健脾利湿法治疗强直性脊柱炎的临床观察
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摘要
目的：观察以健脾利湿法自拟强脾治痹汤对强直性脊柱炎的疗效。方法：采用治疗前后自身对照，对72例强直性脊柱炎患者进行临床观察。疗程8周，强脾治痹汤用量为1剂／d，分2次口服。结果：12项临床观察指标中有9项(晨僵、骶髂关节压痛度、扩胸度、外周关节压痛数和肿胀数、外周关节压痛积分和肿胀积分、15m步行时间、患者与医生评估)治疗前后明显改善(P<0.01或P<0.05)；实验指标中的血小板、血细胞沉降率、γ球蛋白，治疗前后比较改善显著(P<0.05或P<0.01)。在8周疗程中除有轻度的口干外，无其他不良反应。结论：健脾利湿法治疗强直性脊柱炎有较好的疗效，尤其在改善患者的临床症状方面。
Objective To oberserve the therapecitic effects of QiangPiZhiBiTang with JianPiLiShi Method in treatment of ankylosing spondylitis (AS). Methods Seventy-two consecutive cases of AS were studied clinically,and the results before and after treatment were compared. The treatment lasted for 8 weeks.The patients were give QiangPiZhiBiTang 1 agent,2 times per day. Results Nine clinical paremeters out of 12 were improved obviously after treatment (P<0.01,P<0.05), including morning stiff, number of peripheral joints pain, number of swelling , the deepness of tenderness off rumpbone, and so on, the comparison of laboratory parameters was significant before and after treatment(P<0.05, P<0.01). There were no other adverse effects except slight xerochcilia during the 8-week treatment. Conclusion The JianPiLiShi method had much better curative effect, particularly in clinical symptoms.
Objective To oberserve the therapecitic effects of QiangPiZhiBiTang with JianPiLiShi Method in treatment of ankylosing spondylitis (AS). Methods Seventy-two consecutive cases of AS were studied clinically,and the results before and after treatment were compared. The treatment lasted for 8 weeks.The patients were give QiangPiZhiBiTang 1 agent,2 times per day. Results Nine clinical paremeters out of 12 were improved obviously after treatment (P<0.01,P<0.05), including morning stiff, number of peripheral joints pain, number of swelling , the deepness of tenderness off rumpbone, and so on, the comparison of laboratory parameters was significant before and after treatment(P<0.05, P<0.01). There were no other adverse effects except slight xerochcilia during the 8-week treatment. Conclusion The JianPiLiShi method had much better curative effect, particularly in clinical symptoms.
引文
[1] Khan M.A current perspective on ankylosing spondylitis and related spondyloarthropathies[J].J Ind Rheum hsso, 1999;7(1):16
[2] 黄烽，张江林，施桂英．幼年与成年强直性脊柱炎的对比研究[J]．军医进修学院学报，1997；18(1)：17
[3] 黄烽，张江林，余得恩．可溶型白细胞相关抗原B27分子基因的克隆与表达[J]．中华医学杂志，2000；80(12)：924
[4] 黄烽，余得恩．和脊柱关节病相关的HLA-B27分子与细菌多肽的分子生物学研究[J]．中华医学杂志，1998；78(4)：281
[5] 张乃铮，Wigley R，曾庆余et al．中国风湿性疾病的流行情况调查[J]．中华风湿病学杂志，1997；(1)：31
[6] Braun J, Bollow M, Remlinger G,et al. Prevalence of spondyloarthropathies in LA-B27 positive and negative blood donors[J]. Arthritis Rheum. 1998;41:58
[7] Khare S, Luthra H, David C. HLA-B27 and other predisposing factors in spondyloarthropathies[J].Curr Opin Rheumatol, 1998;10:282
[8] Sieper J, Braun J. Triggering mecharnisms and T cell responses in spondyloarthropathies[M].In:Calin A, Taurog J eds. Spondyloarthropathies. Oxford: Oxford University Press, 1998:195-206
[9] Brown M, Kennedy L, MacGregor A, et al. Susceptibility to ankylosing spondylitis in twins: the role of genes, HLA, and environment[J].Arthrits Rheum, 1997;40:823
[10] Khan M. the 21 HLA-B27 subtypes[J].J Rheumatol,2000;27(suppl 59):29
[11] Lopez-Larrea C, Gonzalez S, Martinez-Borra J, et al. The role of HLA-B27 polymorphism and molecular mimicry in spondyloarthropathies [J] Molecular Med Today, 1998;4:540
[12] Huang F, Gu Jieruo, Braun J, et al. Identifying the targets of thalidomid and anti-TNFa antibody treatments in ankylosing spondylitis [J].Arthrits Rheum, 2000;43(9):S396
[13] Gu J, Huang F, Braun J, et al. Contrusting effect of thalidomide and anti-TNFa MoAb therapies on gene expression profiles AS[J].J Rheumatol,2000;27(8)S24
[14] Tani Y, Sato H, Tanaka N, et al. Serum IgA1 and IgA2 subclass antibodies against collagens in patients with ankylosing spondylitis[J]. Scand J
Rheumatol, 1997;26:380
[15] Ahmadi K, Wison C, Tiwana H. et al. Antibodies to Klebsiessa pneumoniae lipooplysaccharide in patients with ankylosing spondylitis[J].Br J Rheumatol, 1998;37:1330
[16] Huang F, Yamaguchi A, Tsuchiya N et al. Bacteria invasion induces altemative splicing of HLA-B27[J].Arthritis Rheum, 1997;40(4):694
[17] Inman R, Chiu B. Synoviocyte packaged Chlamydia trachomatis induces a chronic aseptic arthritis[J].J Clin Invest,1998;102:1776
[18] Khare S, Bull M, Hanson J, et al. Spontaneous inflammatory disease in HLAB27 transgenic mice is independent of MHC class Ⅱ molecules:a direct role for B27 heavy chains and not B27-derived peptides[J].J, Immunol, 1998;160:101
[19] Huang F, Hermann E, Wang J, et al. A patient derived cytotoxic T-lymphocyte clone and two peptide dependent MoAbs recognize HLA-B27-peptide complexes with low stringency for peptide sequences[J].Infect Immun, 1996;64(1):120
[20] 朱剑，刘湘源，黄烽．强直性脊柱炎患者外周血Th1／Th2淋巴细胞类型[J]．中华风湿病学杂志，2000；4(4)：202
[21] 赵伟，黄烽．单核因子与脊柱关节病[J]．中华风湿病学杂志，2000；4(4)：248
[22] Archer J, Keat A. Ankylosing spondylitis:time to focus on ankylosis J Rheumatol, 1999,26,761,764
[23] Claudepierre P, Rymer JC, Chevalier X. IL-10 plasma levels correlate with disease activity in spondyloarthropathy. J Rheumatol, 1997,24:1659-1661.
[24] Canete J, Llena J, Collado A, et al. Comparative cytokine gene expression in synovial tissue of early rheumatoid arthritis and seronegative spondy-loarthropathies. Br J Rheumatol, 1997,36;38-42
[25] Yin Z, Braun J, Neure L, et al. Crucial role of IL-10/IL-12 balance in the regulation Of the type 2 T helper cytokine response in reactive arthritis Arthritis Rheum, 1997,40:1788-1797.
[26] Euldennk F, Ivanyi P, Weinreich S. Histopathology of murine ankylosing enthesopathy[J].Pathol Res Proct, 1998;194:797
[27] Onderdonk A, Richardson J, Hammer R et al. Correlation of fecal microflora of HLA-B27 transgenic rats with inflammatory bowel disease[J].Infect Immun, 1998;66:6022
[28] Guerassimov A, Zhang Y, Banerjee S et al. Autoimmunity to cartilage link protein in patients with rheumatoid arthritis and ankylosing spondylits[J].J Rhuematol, 1998;25:1480
[29] Leroux J, Guerassimov A, Banerjee S et al. Immunity to the G1 globular domain
of the cartilage proteoglycan can induce inflanmatory erosive polyarthritis and spondylitis in BALB/c mice but inmmunity to G1 is inhibited by covalently bound keratan sulfate in vitro and in vivo [J].J Clin Invest, 1995;97:621
[30] Crew M, Effros R, Walford R et al. Transgenic mice expressing a truncated peromyscus leucopus TNF-alpha gene manifest an arthritis resembling andylosing spondylitis[J].J Interon Cytockine Res, 1998;8:219
[31] Clegg DO, Reda D J, Abdellatif M. Comparison of sulfasalazine and placebo for the treatment of axial and peripheral articular manifestations of seronegative spondylarthropathies[J].Arthritis Rheum, 1999,42(11):2325-2329
[32] Toussirot E, Wendling D, Current guidelines for the drug treatment of ankylosing spondylitis[J].Drugs, 1998,56(2):225-240.
[33] Van Der LS, Van Der HD. Ankylosing spondylitis. Clinical featuers[J].Rheum Dis Clin North Am, 1998,24(4):663-676.
[34] Dougados M, Behier J Jolchine-I, et al. Efficacy of celecoxib, a COX-2 specific hibitor in the treatment of ankylosing spondylitis[J]Arthritis Rheum, 2001;44(1)180-185
[35] Biasi D, Carletto A, Caamaschi P, et al. Efficacy of methotrexate in the treatment of ankylosing spondylites:a three-year open study[J].Clin Rheumatol,2000;19(2):114-117
[36] Sampaio BPD, Costallat LTL, Bertolo M, et al Methotrexate in the treatment of ankylosing spondylitis[J].Scand J Rheumatol,2000,29(3):160-162
[37] Braun J, Bollow M, Neure L, et al. Use of immunohistologic and in situ hybridization techniques in the examination of sacroiliac joint biopsy specimens from patients with ankylosing spondylitis[J].Arthritis Rheum, 1995,38(4):499-505
[38] gratacos J, Collado A, Filella X, et al. Serum cytokines(IL-6, TNF-a, IL-I and IFN-γ)in ankylosing spondylitis:a close correlation between serum IL-6 and disease activity and severity[J].Br J Rheumatol,1994,331-931
[39] Huang F, Gu J, Braun J, et al. Identifying the targets of thalidomide and anti-TNFa antibody treatments in ankylosing spondylitis[J].Arthritis Rheum, 2000,43(9):396
[40] 黄烽，赵伟，反应停对强直性脊柱炎治疗作用的初步观察[A]．首届华夏风湿性疾病诊断治疗学术会议论文汇编[C]上海：中华医学会风湿病学会，1999，123
[41] 施杞主编，中国中医骨伤科百家方技精华．第1版，北京．中国中医药出版社．1991：413～414
[42] 付新利．强直性脊柱炎证治浅见．山东中医杂志，1992，(5)：2
[43] 聂志伟，中药治疗强直性脊柱炎267例分析．辽宁中医杂志，1987；11(6)：22
[44] 刘俊士等，中医治疗强直性脊柱炎20例观察．中医杂志，1987；28(7)：36．
[45] 李在尧，中西医结合治疗强直性脊柱炎80例临床观察．新中医，1994；26(7)7：24
[46] 奕炯等，强直性脊柱炎72例辨证施治．浙江中医杂志．1994；29(2)：65
[47] 王凤仪，马在山老中医治疗强直性脊柱炎的经验．北京中医，1993；(2)：43
[48] 邱玉珍，肾痹汤治疗强直性脊柱炎30例．陕西中医，1991；12(2)：62
[49] 张正泉，白虎通痹汤治疗强直性脊柱炎2例．新中医，1989(8)：15
[50] 潘玉海，散痹汤治疗强直性脊柱炎32例．陕西中医1990；13(3)：117
[51] 娄玉玲，肾痹汤治疗强直性脊柱炎53例报告．中医正骨．1992；4(4)：17
[52] 阎小萍，焦树德治疗强直性脊柱炎的经验．中医杂志。1994；35(7)：407
[53] 高根德，扶正化痰为主治疗强直性脊柱炎．上海中医药杂志，1991；(9)：15
[54] 王忍生，中药治疗强直性脊柱炎．陕西中医，1993；14(5)：199
[55] 李瑞林，强直性脊柱炎80例分析及雷公藤治疗的临床观察．中国中医骨伤科杂志，1987；3(3)：39
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[60] 田常炎等，洋金花治疗强直性脊炎的疗效观察．中医杂志，1988；29(4)：46
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[62] 冯文岭等，中药风湿灵治疗强直性脊柱炎的实验研究与临床观察．中国骨伤，1994；7(3)12
[63] 陈纪潘等，通痹灵治疗强直性脊柱炎323例疗效观察．新中医，1994；26(7)22
[2] 黄烽，张江林，施桂英．幼年与成年强直性脊柱炎的对比研究[J]．军医进修学院学报，1997；18(1)：17
[3] 黄烽，张江林，余得恩．可溶型白细胞相关抗原B27分子基因的克隆与表达[J]．中华医学杂志，2000；80(12)：924
[4] 黄烽，余得恩．和脊柱关节病相关的HLA-B27分子与细菌多肽的分子生物学研究[J]．中华医学杂志，1998；78(4)：281
[5] 张乃铮，Wigley R，曾庆余et al．中国风湿性疾病的流行情况调查[J]．中华风湿病学杂志，1997；(1)：31
[6] Braun J, Bollow M, Remlinger G,et al. Prevalence of spondyloarthropathies in LA-B27 positive and negative blood donors[J]. Arthritis Rheum. 1998;41:58
[7] Khare S, Luthra H, David C. HLA-B27 and other predisposing factors in spondyloarthropathies[J].Curr Opin Rheumatol, 1998;10:282
[8] Sieper J, Braun J. Triggering mecharnisms and T cell responses in spondyloarthropathies[M].In:Calin A, Taurog J eds. Spondyloarthropathies. Oxford: Oxford University Press, 1998:195-206
[9] Brown M, Kennedy L, MacGregor A, et al. Susceptibility to ankylosing spondylitis in twins: the role of genes, HLA, and environment[J].Arthrits Rheum, 1997;40:823
[10] Khan M. the 21 HLA-B27 subtypes[J].J Rheumatol,2000;27(suppl 59):29
[11] Lopez-Larrea C, Gonzalez S, Martinez-Borra J, et al. The role of HLA-B27 polymorphism and molecular mimicry in spondyloarthropathies [J] Molecular Med Today, 1998;4:540
[12] Huang F, Gu Jieruo, Braun J, et al. Identifying the targets of thalidomid and anti-TNFa antibody treatments in ankylosing spondylitis [J].Arthrits Rheum, 2000;43(9):S396
[13] Gu J, Huang F, Braun J, et al. Contrusting effect of thalidomide and anti-TNFa MoAb therapies on gene expression profiles AS[J].J Rheumatol,2000;27(8)S24
[14] Tani Y, Sato H, Tanaka N, et al. Serum IgA1 and IgA2 subclass antibodies against collagens in patients with ankylosing spondylitis[J]. Scand J
Rheumatol, 1997;26:380
[15] Ahmadi K, Wison C, Tiwana H. et al. Antibodies to Klebsiessa pneumoniae lipooplysaccharide in patients with ankylosing spondylitis[J].Br J Rheumatol, 1998;37:1330
[16] Huang F, Yamaguchi A, Tsuchiya N et al. Bacteria invasion induces altemative splicing of HLA-B27[J].Arthritis Rheum, 1997;40(4):694
[17] Inman R, Chiu B. Synoviocyte packaged Chlamydia trachomatis induces a chronic aseptic arthritis[J].J Clin Invest,1998;102:1776
[18] Khare S, Bull M, Hanson J, et al. Spontaneous inflammatory disease in HLAB27 transgenic mice is independent of MHC class Ⅱ molecules:a direct role for B27 heavy chains and not B27-derived peptides[J].J, Immunol, 1998;160:101
[19] Huang F, Hermann E, Wang J, et al. A patient derived cytotoxic T-lymphocyte clone and two peptide dependent MoAbs recognize HLA-B27-peptide complexes with low stringency for peptide sequences[J].Infect Immun, 1996;64(1):120
[20] 朱剑，刘湘源，黄烽．强直性脊柱炎患者外周血Th1／Th2淋巴细胞类型[J]．中华风湿病学杂志，2000；4(4)：202
[21] 赵伟，黄烽．单核因子与脊柱关节病[J]．中华风湿病学杂志，2000；4(4)：248
[22] Archer J, Keat A. Ankylosing spondylitis:time to focus on ankylosis J Rheumatol, 1999,26,761,764
[23] Claudepierre P, Rymer JC, Chevalier X. IL-10 plasma levels correlate with disease activity in spondyloarthropathy. J Rheumatol, 1997,24:1659-1661.
[24] Canete J, Llena J, Collado A, et al. Comparative cytokine gene expression in synovial tissue of early rheumatoid arthritis and seronegative spondy-loarthropathies. Br J Rheumatol, 1997,36;38-42
[25] Yin Z, Braun J, Neure L, et al. Crucial role of IL-10/IL-12 balance in the regulation Of the type 2 T helper cytokine response in reactive arthritis Arthritis Rheum, 1997,40:1788-1797.
[26] Euldennk F, Ivanyi P, Weinreich S. Histopathology of murine ankylosing enthesopathy[J].Pathol Res Proct, 1998;194:797
[27] Onderdonk A, Richardson J, Hammer R et al. Correlation of fecal microflora of HLA-B27 transgenic rats with inflammatory bowel disease[J].Infect Immun, 1998;66:6022
[28] Guerassimov A, Zhang Y, Banerjee S et al. Autoimmunity to cartilage link protein in patients with rheumatoid arthritis and ankylosing spondylits[J].J Rhuematol, 1998;25:1480
[29] Leroux J, Guerassimov A, Banerjee S et al. Immunity to the G1 globular domain
of the cartilage proteoglycan can induce inflanmatory erosive polyarthritis and spondylitis in BALB/c mice but inmmunity to G1 is inhibited by covalently bound keratan sulfate in vitro and in vivo [J].J Clin Invest, 1995;97:621
[30] Crew M, Effros R, Walford R et al. Transgenic mice expressing a truncated peromyscus leucopus TNF-alpha gene manifest an arthritis resembling andylosing spondylitis[J].J Interon Cytockine Res, 1998;8:219
[31] Clegg DO, Reda D J, Abdellatif M. Comparison of sulfasalazine and placebo for the treatment of axial and peripheral articular manifestations of seronegative spondylarthropathies[J].Arthritis Rheum, 1999,42(11):2325-2329
[32] Toussirot E, Wendling D, Current guidelines for the drug treatment of ankylosing spondylitis[J].Drugs, 1998,56(2):225-240.
[33] Van Der LS, Van Der HD. Ankylosing spondylitis. Clinical featuers[J].Rheum Dis Clin North Am, 1998,24(4):663-676.
[34] Dougados M, Behier J Jolchine-I, et al. Efficacy of celecoxib, a COX-2 specific hibitor in the treatment of ankylosing spondylitis[J]Arthritis Rheum, 2001;44(1)180-185
[35] Biasi D, Carletto A, Caamaschi P, et al. Efficacy of methotrexate in the treatment of ankylosing spondylites:a three-year open study[J].Clin Rheumatol,2000;19(2):114-117
[36] Sampaio BPD, Costallat LTL, Bertolo M, et al Methotrexate in the treatment of ankylosing spondylitis[J].Scand J Rheumatol,2000,29(3):160-162
[37] Braun J, Bollow M, Neure L, et al. Use of immunohistologic and in situ hybridization techniques in the examination of sacroiliac joint biopsy specimens from patients with ankylosing spondylitis[J].Arthritis Rheum, 1995,38(4):499-505
[38] gratacos J, Collado A, Filella X, et al. Serum cytokines(IL-6, TNF-a, IL-I and IFN-γ)in ankylosing spondylitis:a close correlation between serum IL-6 and disease activity and severity[J].Br J Rheumatol,1994,331-931
[39] Huang F, Gu J, Braun J, et al. Identifying the targets of thalidomide and anti-TNFa antibody treatments in ankylosing spondylitis[J].Arthritis Rheum, 2000,43(9):396
[40] 黄烽，赵伟，反应停对强直性脊柱炎治疗作用的初步观察[A]．首届华夏风湿性疾病诊断治疗学术会议论文汇编[C]上海：中华医学会风湿病学会，1999，123
[41] 施杞主编，中国中医骨伤科百家方技精华．第1版，北京．中国中医药出版社．1991：413～414
[42] 付新利．强直性脊柱炎证治浅见．山东中医杂志，1992，(5)：2
[43] 聂志伟，中药治疗强直性脊柱炎267例分析．辽宁中医杂志，1987；11(6)：22
[44] 刘俊士等，中医治疗强直性脊柱炎20例观察．中医杂志，1987；28(7)：36．
[45] 李在尧，中西医结合治疗强直性脊柱炎80例临床观察．新中医，1994；26(7)7：24
[46] 奕炯等，强直性脊柱炎72例辨证施治．浙江中医杂志．1994；29(2)：65
[47] 王凤仪，马在山老中医治疗强直性脊柱炎的经验．北京中医，1993；(2)：43
[48] 邱玉珍，肾痹汤治疗强直性脊柱炎30例．陕西中医，1991；12(2)：62
[49] 张正泉，白虎通痹汤治疗强直性脊柱炎2例．新中医，1989(8)：15
[50] 潘玉海，散痹汤治疗强直性脊柱炎32例．陕西中医1990；13(3)：117
[51] 娄玉玲，肾痹汤治疗强直性脊柱炎53例报告．中医正骨．1992；4(4)：17
[52] 阎小萍，焦树德治疗强直性脊柱炎的经验．中医杂志。1994；35(7)：407
[53] 高根德，扶正化痰为主治疗强直性脊柱炎．上海中医药杂志，1991；(9)：15
[54] 王忍生，中药治疗强直性脊柱炎．陕西中医，1993；14(5)：199
[55] 李瑞林，强直性脊柱炎80例分析及雷公藤治疗的临床观察．中国中医骨伤科杂志，1987；3(3)：39
[56] 武先民，雷公藤82糖浆治疗强直性脊柱炎．中药药理与临床，1998
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