床观察[J].天津中医药,2017,34(1):26-31.
[13]邓俊花,于志谋,李响,等.针药联合治疗原发性干燥综合征口干55例[J].中国中医药现代远程教育,2017,15(8):40-42.
[14]刘晓亚,房丹,刘维.针药并用治疗干燥综合征30例[J].福建中医药,2014,45(1):14-15.
[15]牛红青,董海原,张莉芸,等.干燥综合征生物制剂治疗的研究进展[J].中国药物与临床,2009,9(7):615-617.
[16]Seror R,Ravaud P,Mariette X,et al.EULAR Sjogren’s Syndrome Patient Reported Index(ESSPRI):development of a consensus patient index for primary Sjogren’s syndrome[J].Ann Rheum Dis,2011,70(6):968-972.
[17]肖红,姜泉,唐晓颇,等.干燥综合征的临床证治经验[J].中医杂志,2018,(15):1337-1339,1345.
[18]赵彦,宋林萱.养阴通络方联合西药治疗干燥综合征(阴虚络阻)随机平行对照研究[J].实用中医内科杂志,2018,(6):34-36.
[19]崔向宁,冯兴华.冯兴华辨治干燥综合征经验[J].中医杂志,2017,58(3):200-202,211.
[20]王艳,郭峰.干燥综合征的中医内科治疗进展[J].内蒙古中医药,2017,(5):131-133.
[21]刘溦溦,汪悦.中医治疗干燥综合征的研究进展[J].长春中医药大学学报,2015,(6):1325-1328.
[22]白雯,阎小萍.阎小萍治疗干燥综合征经验[J].中医杂志,2015,56(10):825-827,830.
[23]孔德花,马宝东.马宝东治疗干燥综合征经验[J].中医药临床杂志,2018,30(1):65-68.
[24]吴青青.中药治疗干燥综合征用药规律分析[J].亚太传统医药,2017,13(21):39-40.
[25]成泽东,卞镝,陈以国,等.进补与六味地黄丸临床应用浅析[J].中医药学刊,2004,22(4):715,717.
[26]时凌云,赵刚.六味地黄丸治疗慢性肾炎肝肾阴虚者[J].实用中医内科杂志,2012,(12):36-37.
[27]Cui Y,Li L,Yin R,et al.Depression in primary Sj?gren’s syndrome:a systematic review and metaanalysis[J].Psychol Health Med,2018,23(2):198-209.
[28]程建中.中医“久病必瘀”的机理探讨及临床应用体会[J].中医药研究,1996,(2):6-8.
[29]陈克知.从瘀论治血管神经性头痛30例临床观察[J].内蒙古中医药,2014,(19):23-24.
[30]高建华,张剑勇,黄华,等.祛斑养阴颗粒剂对狼疮鼠白细胞介素-10、肿瘤坏死因子-?及肾脏组织病理的影响[J].河北中医,2011,33(3):428-430.
[31]张剑勇,谢静静,高建华,等.祛斑养阴颗粒对系统性红斑狼疮患者生存质量的影响[J].中华中医药学刊,2014,32(5):1044-1046.
[32]何琦.合谷穴发泡法治疗扁桃体炎23例[J].医学文选,1994,(2):44.
[33]鲍治安.足三里穴注人胚混合匀浆调节改善机体免疫功能失调70例[J].中国针灸,1990,10(3):29-30.
[34]施孝文.针灸治疑难病3则[J].中国针灸,2002,22(S1):16-17.
[35]戈海青,任文肖,徐强,等.酸甘颗粒联合针刺治疗原发性干燥综合征临床观察[J].河北中医,2015,37(10):1460-1463.
[36]仇山波,夏有兵,程洁,等.针灸治疗干眼的临床与机制研究进展[J].中国中医眼科杂志,2014,24(6):456-458.
[37]姜劲峰,王玲玲,徐斌,等.抗炎-艾灸温通的效应机制[J].中国针灸,2013,33(9):860-864.
[38]沈洁,沈梅红,李忠仁,等.艾灸肾俞穴对绝经前后亚健康状态女性性激素及AMH水平的影响[J].中国针灸,2017,37(4):381-385.
[39]刘永进,杜博,邵江健,等.针刺治疗干燥综合征临床疗效的Meta分析[J].风湿病与关节炎,2017,6(8):41-45.
[40]刘炜宏,王凡,王玲玲,等.论针灸医学的特色与优势[J].中国针灸,2011,31(8):673-678.
[41]王华,顾军花.针药结合治疗干燥综合征[J].河南中医,2013,33(7):1174-1175.
[2]陈秀芳,范永升.干燥综合征的中医药研究进展[J].中医药导报,2011,17(3):115-117.
[3]何慧珍,金桂兰.干燥综合征的中医论治近况[J].环球中医药,2011,(6):486-489.
[4]雷玲,赵铖,米存东,等.原发性和继发性干燥综合征患者的临床及实验室特征分析[J].军医进修学院学报,2008,(5):371-373.
[5]谭飞,赖维,王海俊,等.原发性和继发性干燥综合征67例临床分析[J].临床皮肤科杂志,2010,39(2):80-82.
[6]梁红,汪元,刘佳佳,等.干燥综合征的中医药治疗进展[J].风湿病与关节炎,2018,7(5):77-80.
[7]李飞燕,吴绍萍.中医外治法治疗干燥综合征研究进展[J].风湿病与关节炎,2018,7(2):72-73,80.
[8]韦尼,范鸿儒,丁明辉,等.中医慢病管理对干燥综合征患者疾病控制及生活质量的影响[J].中医杂志,2017,(4):316-320.
[9]中华医学会风湿病学分会.干燥综合征诊断及治疗指南[J].中华风湿病学杂志,2010,14(11):766-768.
[10]中华人民共和国卫生部.中药新药临床研究指导原则[S].北京:人民卫生出版社,1993:210-213.
[11]冯海霞.针刺结合温润附葛汤治疗阳虚型干燥综合征的临床疗效观察[D].黑龙江中医药大学硕士论文,2017:1-53.
[12]李奔,薛鸾,朴雪梅,等.针药结合对原发性干燥综合征疾病相关指数影响的临床观察[J].天津中医药,2017,34(1):26-31.
[13]邓俊花,于志谋,李响,等.针药联合治疗原发性干燥综合征口干55例[J].中国中医药现代远程教育,2017,15(8):40-42.
[14]刘晓亚,房丹,刘维.针药并用治疗干燥综合征30例[J].福建中医药,2014,45(1):14-15.
[15]牛红青,董海原,张莉芸,等.干燥综合征生物制剂治疗的研究进展[J].中国药物与临床,2009,9(7):615-617.
[16]Seror R,Ravaud P,Mariette X,et al.EULAR Sjogren’s Syndrome Patient Reported Index(ESSPRI):development of a consensus patient index for primary Sjogren’s syndrome[J].Ann Rheum Dis,2011,70(6):968-972.
[17]肖红,姜泉,唐晓颇,等.干燥综合征的临床证治经验[J].中医杂志,2018,(15):1337-1339,1345.
[18]赵彦,宋林萱.养阴通络方联合西药治疗干燥综合征(阴虚络阻)随机平行对照研究[J].实用中医内科杂志,2018,(6):34-36.
[19]崔向宁,冯兴华.冯兴华辨治干燥综合征经验[J].中医杂志,2017,58(3):200-202,211.
[20]王艳,郭峰.干燥综合征的中医内科治疗进展[J].内蒙古中医药,2017,(5):131-133.
[21]刘溦溦,汪悦.中医治疗干燥综合征的研究进展[J].长春中医药大学学报,2015,(6):1325-1328.
[22]白雯,阎小萍.阎小萍治疗干燥综合征经验[J].中医杂志,2015,56(10):825-827,830.
[23]孔德花,马宝东.马宝东治疗干燥综合征经验[J].中医药临床杂志,2018,30(1):65-68.
[24]吴青青.中药治疗干燥综合征用药规律分析[J].亚太传统医药,2017,13(21):39-40.
[25]成泽东,卞镝,陈以国,等.进补与六味地黄丸临床应用浅析[J].中医药学刊,2004,22(4):715,717.
[26]时凌云,赵刚.六味地黄丸治疗慢性肾炎肝肾阴虚者[J].实用中医内科杂志,2012,(12):36-37.
[27]Cui Y,Li L,Yin R,et al.Depression in primary Sj?gren’s syndrome:a systematic review and metaanalysis[J].Psychol Health Med,2018,23(2):198-209.
[28]程建中.中医“久病必瘀”的机理探讨及临床应用体会[J].中医药研究,1996,(2):6-8.
[29]陈克知.从瘀论治血管神经性头痛30例临床观察[J].内蒙古中医药,2014,(19):23-24.
[30]高建华,张剑勇,黄华,等.祛斑养阴颗粒剂对狼疮鼠白细胞介素-10、肿瘤坏死因子-?及肾脏组织病理的影响[J].河北中医,2011,33(3):428-430.
[31]张剑勇,谢静静,高建华,等.祛斑养阴颗粒对系统性红斑狼疮患者生存质量的影响[J].中华中医药学刊,2014,32(5):1044-1046.
[32]何琦.合谷穴发泡法治疗扁桃体炎23例[J].医学文选,1994,(2):44.
[33]鲍治安.足三里穴注人胚混合匀浆调节改善机体免疫功能失调70例[J].中国针灸,1990,10(3):29-30.
[34]施孝文.针灸治疑难病3则[J].中国针灸,2002,22(S1):16-17.
[35]戈海青,任文肖,徐强,等.酸甘颗粒联合针刺治疗原发性干燥综合征临床观察[J].河北中医,2015,37(10):1460-1463.
[36]仇山波,夏有兵,程洁,等.针灸治疗干眼的临床与机制研究进展[J].中国中医眼科杂志,2014,24(6):456-458.
[37]姜劲峰,王玲玲,徐斌,等.抗炎-艾灸温通的效应机制[J].中国针灸,2013,33(9):860-864.
[38]沈洁,沈梅红,李忠仁,等.艾灸肾俞穴对绝经前后亚健康状态女性性激素及AMH水平的影响[J].中国针灸,2017,37(4):381-385.
[39]刘永进,杜博,邵江健,等.针刺治疗干燥综合征临床疗效的Meta分析[J].风湿病与关节炎,2017,6(8):41-45.
[40]刘炜宏,王凡,王玲玲,等.论针灸医学的特色与优势[J].中国针灸,2011,31(8):673-678.
[41]王华,顾军花.针药结合治疗干燥综合征[J].河南中医,2013,33(7):1174-1175.