李国瑛 唐慧 李翼

【摘 要】目的：观察中医通督三联疗法联合塞来昔布治疗强直性脊柱炎急性活动期的临床疗效。方法：将53例急性活动期强直性脊柱炎患者随机分为治疗组27例和对照组26例。对照组口服塞来昔布胶囊治疗，治疗组在对照组基础上采用通督升阳三联疗法（即口服中药通督升阳汤、针灸通督疗法、正清风痛宁注射液腰宜穴深部注射）治疗。2组均以8周为1个疗程。观察2组临床疗效，以及治疗前后临床症状（枕墙距、指地距、胸廓扩张度）和实验室指标（红细胞沉降率、C反应蛋白）。结果：治疗组好转12例，显效8例，有效5例，无效2例，总有效率为92.59%;对照组好转6例，显效6例，有效8例，无效6例，总有效率为76.92%。2组比较，差异有统计学意义（P < 0.05）。治疗后，2组枕墙距、指地距、胸廓扩张度、红细胞沉降率、C反应蛋白较治疗前均有改善（P < 0.05）;且治疗组优于对照组（P < 0.05）。结论：通督升阳三联疗法联合塞来昔布治疗强直性脊柱炎急性活动期患者能提高疗效，明显改善临床症状和实验室指标。

【关键词】 强直性脊柱炎;急性活动期;通督升阳;三联疗法;临床疗效

【ABSTRACT】Objective：To observe the clinical efficacy of Tongdu Shengyang Triple Therapy combined with celecoxib in the treatment of active ankylosing spondylitis.Methods：Fifty-three patients with acute active ankylosing spondylitis were randomly divided into a treatment group（27 cases）and a control group（26 cases）.The control group was treated with celecoxib capsule，and the treatment group was treated with Tongdu Shengyang Triple Therapy（Tongdu Shengyang Tang—通督升陽汤，acupuncture and moxibustion for the Governor Vessel，deep acupoint injection of Zhengqing Fengtongning—正清风痛宁），based on the treatment for the control group.Both groups were treated for eight weeks as a course of treatment.The clinical efficacy，clinical symptoms（occipital wall distance，finger ground distance，thoracic expansion）before and after treatment and laboratory indexes（erythrocyte sedimentation rate，C-reactive protein）were observed.Results：In the treatment group，12 cases were improved，8 cases were markedly effective，5 cases were effective，2 cases were ineffective，and the total effective rate was 92.59%;In the control group，6 cases were improved，6 cases were markedly effective，8 cases were effective，6 cases were ineffective，and the total effective rate was 76.92%.The difference between the two groups was statistically significant（P < 0.05）.After treatment，occipital wall distance，finger ground distance，thoracic dilatation，erythrocyte sedimentation rate and C-reactive protein of the two groups were improved compared with those before treatment（P < 0.05），and the treatment group was better than the control group（P < 0.05）.Conclusion：Tongdu Shengyang Triple Therapy combined with celecoxib in the treatment of active ankylosing spondylitis can improve the curative effect，clinical symptoms and laboratory indicators.

【Keywords】 ankylosing spondylitis;acute active phase;Tongdu Shengyang;Triple Therapy;clinical efficacy

强直性脊柱炎（ankylosing spondylitis，AS）以骶髂关节和脊柱附着点炎症为主要表现，严重者导致脊柱僵直和畸形[1]。据调查，我国AS患病率为0.3%左右[2]，近年来有明显上升趋势。AS病因尚不明确，与人类白细胞抗原-B27（HLA-B27）有明显关联性[3]。研究发现，miR-146a表达水平与疾病活动性和胸腰椎后凸畸形的严重程度可能有一定的相关性[4]。AS好发于青壮年，男性多于女性，且有明显的家族聚集性[5]。本病起病隐匿，多呈慢性、渐进性发展，致残率高，疗效欠佳。笔者运用通督开阳三联疗法（口服通督升阳汤、针灸通督疗法、正清风痛宁注射液腰宜穴深部注射）联合塞来昔布治疗急性活动期AS患者，现总结报道如下。……