类风湿关节炎辨证初步研究及通痹灵治疗类风湿关节炎疗效观察
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摘要
类风湿关节炎(RA)是一种常见的以关节组织慢性炎症性病变为主要表现的全身性自身免疫性疾病。侵犯多个关节,进展性的滑膜增生,不可逆的关节软骨的丢失并最终导致软骨下骨质的破坏,是类风湿关节炎发病的主要病理特征。根据统计,RA在我国的发病率约为0.3-0.6%。欧美国家发病率更高,根据国外统计,美国约有500-600万患者,日本约有1000万患者,且近年来该病呈上升趋势。本病任何年龄均可发病,多发于30～60岁之间,45岁左右最常见。随年龄增长,发病率也增高,在35岁以下成年人约0.3%发病,而65岁以上者发病率超过10%。男女发病比率为1:2～4。此外,本病还存在季节性高发现象,常在每年春季的春分及秋季的秋分前后或二、八月发病、加重或恶化。本病有较高的致残率,据统计在发病起计10年内约有60%的病人会致残。类风湿损害人类健康的同时也给国家及社会带来了巨大的经济负担。
类风湿性关节炎的治疗目的在于控制病情发展,减轻疼痛,阻止不可逆的骨破坏,保护关节及肌肉的功能,改善患者的生活质量。近年来西医学在RA发病机制及病理变化研究方面取得了明显进展,然而在治疗和药物上仍没有一种药物能够减慢或阻止类风湿关节炎骨质侵袭及关节破坏。缺乏有效真正控制病情发展的药物。故我们当前最紧迫的研究课题是,研究和寻找治疗RA的新途径、新药物。
中医对RA的认识和治疗积累了较为丰富的经验,具有方法多、疗效确切、毒副作用小的特点,在临床研究上,对RA的辨证分型仍存在诸多的分歧,各家分型不统一,不利于中医疾病的标准化与客观化的研究,制约了其在治疗学上的发展。近年来,中药复方和单味、单体中药制剂上市,成为我国治疗RA等难治性免疫性疾病的一大特色,受到国际抗风湿病学术界的关注。但在较多研究药物单一有效成分的研究及专病专方时,忽略了辨证论治方面的研究。所以中医在辨证分型治疗RA中的疗效成为我们研究所关注的焦点。
本研究分为临床观察与实验研究两个部分。临床观察中重点探讨症状与证型间的相关性及证型在临床患病人群中的分布情况,同时观察了中药复方通痹灵治疗RA的疗效。实验研究进一步观察通痹灵对AA大鼠急性关节炎症的影响作用。
为了探讨RA病症辨证分型的可行性,以进一步指导临床用药及治疗规范化的实施,我们进行了如下的临床调查研究。本研究基于导师多年临床实践经验的基础,结
Rheumatoid arthritis (RA) is a common systematic autoimmune disease symbolized with chronic inflammation of joints and tissues. The main pathologic features include various joints invaded, evolving synovial hyperplasia, irreversible cartilage loss, resulting in sub-cartilaginous bone destruction. It shows that the incidence of RA is about 0.3-0.6% in China. That will still be higher abroad. RA not only impairs patients' health but also brings heavy economic burden to the country and society.The objective of theraputics on RA is to control the process of the disease, . alleviate pain and prevent bones from irreversible destruction, as well as to protect the function of joints and muscles and improve the quality of patients' lives. During these years, western medicine has made great process in the research of pathogenesis and pathology. But it is completely different in therapies and efficient medicines dealing on bones invasion and joints destruction. As a result, it becomes urgent and tough for us to explore and find out an effective method and drug in treating RA.There is plenty of experience on RA in traditional Chinese medicine (TCM). Holding divergences on syndrome differentiation in clinical research, compound and single Chinese medicine have been found in market recently, which becomes characteristic of TCM in dealing with refractory immuno-disease. In the same time, ignorance on syndrome differentiation appears. So we all focus on the curative effect of syndrome differentiation in TCM.This research is composed of two segments: Clinical observation and test section, discussing pertinence and subsection of syndrome and type, and observing curative effect of TBL on RA.
类风湿性关节炎的治疗目的在于控制病情发展,减轻疼痛,阻止不可逆的骨破坏,保护关节及肌肉的功能,改善患者的生活质量。近年来西医学在RA发病机制及病理变化研究方面取得了明显进展,然而在治疗和药物上仍没有一种药物能够减慢或阻止类风湿关节炎骨质侵袭及关节破坏。缺乏有效真正控制病情发展的药物。故我们当前最紧迫的研究课题是,研究和寻找治疗RA的新途径、新药物。
中医对RA的认识和治疗积累了较为丰富的经验,具有方法多、疗效确切、毒副作用小的特点,在临床研究上,对RA的辨证分型仍存在诸多的分歧,各家分型不统一,不利于中医疾病的标准化与客观化的研究,制约了其在治疗学上的发展。近年来,中药复方和单味、单体中药制剂上市,成为我国治疗RA等难治性免疫性疾病的一大特色,受到国际抗风湿病学术界的关注。但在较多研究药物单一有效成分的研究及专病专方时,忽略了辨证论治方面的研究。所以中医在辨证分型治疗RA中的疗效成为我们研究所关注的焦点。
本研究分为临床观察与实验研究两个部分。临床观察中重点探讨症状与证型间的相关性及证型在临床患病人群中的分布情况,同时观察了中药复方通痹灵治疗RA的疗效。实验研究进一步观察通痹灵对AA大鼠急性关节炎症的影响作用。
为了探讨RA病症辨证分型的可行性,以进一步指导临床用药及治疗规范化的实施,我们进行了如下的临床调查研究。本研究基于导师多年临床实践经验的基础,结
Rheumatoid arthritis (RA) is a common systematic autoimmune disease symbolized with chronic inflammation of joints and tissues. The main pathologic features include various joints invaded, evolving synovial hyperplasia, irreversible cartilage loss, resulting in sub-cartilaginous bone destruction. It shows that the incidence of RA is about 0.3-0.6% in China. That will still be higher abroad. RA not only impairs patients' health but also brings heavy economic burden to the country and society.The objective of theraputics on RA is to control the process of the disease, . alleviate pain and prevent bones from irreversible destruction, as well as to protect the function of joints and muscles and improve the quality of patients' lives. During these years, western medicine has made great process in the research of pathogenesis and pathology. But it is completely different in therapies and efficient medicines dealing on bones invasion and joints destruction. As a result, it becomes urgent and tough for us to explore and find out an effective method and drug in treating RA.There is plenty of experience on RA in traditional Chinese medicine (TCM). Holding divergences on syndrome differentiation in clinical research, compound and single Chinese medicine have been found in market recently, which becomes characteristic of TCM in dealing with refractory immuno-disease. In the same time, ignorance on syndrome differentiation appears. So we all focus on the curative effect of syndrome differentiation in TCM.This research is composed of two segments: Clinical observation and test section, discussing pertinence and subsection of syndrome and type, and observing curative effect of TBL on RA.
引文
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[3] 路志正等,实用中医风湿病学.人民卫生出版社,1996,453(1)
[4] 王忆黎,严余明,李志尚.浙江中医杂志,1996,2:52-53
[5] 刘玉铉,范金茹,范伏元.湖南中医学院学报,1997,3(11):8-10
[6] 周学平,周仲瑛,金妙文等.中医杂志,1998,10(39):606-609
[7] 王开峰,辨证分型治疗类风湿性关节炎62例.广西中医药,2000,25(3):15-16
[8] 谢幼红,79例类风湿性关节炎临床观察.北京中医,2000,(3):32-33
[9] 郝文,痹痛消煎剂治疗类风湿性关节炎急性急性期30例。实用中医内科杂志,2000,14(2):36-37
[10] 高芦珍,张春香.河北中医,1998,5(20):265-266
[11] 王明义,类风湿性关节炎125例疗效观察[J].四川中医,1993,(1):38
[12] 陈康德.浙江中医学院学报,1999,4(23),37-38
[13] 梁光宇,分型治疗风湿类风湿性关节炎[J].中国民间疗法,1999(4)
[14] 周学平等.中国中西医结合杂志,1999,2(19),80-83
[15] 李典鸿,胡祖光.现代中医,1997,1(34),20-21
[16] 钱国忠,雷公藤合剂治疗类风湿性关节炎150例疗效观察[J]。浙江中医学院学报,1996,20(6):11
[17] 邓兆智,陈伟.中医杂志,1996,2(36),93-95
[18] 石玉山等.中医杂志,1997,7(38),41-43
[19] 杨骏,程宗敏,乌头汤加味治疗类风湿性关节炎。河北医学,2000,6(2):190
[20] 赵芳,独活乌头煎治疗类风湿性关节炎47例.河北中医,2000,2l(1):44-45
[21] 舒达夫,雷公藤甲素和雷公藤醋酸乙酯提取物治疗RA临床观察.中国中西医结合杂志,1990;10(3):114
[22] 邓兆智,雷公藤治疗RA制剂及毒副反应的概况.安徽中医临床杂志,1998,10(3):186
[23] 李瑞林,刘沛霖,吴旭初等,雷公藤缓释片治疗类风湿性关节炎的临床及实验研究.中国中西医结合杂志
[24] 戴敏,刘青云,赵春,雷公藤帖膏免疫学、毒理学及临床疗效探讨。中成药1998,20(8):36-38
[25] 杜秀兰等,雷络酯片治疗类风湿性关节炎的临床研究.中国中西医结合杂志,1998,18(02):88-91
[26] 孙瑞华,林宗广,“正清风痛宁”治疗类风湿性关节炎38例疗效观察.上海中医药杂志,1999,(2):21-22
[27] 唐庆年,炯华,南蛇藤治疗风湿性类风湿性关节炎500例探讨.实用中医药杂志,1998,14(3):20
[28] 张芳,张之澧,沈杰等,乌梢蛇水解液治疗类风湿性关节炎120例临床观察.上海中医药大学学报,2001,15(2):21-24
[29] 张源潮,杨清锐,尹宏恩等,草乌甲素治疗骨关节炎及类风湿关节炎临床观察.中药药理与临床,2000,16(2):43-45
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