五联抗结核联合中医辨证论治保守治疗无后凸畸形脊柱结核的效果研究  

Effects of Five Anti-Tuberculosis Combinations with Traditional Chinese Medicine on Conservative Treatment of Spinal Tuberculosis without Kyphosis

作　　者：雒军强 卫建民[1] 杨俊松 王自立 冯万立[1] 夏斌[1] 吕会强 LUO Junqiang;WEI Jianmin;YANG Junsong;WANG Zili;FENG Wanli;XIA Bin;LYU Huiqiang(Dept.of Spine,Baoji Hospital of Traditional Chinese Medicine,Shaanxi Baoji 721001,China)

机构地区：[1]宝鸡市中医医院脊柱二科,陕西宝鸡721001

出　　处：《中国医院用药评价与分析》2022年第3期319-322,共4页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：陕西中医药管理局科研项目(No.2021-ZZ-LC026)。

摘　　要：目的:探讨五联抗结核联合中医辨证论治保守治疗无后凸畸形脊柱结核的效果及安全性。方法:选取2018年1月至2020年2月该院拟行保守治疗的无后凸畸形脊柱结核患者86例,采用简单随机化法分为五联组和联合中药组,每组43例。五联组患者强化期使用HRZE四联制剂联合链霉素,巩固期口服HRZE四联制剂。联合中药组患者强化期、巩固期抗结核治疗与五联组相同,根据患者病程、症状进行中医辨证治疗,选择阳和汤合补阳还五汤或加味清骨散1日1剂。分别于治疗前、强化期结束时及停药时评估患者视觉模拟评分(VAS)和红细胞沉降率(ESR)、C反应蛋白(CRP)水平;治疗前及停药时以健康调查简表(SF-36)评估患者的生活质量,比较治疗前后Cobb角变化;比较两组患者手术率、复发率、治疗时间及治疗期间的不良反应。结果:强化期末及停药时,两组患者VAS评分、ESR和CRP水平均低于治疗前,其中强化期末联合中药组患者的VAS评分和CRP水平低于五联组,组间差异有统计学意义(P<0.05)。联合中药组患者的治疗时间为(10.23±0.74)个月,短于五联组的(11.47±0.62)个月;联合中药组患者的手术率为2.33%(1/43),低于五联组的13.95%(6/43),上述差异均有统计学意义(P<0.05)。五联组、联合中药组患者的复发率分别为2.33%(1/43)、4.65%(2/43),差异无统计学意义(P>0.05)。治疗后,两组患者SF-36评分高于治疗前,但组间比较差异无统计学意义(P>0.05)。治疗前后,两组患者Cobb角比较的差异均无统计学意义(P>0.05)。五联组、联合中药组患者的不良反应发生率分别为16.28%(7/43)、13.95%(6/43),差异无统计学意义(P>0.05)。结论:对于保守治疗的患者,采用中医辨证论治配合五联抗结核治疗可以迅速控制无后凸畸形脊柱结核患者的疼痛症状,降低手术率和复发率,改善患者的生活质量,并可缩短治疗时间。OBJECTIVE: To probe into the efficacy and safety of five anti-tuberculosis combinations with traditional Chinese medicine on conservative treatment of spinal tuberculosis without kyphosis. METHODS: Totally 86 patients with spinal tuberculosis without kyphosis undergoing conservative treatment in the hospital from Jan. 2018 to Feb. 2020 were extracted to be divided into the five-combination group and the traditional Chinese medicine combined group via the simple randomization method, with 43 cases in each group. The five-combination group was given HRZE quadruple preparation combined with streptomycin in the intensive stage, and HRZE quadruple preparation orally in the consolidation stage. Patients in the traditional Chinese medicine combined group were treated with the same anti-tuberculosis treatment during the intensive and consolidation periods as in the five-combination group, and traditional Chinese medicine therapy was selected according to the duration of the disease and symptoms of the patients, such as Yanghe decoction, Buyang Huanwu decoction or Jiawei Qinggu powder for one dose daily. Visual analog scale(VAS), erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) levels were assessed before treatment, at the end of intensive stage and drug withdrawal. Patients’ quality of life was evaluated by SF-36 before treatment and at drug withdrawal, changes of Cobb before and after treatment were compared. The surgery rate, recurrence rate, treatment duration and adverse drug reactions were compared between two groups. RESULTS: At the end of intensive stage and drug withdrawal, the VAS score, ESR and CRP levels in two groups were lower than those before treatment, VAS score and CRP levels at the end of intensive stage in the traditional Chinese medicine combined group were lower than those in the five-combination group, with statistically significant differences(P<0.05). The treatment duration of traditional Chinese medicine combined group was(10.23±0.74) months, shorter than(11.47±0.62) months of

关 键 词：保守治疗 脊柱结核 抗结核 中药 阳和汤 补阳还五汤 清骨散 

分 类 号：R978.3[医药卫生—药品] R932[医药卫生—药学]