解毒祛瘀滋阴法配合激素治疗系统性红斑狼疮及其对下丘脑-垂体-肾上腺轴的作用研究  

Treating systemic lupus erythematosus by toxin removing,stasis removing and yin supplementing therapy combined with glucocorticoid and its effect on hypothalamic-pituitary-adrenal axis

作　　者：温成平[1] 唐晓颇[2] 范永升[1] 曹灵勇[1] 李永伟[3] 

机构地区：[1]浙江中医药大学,浙江310053 [2]中国中医科学院广安门医院 [3]浙江大学医学院附属一院

出　　处：《北京中医药大学学报》2007年第7期494-497,共4页Journal of Beijing University of Traditional Chinese Medicine

基　　金：国家自然科学基金资助项目(No.39870921)

摘　　要：目的观察解毒祛瘀滋阴法治疗系统性红斑狼疮(SLE)对激素撤减的作用,并探讨其对下丘脑-垂体-肾上腺轴的影响。方法147例女性SLE患者被随机分为中西结合组(79例)和西药组(68例),西药组口服强的松为主治疗,中西结合组在强的松基础上结合解毒祛瘀滋阴药治疗。两组均以3个月为1个疗程,连续治疗观察2个疗程。统计两组治疗过程中的激素用量,并检测促肾上腺皮质激素(ACTH)、皮质醇(CS)的水平变化。结果随着病情得到控制后,两组均按激素撤减方法逐渐减量,第1个疗程中西结合组强的松用量低于西药组,但差异无显著性(P>0.05),2个疗程后两组间差异则有显著性(P<0.05);中西结合组2个疗程激素使用总量(3542.5±124.4mg)显著低于西药组(5126.4±169.7mg)(P<0.01);中西结合组治疗中因病情反复激素需加量的病例比率(5.06%)显著低于西药组(13.24%)(P<0.05)。治疗前重度活动期ACTH(16.53±0.79)ng/L、CS(168.07±9.84)μg/L水平均显著低于其余各期和正常组(P<0.05)。西药组第90、180d后ACTH和CS水平均显著低于治疗前(P<0.05),中西结合组第90d后CS水平显著下降(P<0.05)之外,其余与治疗前差异不显著;治疗后两组间比较,第90d后差异无显著性,第180d后ACTH和CS水平差异均有显著性(P<0.05)。结论解毒祛瘀滋阴法在治疗SLE同时能有效撤减激素用量,对下丘脑-垂体-肾上腺轴具有保护作用,能激发和升高内源性皮质激素的水平,从而提高临床疗效。Objects To observe the effect of toxin removing, stasis removing and yin supplementing therapy on decreasing the dosage of glucocorticoid （GC） and protecting the hypothalamic - pituitary- adrenal axis （HPAA） of patients with systemic lupus erythematosus （SLE）. Methods 147 cases of SLE were randomly divided into the integrated traditional Chinese and western medicine group （79 cases） and the western medicine group （68 cases）. The western medicine group was treated mainly with prednisone only, while the integrated traditional Chinese and western medicine group with toxin removing, stasis removing and y/n supplementing therapy on the basis of prednisone. Both groups had been treated for 2 course, 3 months as a therapy course. The prednisone dosage in the therapy course were counted. Then the levels of adrenocorticotrophic hormone （ACTH） and corticosteroid （CS） in SLE patients were checked. Results The dosage of prednisone in both groups were decreased gradually after the state of disease had been relieved. The prednisone dosage in the integrated traditional Chinese and western medicine group was lower than that in the western medicine group in the first therapy course, but without significant difference（ p 〉 0.05 ）, while with significant difference in the second therapy course （P 〈 0. 05）. The total prednisone dosage in the integrated traditional Chinese and western medicine group （3542.5±124.4mg） was markedly lower than that in the western medicine group（5126.4 ± 169.7mg） （P 〈0.01 ）. The ratio of cases who had to add prednisone for aggravating disease in the integrated traditional Chinese and western medicine group （ 5.06% ） was less than that in the western medicine group（13.24% ） significantly（P 〈0.05）. Before treatment, the levels of ACTH and CS in the severe active period were lower than those in the other group significantly（P 〈0.05）. The levels of ACTH and CS on the 90th day and 180th day were markedly lower than those b

关 键 词：系统性红斑狼疮 下丘脑-垂体-肾上腺轴 强的松 解毒祛瘀滋阴法 

分 类 号：R259.324.1[医药卫生—中西医结合]