沈氏羌活地黄汤治疗强直性脊柱炎疗效观察  

Clinical Observation on Ankylosing Spondylitis Treated by Shenshi Qianghuo Dihuang Decoction(沈氏羌活地黄汤)

作　　者：于博 唐华燕[1] 张娜[1] 徐星宇 孙蓓蓓 YU Bo;TANG Huayan;ZHANG Na;XU Xingyu;SUN Beibei(Shanghai Municipal Hospital of Traditional Chinese Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200071,China)

机构地区：[1]上海中医药大学附属市中医医院,上海200071

出　　处：《中华中医药学刊》2024年第8期142-145,共4页Chinese Archives of Traditional Chinese Medicine

基　　金：国家重点研发计划项目(2018YFC1705502);上海市卫生和计划生育委员会中医药科研项目(2018LP031)。

摘　　要：目的观察沈氏羌活地黄汤治疗强直性脊柱炎的临床疗效及安全性。方法采用随机对照研究方法,将强直性脊柱炎患者90例分为治疗组和对照组各45例,对照组口服甲氨蝶呤片,每次15 mg,1次/周;治疗组在对照组用药基础上加用沈氏羌活地黄汤口服,每次200 mL,2次/d。疗程12周。结果治疗组总有效率91%(41/45),ASAS20%反应标准(ASAS20)评分标准者占治疗组总人数93%(42/45);对照组总有效率53%(24/45)、ASAS20评分标准者占67%(30/45),治疗组疗效优于对照组(P<0.05)。两组患者强直性脊柱炎疾病活动度指数(BASDAI)积分、脊柱痛显著改善(P<0.01),治疗组显著优于对照组(P<0.01)。治疗组强直性脊柱炎功能指数(BASFI)积分显著改善(P<0.01),明显优于对照组(P<0.01)。两组患者经治疗后炎症活动指标、C反应蛋白(CRP)、病情总体评价(PGA)明显改善(P<0.01),组间差异无统计学意义。治疗组血沉(ESR)改善有统计学意义(P<0.01),优于对照组(P<0.05)。两组患者中医证候积分显著改善(P<0.01),治疗组显著优于对照组(P<0.01)。结论沈氏羌活地黄汤联合甲氨蝶呤治疗强直性脊柱炎疗效好于甲氨蝶呤单一治疗,且无不良反应。Objective To observe the clinical efficacy and safety of Shenshi Qianghuo Dihuang Decoction(沈氏羌活地黄汤) in the treatment of ankylosing spondylitis. Methods In this study, 90 patients with ankylosing spondylitis were divided into treatment group and control group, 45 cases in each group. The control group received methotrexate tablets, 15 mg for each time, once a week. The treatment group was combined with Shenshi Qianghuo Dihuang Decoction orally on the basis of the control group, 200 mL for each time, twice a day. The course of treatment was 12 weeks. Results The total effective rate of the treatment group was 91%(41/45),and ASAS20 scores accounted for 93%(42/45) of the total number of patients in the treatment group. The total effective rate of the control group was 53%(24/45),and the ASAS20 scoring standard accounted for 67%(30/45). The curative effect of the treatment group was better than that of the control group(P<0.05). Bath ankylosing spondylitis disease activity index(BASDAI) scores were significantly improved in both groups(P<0.01),and the BASDAI score of the treatment group was significantly better than that of the control group(P<0.01). Bath andylosing spondylitis function index(BASFI) score in the treatment group was significantly improved(P<0.01) and significantly better than that in the control group(P<0.01). After treatment, inflammatory activity indexes, C-reactive protein(CRP) and overall assessment(PGA) were significantly improved in two groups(P<0.01),and there was no difference between groups. The improvement of erythrocyte sedimentation rate(ESR) in the treatment group was significant(P<0.01),which was significantly better than that in control group(P<0.05). Conclusion The effect of combined treatment with methotrexate on ankylosing spondylitis is better than that of single treatment with methotrexate without adverse reactions.

关 键 词：强直性脊柱炎 羌活地黄汤 甲氨蝶呤 沈丕安 名中医 中医治疗 

分 类 号：R255.6[医药卫生—中医内科学] R593.23[医药卫生—中医学]