青竹汤治疗成人still病的临床研究(1)
【摘要】目的 通过随机对照试验观察青竹汤治疗成人still病(AOSD)的疗效。方法 选取2015年1月～2017年5月门诊及住院AOSD患者(气阴两虚兼湿热痹阻证)50例作为研究对象，将其随机分为试验组和对照组，各25例，试验组予青竹汤1剂po bid，对照组予双氯芬酸缓钠释片75 mg po bid，疗程2周。记录治疗前后症状体征积分、白细胞(WBC)、C-反应蛋白(CRP)、血沉(ESR)及血清铁蛋白(SF)变化情况。疗程结束后第4、8周随访记录患者症状体征积分及糖皮质激素服用量。结果 治疗后试验组症状体征积分、WBC、CRP、ESR、SF指标改善均优于对照组，差异有统计学意义(P<0.05)，无不良反应；疗程结束后第4、8周随访记录试验组患者症状体征积分，改善明显优于对照组，差异有统计学意义(P<0.01)；试验组口服激素用量减少，差异有统计学意义(P<0.05)。结论 青竹汤治疗气阴两虚兼湿热痹阻证AOSD疗效确切，安全性高，可辅助撤减激素用量。
【关键词】成人still病；青竹汤；疗效
【中图分类号】R259 【文献标识码】A 【文章编号】ISSN.2095-6681.2018.22..04
A Clinical Study on Chinese Herbal Recipe Qingzhu Tang in the treatment of Adult Onset Still's Disease
TAO Qiu-lian1，DENG Tian-lian2*，TANG Xian-ping3
(1.Jingjiang city second people's hospital，Jiangsu Jinjiang 214531，China；
2.Liulitun Community Health Service Center Chaoyang，Beijing 100026，China；
3.Wangjing Hospital，China Academy of Chinese Medical sciences，Beijing 100102，China)
【Abstract】Objective Based on RCT，observing the effectiveness of Chinese Herbal Recipe Qingzhu Tang for the treatment of adult onset Still's disease (AOSD).Methods 50 patients with AOSD (Qi and Yin deficiency and damp-heat blockage type) which came from Outpatient and inpatient from January 2015 to May 2017 were randomly divided into test group (n=25) and control group (n=25).The test group was treated with Chinese Herbal Recipe Qingzhu Tang 200ml po bid，while the control group was treated with diclofenac sodium sustained release tablets 75mg po bid，the treatment course was 2 weeks.Recording the scores of symptoms and signs，level of WBC，CRP，ESR，SF before treatment and after treatment.At week 4 and week 8 after treatment，also recording the scores of symptoms and signs and the intake of glucocorticoid.Results Scores of symptoms and signs，level of WBC，CRP，ESR，SF that improved which in test group is better than the control group(P<0.05)，and no adverse reaction；According to the follow-up record of symptoms and signs scores at week 4 and week 8 after treatment，test group was significantly superior to control group(P<0.01)；the dosage of corticosteroid use was decreased in patients of test group(P<0.05).Conclusion The Chinese Herbal Recipe Qingzhu Tang cure AOSD efficacy and safty，at the same time can help reduce the dosage of
corticosteroid use.
【Key words】Adult onset Still's disease；Chinese Herbal Recipe Qingzhu Tang；Curative effect
成人斯蒂爾病(Adult Onset Still's Disease，AOSD)是一种以反复高热、一过性多形性皮疹、关节炎(痛)，并伴有白细胞明显增高、肝脾及淋巴结肿大为主要特征，严重时伴有多系统受累的自身免疫疾病[1-2]。随着国内外风湿病学的发展，近年来各界对AOSD的认识也逐渐加深，其发病率呈现逐年上升的趋势。目前本病的西医治疗仍是首选非甾体抗炎药(NSAIDs)及糖皮质激素(GC)[3]，病情控制不佳时可联合使用缓解风湿病情药物(DMARDs)。近期有学者提出对于难治性AOSD可考虑使用生物制剂及新型免疫抑制剂[4]，但因其多为小样本无对照性研究，临床应用价值还有待证实，且价格昂贵，患者接受程度低，使临床应用相对受到限制。而长期应用NSAIDs、DMARDs、GC所带来的如肝肾损害、骨髓抑制、骨质疏松等副作用[5]一直是临床不容忽视的问题。特别是在撤减激素的过程中病情极易反复，常导致患者需长期服用维持量治疗[6]。近年来中医药对AOSD的认识和治疗已取得不少进展，特别是对其发热、咽痛、关节痛的改善及协助顺利撤减激素甚至替代激素上都彰显出了很大优势[7]。目前各医家对AOSD的辨证分型不统一，但通过我们前期对本病证型分布的流行病学研究发现，最常见证型为气阴两虚兼湿热痹阻证[8]；同时从开展中医传承辅助系统分析AOSD用药规律的研究得出，青竹汤为治疗AOSD的核心组方[9]。基于此本研究采用随机、平行、对照的试验方法，评价青竹汤对AOSD的疗效及安全性，观察其对糖皮质激素撤减的影响，为临床使用青竹汤治疗AOSD提供科学依据。, 百拇医药(陶秋莲 邓田莲 唐先平)
【关键词】成人still病；青竹汤；疗效
【中图分类号】R259 【文献标识码】A 【文章编号】ISSN.2095-6681.2018.22..04
A Clinical Study on Chinese Herbal Recipe Qingzhu Tang in the treatment of Adult Onset Still's Disease
TAO Qiu-lian1，DENG Tian-lian2*，TANG Xian-ping3
(1.Jingjiang city second people's hospital，Jiangsu Jinjiang 214531，China；
2.Liulitun Community Health Service Center Chaoyang，Beijing 100026，China；
3.Wangjing Hospital，China Academy of Chinese Medical sciences，Beijing 100102，China)
【Abstract】Objective Based on RCT，observing the effectiveness of Chinese Herbal Recipe Qingzhu Tang for the treatment of adult onset Still's disease (AOSD).Methods 50 patients with AOSD (Qi and Yin deficiency and damp-heat blockage type) which came from Outpatient and inpatient from January 2015 to May 2017 were randomly divided into test group (n=25) and control group (n=25).The test group was treated with Chinese Herbal Recipe Qingzhu Tang 200ml po bid，while the control group was treated with diclofenac sodium sustained release tablets 75mg po bid，the treatment course was 2 weeks.Recording the scores of symptoms and signs，level of WBC，CRP，ESR，SF before treatment and after treatment.At week 4 and week 8 after treatment，also recording the scores of symptoms and signs and the intake of glucocorticoid.Results Scores of symptoms and signs，level of WBC，CRP，ESR，SF that improved which in test group is better than the control group(P<0.05)，and no adverse reaction；According to the follow-up record of symptoms and signs scores at week 4 and week 8 after treatment，test group was significantly superior to control group(P<0.01)；the dosage of corticosteroid use was decreased in patients of test group(P<0.05).Conclusion The Chinese Herbal Recipe Qingzhu Tang cure AOSD efficacy and safty，at the same time can help reduce the dosage of
corticosteroid use.
【Key words】Adult onset Still's disease；Chinese Herbal Recipe Qingzhu Tang；Curative effect
成人斯蒂爾病(Adult Onset Still's Disease，AOSD)是一种以反复高热、一过性多形性皮疹、关节炎(痛)，并伴有白细胞明显增高、肝脾及淋巴结肿大为主要特征，严重时伴有多系统受累的自身免疫疾病[1-2]。随着国内外风湿病学的发展，近年来各界对AOSD的认识也逐渐加深，其发病率呈现逐年上升的趋势。目前本病的西医治疗仍是首选非甾体抗炎药(NSAIDs)及糖皮质激素(GC)[3]，病情控制不佳时可联合使用缓解风湿病情药物(DMARDs)。近期有学者提出对于难治性AOSD可考虑使用生物制剂及新型免疫抑制剂[4]，但因其多为小样本无对照性研究，临床应用价值还有待证实，且价格昂贵，患者接受程度低，使临床应用相对受到限制。而长期应用NSAIDs、DMARDs、GC所带来的如肝肾损害、骨髓抑制、骨质疏松等副作用[5]一直是临床不容忽视的问题。特别是在撤减激素的过程中病情极易反复，常导致患者需长期服用维持量治疗[6]。近年来中医药对AOSD的认识和治疗已取得不少进展，特别是对其发热、咽痛、关节痛的改善及协助顺利撤减激素甚至替代激素上都彰显出了很大优势[7]。目前各医家对AOSD的辨证分型不统一，但通过我们前期对本病证型分布的流行病学研究发现，最常见证型为气阴两虚兼湿热痹阻证[8]；同时从开展中医传承辅助系统分析AOSD用药规律的研究得出，青竹汤为治疗AOSD的核心组方[9]。基于此本研究采用随机、平行、对照的试验方法，评价青竹汤对AOSD的疗效及安全性，观察其对糖皮质激素撤减的影响，为临床使用青竹汤治疗AOSD提供科学依据。, 百拇医药(陶秋莲 邓田莲 唐先平)