章懿婷 刘秋红 李晓茹

【摘 要】目的：观察三伏贴联合塞来昔布治疗肾虚督寒型强直性脊柱炎的临床疗效与安全性。方法：将50例肾虚督寒型强直性脊柱炎患者随机分为治疗组和对照组，每组25例。对照组给予塞来昔布口服治疗，治疗组在对照组基础上加用三伏貼治疗。观察2组临床疗效，以及治疗前后中医证候积分、强直性脊柱炎病情活动度评分（ASDAS-CRP）、Bath强直性脊柱炎功能指数（BASFI评分）、强直性脊柱炎生活质量问卷（ASQoL）评分，同时记录2组不良反应。结果：治疗组临床缓解0例，显效17例，有效7例，无效1例，总有效率为96.00%;对照组临床缓解0例，显效12例，有效10例，无效3例，总有效率为88.00%。2组比较，差异有统计学意义（P < 0.05）。治疗后，2组中医证候积分、ASDAS-CRP、BASFI评分、ASQoL评分较治疗前均有改善，差异有统计学意义（P < 0.05）;除ASDAS-CRP外，治疗组以上指标差值均优于对照组，差异有统计学意义（P < 0.05）。治疗组ASDAS-CRP临床重要改善率和显著改善率均高于对照组（P < 0.05）。结论：三伏贴联合塞来昔布治疗肾虚督寒型强直性脊柱炎具有较好的疗效及良好的安全性。

【关键词】 强直性脊柱炎;肾虚督寒型;三伏贴;中医外治;临床疗效

【ABSTRACT】 Objective：To observe the clinical efficacy and safety of Sanfu Plaster combined with celecoxibin the treatment of ankylosing spondylitis due to kidney deficiency and cold attacking the governor vessel.Methods：Fifty patients with ankylosing spondylitis due to kidney deficiency and cold attacking the governor vessel were randomly divided into a treatment group and a control group，25 cases in each group.The control group was treated with celecoxib，and the treatment group was treated with Sanfu Plaster based on the treatment with celecoxib.The clinical efficacy，TCM syndrome scores，ASDAS-CRP，BASFI and ASQoL scores were observed before and after treatment，and the adverse reactions of two groups were recorded.Results：In the treatment group，there were no cases of clinical remission，17 cases were markedly effective，7 cases were effective，1 case was ineffective，and the total effective rate was 96.00%;In the control group，there were no cases of clinical remission，12 cases were markedly effective，10 cases were effective and 3 cases were ineffective，and the total effective rate was 88.00%.The difference between both groups was statistically significant（P < 0.05）.After treatment，the TCM syndrome scores，ASDAS-CRP，BASFI and ASQoL scores of the two groups were improved compared with those before treatment，and the difference was statistically significant（P < 0.05）;Except for ASDAS-CRP，the differences of the above indexes in the treatment group were better than those in the control group，and the differences were statistically significant（P < 0.05）.The clinical significant improvement rate and the obvious improvement rate of ASDAS-CRP in the treatment group were higher than those in the control group（P < 0.05）.Conclusion：Sanfu Plaster combined with celecoxib has good efficacy and safety in the treatment of ankylosing spondylitis due to kidney deficiency and cold attacking the governor vessel.

【Keywords】 ankylosing spondylitis;kidney deficiency and cold attacking the governor vessel;Sanfu Plaster;TCM external treatment;clinical efficacy

强直性脊柱炎（ankylosing spondylitis，AS）主要表现为中轴关节的慢性炎症，可累及外周关节，并可出现关节外表现如前葡萄膜炎、炎症性肠病和银屑病等。本病常首发于骶髂关节，病变逐渐上行出现脊柱的骨性强直，临床表现为慢性腰背疼痛、活动受限、脊柱僵硬甚至畸形，导致肢体功能、工作能力及生活质量严重下降[1]。西医临床常予非甾体抗炎药和生物制剂等治疗，非甾体抗炎药长期应用存在肝肾功能损害、胃黏膜损害等不良反应;生物制剂治疗起效快、疗效较好，但存在感染机会增加的风险，且价格昂贵，临床应用受到一定的限制[2]。笔者所在科室近年来将三伏贴运用于AS的治疗，取得一定的疗效，现总结报道如下。

1 临床资料