溫陽通絡法治療寒濕痹阻型強直性脊柱炎的療效

谷家立　馬瑩

摘要 目的：觀察溫陽通絡法治療寒濕痹阻型強直性脊柱炎（AS）的臨床療效。方法：選取2016年1月至2017年3月南京理工大學醫院收治的寒濕痹阻型AS患者60例，隨機分為觀察組和對照組，每組30例。對照組給予西醫常規治療，觀察組在對照組治療基礎上給予溫陽通絡法治療。2組均以4周為1個療程，治療3個療程后，比較2組治療前后主要臨床指標（胸廓活動度、枕墻距、指地距、Schober試驗）、AS功能活動評分[巴氏強直性脊柱炎活動指數（BASDAI）、巴氏強直性脊柱炎功能指數（BASFI）]、實驗室檢查指標[紅細胞沉降率（ESR）、C反應蛋白（CRP）、腫瘤壞死因子-α（TNF-α）、白細胞介素-6（IL-6）]的改善情況，并比較2組臨床療效。結果：與治療前比較，2組治療后胸廓活動度和Schober試驗測量值均顯著升高（P<0.05），枕墻距和指地距均顯著降低（P<0.05），且觀察組治療后上述指標改善程度更為顯著，組間比較差異有統計學意義（P<0.05）；2組治療后BASDAI評分和BASFI評分均顯著降低（P<0.05），且觀察組治療后上述評分降低程度更為顯著，組間比較差異有統計學意義（P<0.05）；2組治療后ESR、CRP、IL-6、TNF-α水平均顯著降低（P<0.05），且觀察組治療后上述指標降低更為顯著，組間比較差異有統計學意義（P<0.05）；治療后，觀察組總有效率為90.0%，顯著高于對照組的66.7%，差異有統計學意義（P<0.05）。結論：溫陽通絡法聯合西醫常規治療寒濕痹阻型AS能夠抑制患者機體炎性反應，快速緩解患者的臨床癥狀和體征，有助于改善患者脊柱功能。

關鍵詞 強直性脊柱炎；寒濕痹阻型；溫陽通絡法；強直性脊柱炎功能活動；實驗室檢查

Abstract Objective：To observe the therapeutic effects of Wenyang Tongluo Therapy on cold-dampness obstruction type ankylosing spondylitis （AS）.Methods：A total of 60 patients with cold-dampness obstruction type AS treated in Nanjing University of Science and Technology Hospital from January 2016 to March 2017 were selected and randomly divided into observation group and control group，with 30 cases in each group.The control group was treated with conventional method while the observation group was treated with Wenyang Tongluo Therapy on the basis of the same treatment for 3 courses （4 weeks as a course）.The clinical effects and the improvement of main clinical indexes （thoracic activity，occipital wall spacing，finger-ground distance，Schober test），AS functional activity score [Barthol′s ankylosing spondylitis activity index （BASDAI），Pap spirometry ankylosing function index （BASFI）]，laboratory test indicators [ESR，C-reactive protein （CRP），tumor necrosis factor-on index，and interleukin-6 （IL-6）] were compared before and after treatment.Results：After treatment，the thoracic activity and Schober test score were significantly increased （P<0.05），and the occipital wall spacing and finger-ground distance were significantly decreased （P<0.05）.The improvement of the above indicators was more significant in the observation group，and there was a statistically significant difference between the groups （P<0.05）.Both BASDAI and BASFI scores decreased significantly after treatment in both groups （P<0.05），and the above scores decreased more significantly after treatment in the observation group，with statistically significant difference between the two groups （P<0.05）.After treatment，the levels of ESR，CRP，IL-6 and TNF-were significantly reduced in both groups （P<0.05），and the decrease of the above indicators was more significant in the observation group，with statistically significant difference between the two groups （P<0.05）.After treatment，the total effective rate of the observation group was 90.0%，which was significantly higher than 66.7% of the control group，and the difference was statistically significant （P<0.05）.Conclusion：The combination of Wenyang Tongluo Therapy and conventional treatment in treating cold-dampness obstruction type AS can inhibit the body inflammatory response of patients，quickly relieve the patient′s clinical symptoms and signs，and help to improve the spinal function of patients.

Key Words AS； Cold-dampness obstruction type； Wenyang Tongluo Therapy； AS functional activity； Laboratory test indicators

中圖分類號：R289.5文獻標識碼：Adoi：10.3969/j.issn.1673-7202.2018.09.032

強直性脊柱炎（Ankylosing Spondylitis，AS）是一類以侵犯中軸關節為主要特征的慢性進行性自身免疫性疾病。本病發病緩慢、隱匿，病理改變一般從骶髂關節開始，從下而上逐漸累及腰椎、胸椎、頸椎及周圍關節，患者主要表現為腰背部疼痛不適、臀部疼痛、足跟痛、足底痛以及脊柱和胸廓活動受限，部分患者還會伴有虹膜炎、肌腱端炎、肺部病變等關節外癥狀，隨著病情的發展，關節逐漸融合，最終可導致脊柱關節畸形甚至功能喪失，嚴重影響患者的身體健康和生命質量[1-2]。盡管AS是一種長期存在的公共健康問題，但目前西醫尚缺乏特效治療手段。……