痹痛膏灸治疗寒湿痹阻型类风湿膝关节炎的疗效及对免疫炎症失衡和血液流变学的影响
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摘要
目的观察痹痛膏灸治疗寒湿痹阻型类风湿膝关节炎的疗效及对免疫炎症失衡和血液流变学的影响。方法将120例寒湿痹阻型类风湿膝关节炎患者随机分为观察组和对照组,每组60例。对照组给予常规西医治疗,观察组在对照组治疗的基础上加用痹痛膏灸治疗,2组疗程均为8周。统计2组临床疗效,并记录2组中医症状积分、西医症状体征和实验室检查指标、膝关节功能、Th17/treg细胞因子和血液流变学指标的变化。结果观察组临床疗效显著优于对照组(P<0.05);2组治疗后中医症状(关节冷痛、关节肿胀、关节屈伸不利、关节晨僵、关节酸软乏力、头晕耳鸣、恶风寒)单项积分和总积分均显著降低(P均<0.05),观察组治疗后以上积分均显著低于对照组(P均<0.05);2组治疗后疼痛VAS评分、晨僵时间、膝关节周径、血清类风湿因子(RF)、血清抗环状瓜氨酸抗体(CCP)和红细胞沉降率(ESR)均显著降低(P均<0.05),观察组治疗后以上指标均显著低于对照组(P均<0.05);2组治疗后Lysholm膝关节评分分级情况、评分均显著改善(P均<0.05),观察组改善情况显著优于对照组(P均<0.05);2组治疗后血清干扰素-γ(IFN-γ)、白细胞介素-17(IL-17)和IL-6水平均显著降低(P均<0.05),转化生长因子-β(TGF-β)、IL-4和IL-10水平显著升高(P均<0.05),观察组治疗后以上指标改善情况均显著优于对照组(P均<0.05);2组治疗后全血黏度高切、中切、低切,血浆黏度,红细胞聚集指数和D-二聚体均显著降低(P均<0.05),观察组治疗后以上指标显著低于对照组(P均<0.05)。2组不良反应发生率比较差异无统计学意义(P>0.05)。结论痹痛膏灸治疗寒湿痹阻型类风湿膝关节炎的疗效确切,可显著缓解患者膝关节疼痛,促进膝关节炎症水肿消散,改善膝关节功能,且安全性好,其机制可能与促进机体免疫炎症细胞因子平衡,降低血液黏稠度和高凝状态有关。
Objective It is to observe the curative effect of moxibustion with Bitonggao on phlegm and moxibustion moxibustion on knee rheumatoid arthritis of syndrome cold-dampness stagnation and its influence on immune inflammatory imbalance and hemorheology. Methods 120 patients with knee rheumatoid arthritis of syndrome cold-dampness stagnation were randomly divided into observation group and control group, 60 cases in each group. The control group was treated with conventional western medicine, and the observation group was treated with moxibustion with Bitonggao on the basis of the control group. Both groups were treated for 8 weeks. The clinical efficacy of the two groups was assessed, and the changes of TCM symptom scores, western medicine symptoms and signs, laboratory tests, knee function, Th17/treg cytokines and hemorheology indexes were observed before and after treatment. Results The clinical efficacy of the observation group was significantly better than that of the control group(P<0.05). The symptoms of TCM after treatment(cold joint pain, joint swelling, joint inhibited flexion and extension, joint stiffness, joint fatigue, dizziness, tinnitus, intolerance of cold and wind) and total scores were significantly decreased after treatment in both groups, and the scores above in the observation group were more lower(P<0.05). The pain VAS score, morning stiffness time, knee circumference, serum rheumatoid factor(RF), anti-cyclic citrulline antibody(CCP) and erythrocyte sedimentation rate(ESR) were significantly decreased in the two groups, the above indicators were lower in the observation group than those in the control group(P<0.05); Lysholm knee score and the average score were significantly improved after treatment in the two groups, the improvements of the observation group were better than that of the control group(P<0.05). The levels of serum interferon-γ(IFN-γ), interleukin-17(IL-17) and IL-6 after treatment were significantly decreased, and the levels of transforming growth factor-β(TGF-β), IL-4 and IL-10 were significantly increased in the two groups, the improvements in the observation group were better than the control group(P<0.05); the blood viscosity of high cut, low cut, plasma viscosity, erythrocyte aggregation index and D-dimer were significantly decreased in the two groups, the above indicators were more lower in the observation group(P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion The clinical efficacy of moxibustion with Bitonggao is obvious in the treatment of knee rheumatoid arthritis,it can significantly alleviate knee pain, promote inflammation and edema of knee joint, improve knee function, and have good safety. The mechanism may be related to promoting the balance of immune inflammatory cytokines and reducing blood viscosity and hypercoagulability.
Objective It is to observe the curative effect of moxibustion with Bitonggao on phlegm and moxibustion moxibustion on knee rheumatoid arthritis of syndrome cold-dampness stagnation and its influence on immune inflammatory imbalance and hemorheology. Methods 120 patients with knee rheumatoid arthritis of syndrome cold-dampness stagnation were randomly divided into observation group and control group, 60 cases in each group. The control group was treated with conventional western medicine, and the observation group was treated with moxibustion with Bitonggao on the basis of the control group. Both groups were treated for 8 weeks. The clinical efficacy of the two groups was assessed, and the changes of TCM symptom scores, western medicine symptoms and signs, laboratory tests, knee function, Th17/treg cytokines and hemorheology indexes were observed before and after treatment. Results The clinical efficacy of the observation group was significantly better than that of the control group(P<0.05). The symptoms of TCM after treatment(cold joint pain, joint swelling, joint inhibited flexion and extension, joint stiffness, joint fatigue, dizziness, tinnitus, intolerance of cold and wind) and total scores were significantly decreased after treatment in both groups, and the scores above in the observation group were more lower(P<0.05). The pain VAS score, morning stiffness time, knee circumference, serum rheumatoid factor(RF), anti-cyclic citrulline antibody(CCP) and erythrocyte sedimentation rate(ESR) were significantly decreased in the two groups, the above indicators were lower in the observation group than those in the control group(P<0.05); Lysholm knee score and the average score were significantly improved after treatment in the two groups, the improvements of the observation group were better than that of the control group(P<0.05). The levels of serum interferon-γ(IFN-γ), interleukin-17(IL-17) and IL-6 after treatment were significantly decreased, and the levels of transforming growth factor-β(TGF-β), IL-4 and IL-10 were significantly increased in the two groups, the improvements in the observation group were better than the control group(P<0.05); the blood viscosity of high cut, low cut, plasma viscosity, erythrocyte aggregation index and D-dimer were significantly decreased in the two groups, the above indicators were more lower in the observation group(P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion The clinical efficacy of moxibustion with Bitonggao is obvious in the treatment of knee rheumatoid arthritis,it can significantly alleviate knee pain, promote inflammation and edema of knee joint, improve knee function, and have good safety. The mechanism may be related to promoting the balance of immune inflammatory cytokines and reducing blood viscosity and hypercoagulability.
引文
[1] 吴跃文.白芍在治疗痹痛中不同剂量的临床效果分析[J].海峡药学,2017,29(6):177-179
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[11] 封昱辰,房晴晴,蔺军平,等.葡萄糖-6-磷酸异构酶、抗环瓜氨酸肽抗体、类风湿因子联合检测对类风湿关节炎的诊断价值[J].检验医学,2016,31(7):567-570
[12] 赵琳,刘先岭,宋蕾.比较类风湿因子、抗环瓜氨酸肽抗体单独或联合检测对类风湿关节炎早期诊断的应用价值分析[J].临床内科杂志,2016,33(1):53-54
[13] 王梁谦,唐杨,李修洋,等.血清中炎性细胞因子在类风湿关节炎患者中的检测及临床意义[J].海南医学院学报,2016,22(8):762-764
[14] 高晨鑫,张湛明,陈继红,等.青藤碱对类风湿关节炎细胞因子影响的研究进展[J].风湿病与关节炎,2017,6(2):72-75
[15] 章平衡,刘健,谈冰,等.类风湿性关节炎患者高凝血状态与核因子κB活化及致炎因子增加有关[J].细胞与分子免疫学杂志,2016,32(3):364-368
[16] 章平衡,刘健,谈冰,等.新风胶囊通过降低NF-κB通路活性改善类风湿关节炎患者血瘀状态[A]//2015年第十三届全国风湿病学术会议[C].中华中医药杂志,2016(11):4684-4689
[17] 何媛.类风湿性关节炎患者Th17/Treg及其相关细胞因子的研究[J].实用临床医学,2016,17(9):17-19
[18] 徐浩,吴淋淋,洪雪莲.类风湿性关节炎患者外周血的Th17/Treg细胞平衡的意义[J].中国卫生检验杂志,2017,27(23):3444-3445
[19] 海亚美,程青青,何东仪.类风湿关节炎中医证候特征分析研究进展[J].上海中医药大学学报,2017,31(4):87-91
[20] 齐兵,杨明路.独活寄生合剂对膝骨关节炎膝关节功能、炎性因子及软骨代谢标志物的影响[J].陕西中医,2017,38(12):1728-1729
[21] 韩炜.川芎的化学成分与药理作用研究进展[J].中国现代中药,2017,19(9):1341-1349
[2] 吕新亮,黄永凯,张金良,等.痹痛康丸联合来氟米特治疗活动期类风湿关节炎的临床研究[J].现代中西医结合杂志,2007,16(33):4912-4914
[3] 胡炜,邹鸿星,杨淮河,等.膝关节类风湿性关节炎与骨关节炎的临床异同点及MRI影像学表现分析[J].中国CT和MRI杂志,2017,15(1):134-136
[4] 林婉敏,吴垚.温针灸对类风湿性膝关节炎患者疼痛、僵硬改善程度的影响[J].黑龙江医药,2015,28(2):376-377
[5] 中华医学会风湿病学分会.类风湿关节炎诊断及治疗指南[J].中华风湿病学杂志,2010,14(4):265-270
[6] 国家中医药管理局.中医病证诊断疗效标准[S].南京:南京大学出版社,1994:234-235
[7] 陈昱文,曹泽标,周小青,等.中医症状量化方法及其临床应用述评[J].湖南中医药大学学报,2016,36(3):82-86
[8] 李卫国.临床疼痛学[M].长春:吉林科学技术出版社,2013:104-105
[9] 苏佳灿.骨与关节损伤评分[M].上海:第二军医大学出版社,2013:189
[10] 国家中医药管理局.中药新药临床研究指导原则(试行)[S].北京:中国医药科技出版社,2002:198-199
[11] 封昱辰,房晴晴,蔺军平,等.葡萄糖-6-磷酸异构酶、抗环瓜氨酸肽抗体、类风湿因子联合检测对类风湿关节炎的诊断价值[J].检验医学,2016,31(7):567-570
[12] 赵琳,刘先岭,宋蕾.比较类风湿因子、抗环瓜氨酸肽抗体单独或联合检测对类风湿关节炎早期诊断的应用价值分析[J].临床内科杂志,2016,33(1):53-54
[13] 王梁谦,唐杨,李修洋,等.血清中炎性细胞因子在类风湿关节炎患者中的检测及临床意义[J].海南医学院学报,2016,22(8):762-764
[14] 高晨鑫,张湛明,陈继红,等.青藤碱对类风湿关节炎细胞因子影响的研究进展[J].风湿病与关节炎,2017,6(2):72-75
[15] 章平衡,刘健,谈冰,等.类风湿性关节炎患者高凝血状态与核因子κB活化及致炎因子增加有关[J].细胞与分子免疫学杂志,2016,32(3):364-368
[16] 章平衡,刘健,谈冰,等.新风胶囊通过降低NF-κB通路活性改善类风湿关节炎患者血瘀状态[A]//2015年第十三届全国风湿病学术会议[C].中华中医药杂志,2016(11):4684-4689
[17] 何媛.类风湿性关节炎患者Th17/Treg及其相关细胞因子的研究[J].实用临床医学,2016,17(9):17-19
[18] 徐浩,吴淋淋,洪雪莲.类风湿性关节炎患者外周血的Th17/Treg细胞平衡的意义[J].中国卫生检验杂志,2017,27(23):3444-3445
[19] 海亚美,程青青,何东仪.类风湿关节炎中医证候特征分析研究进展[J].上海中医药大学学报,2017,31(4):87-91
[20] 齐兵,杨明路.独活寄生合剂对膝骨关节炎膝关节功能、炎性因子及软骨代谢标志物的影响[J].陕西中医,2017,38(12):1728-1729
[21] 韩炜.川芎的化学成分与药理作用研究进展[J].中国现代中药,2017,19(9):1341-1349