温针灸联合涌泉灸治疗肾虚髓亏型膝骨关节炎:随机对照研究
|
摘要
目的:比较温针灸联合涌泉灸与单纯温针灸治疗肾虚髓亏型膝骨关节炎的临床疗效。方法:将66例肾虚髓亏型膝骨关节炎患者随机分为观察组和对照组,每组33例。两组均采用温针灸治疗,穴取患侧内膝眼、犊鼻、足三里、悬钟。观察组在温针灸的基础上联合涌泉灸治疗,穴取双侧涌泉穴,以艾条行温和灸。每次治疗30 min,每周治疗3次(隔日1次),连续治疗6周。观察两组患者治疗前后西安大略和麦克马斯特大学骨关节炎指数(WOMAC)量表(关节疼痛、僵硬程度、日常活动功能)评分、膝关节腔内积液量以及血清白介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、超敏C-反应蛋白(hs-CRP)含量的变化。结果:观察组总有效率为93.3%(28/30),优于对照组的87.1%(27/31,P<0.05);两组患者治疗后关节疼痛、僵硬程度、日常活动功能评分,膝关节腔内积液量以及血清IL-1β、TNF-α、hs-CRP含量均较治疗前明显降低(均P<0.05),观察组治疗后关节疼痛、僵硬程度、日常活动功能评分,膝关节腔内积液量以及血清IL-1β、TNF-α、hs-CRP含量均低于对照组(均P<0.05)。结论:温针灸联合涌泉灸治疗肾虚髓亏型膝骨关节炎能有效改善膝关节功能,减少膝关节腔内积液量以及降低炎性细胞因子含量,疗效优于单纯温针灸。
Objective To compare the clinical effect between warming acupuncture combined with moxibustion at Yongquan(KI 1) and simple warming acupuncture for knee osteoarthritis with kidney-marrow deficiency. Methods A total of 66 patients of knee osteoarthritis with kidney-marrow deficiency were randomized into an observation group and a control group, 33 cases in each one. Warming acupuncture was applied at Neixiyan(EX-LE 4), Dubi(ST 35), Zusanli(ST 36) and Xuanzhong(GB 39) on the affected side in both of the groups. In the observation group, mild moxibustion at bilateral Yongquan(KI 1) was adopted additionally. Each treatment lasted for 30 min, 3 times a week(once every other day), and the consecutive 6 weeks of treatment were required. The Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC) score(such as joint pain, stiffness and physical function), the amount of joint effusion and the serum contents of interleukin-1β(IL-1β), tumor necrosis factor-α(TNF-α) and high-sensitivity C-reactive protein(hs-CRP) were observed before and after treatment in the two groups. Results The total effective rate in the observation group was 93.3%(28/30), which was superior to 87.1%(27/30) in the control group(P<0.05). Compared before treatment, the pain scores, stiffness scores, physical function scores, the amount of joint effusion and the contents of IL-1β, TNF-α and hs-CRP after treatment were significantly reduced in the two groups(P<0.05), and the improvements of these indices in the observation group were superior to the control group(P<0.05). Conclusion Warming acupuncture combined with moxibustion at Yongquan(KI 1) can improve joint function, reduce the amount of joint effusion and the contents of inflammatory response indices for knee osteoarthritis with kidney-marrow deficiency. The therapeutic effect of warming acupuncture combined with moxibustion at Yongquan(KI 1) is better than simple warming acupuncture.
Objective To compare the clinical effect between warming acupuncture combined with moxibustion at Yongquan(KI 1) and simple warming acupuncture for knee osteoarthritis with kidney-marrow deficiency. Methods A total of 66 patients of knee osteoarthritis with kidney-marrow deficiency were randomized into an observation group and a control group, 33 cases in each one. Warming acupuncture was applied at Neixiyan(EX-LE 4), Dubi(ST 35), Zusanli(ST 36) and Xuanzhong(GB 39) on the affected side in both of the groups. In the observation group, mild moxibustion at bilateral Yongquan(KI 1) was adopted additionally. Each treatment lasted for 30 min, 3 times a week(once every other day), and the consecutive 6 weeks of treatment were required. The Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC) score(such as joint pain, stiffness and physical function), the amount of joint effusion and the serum contents of interleukin-1β(IL-1β), tumor necrosis factor-α(TNF-α) and high-sensitivity C-reactive protein(hs-CRP) were observed before and after treatment in the two groups. Results The total effective rate in the observation group was 93.3%(28/30), which was superior to 87.1%(27/30) in the control group(P<0.05). Compared before treatment, the pain scores, stiffness scores, physical function scores, the amount of joint effusion and the contents of IL-1β, TNF-α and hs-CRP after treatment were significantly reduced in the two groups(P<0.05), and the improvements of these indices in the observation group were superior to the control group(P<0.05). Conclusion Warming acupuncture combined with moxibustion at Yongquan(KI 1) can improve joint function, reduce the amount of joint effusion and the contents of inflammatory response indices for knee osteoarthritis with kidney-marrow deficiency. The therapeutic effect of warming acupuncture combined with moxibustion at Yongquan(KI 1) is better than simple warming acupuncture.
引文
[1]叶国平,苏美玲,吴明霞,等.不同壮数温针灸对膝骨性关节炎疗效及关节腔积液的影响[J].中华中医药杂志,2017,32(9):4312-4316.
[2]王晓玲,王芗斌,侯美金,等.温针灸治疗膝骨关节炎:随机对照研究[J].中国针灸,2017,37(5):457-462.
[3]涂雪松,刘晓安,胡利霞,等.温针灸治疗膝关节骨性关节炎的临床随机对照研究[J].针灸临床杂志,2016,32(6):38-40.
[4]梅江,杨子入,李辉,等.温针灸治疗早中期膝骨关节炎疗效观察[J].上海针灸杂志,2014,33(1):52-54.
[5]王建国,何丽娟.温针灸治疗膝骨关节炎疗效观察[J].中国针灸,2007,27(3):191-192.
[6]中华人民共和国国务院.医疗机构管理条例[S].北京:中国法制出版社,1994.
[7]中华医学会骨科学分会.骨关节炎诊治指南(2007年版)[J].中华骨科杂志,2007,27(10):793-796.
[8]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994.
[9]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:119-123.
[10]Stratford PW,Kennedy DM.Does parallel item content on WOMAC’s pain and function subscales limit its ability to detect change in functional status[J].BNC Musculoskelet Disord,2004,5:17.
[11]Walther M,Harms H,Krenn V,et al.Synovial tissue of the hip at power doppler US:correlation between vascularity and power doppler US signal[J].Radiology,2002,225(1):225-231.
[12]Roos EM,Kl?ssbo M,Lohmander LS.WOMAC osteoarthritis index.Reliability,validity,and responsiveness in patients with arthroscopically assessed osteoarthritis.Western Ontario and MacMaster Universities[J].Scand Rheumatol J,1999,28(4):210-215.
[13]Giwnewer U,Rubin G,Orbach H,et al.Treatment for osteoarthritis of the knee[J].Harefuah,2016,155(7):403-406.
[14]耿洪岳.温针灸治疗膝关节骨性关节炎效果观察[J].实用中医药杂志,2018,34(7):836-837.
[15]郭凯云,陈东林.温针灸治疗膝骨关节炎的系统评价[J].中医正骨,2018,30(7):17-20.
[16]徐欣,洪昆达,吴明霞,等.温针灸对肾虚髓亏型膝骨性关节炎关节滑液MMP-3与细胞因子的影响[J].福建中医学院学报,2009,19(6):42-45.
[17]Grigolo B,Roseti L,Fiorini M,et al.Enhanced lipid peroxidation in synoviocytes from patients with osteoarthritis[J].J Rheumatol,2003,30(2):345-347.
[18]Vuolteenaho K1,Moilanen T,H?m?l?inen M,et al.Regulation of nitric oxide production in osteoarthritic and rheumatoid cartilage.Role of endogenous IL-1 inhibitors[J].Scand J Rheumatol,2003,32(1):19-24.
[19]朱冰梅,陆懋宣,刘杰,等.艾灸涌泉穴延缓衰老机制的探讨[J].四川生理科学杂志,1995,17(S1):138-139.
[20]陈丽宜,陈红云,潘建科,等.改良冰敷法配合按摩涌泉穴在膝关节创伤性滑膜炎中的运用[J].现代医院,2013,13(10):8-9.
[21]任海亮,马剑雄,马信龙,等.膝骨关节炎时关节滑液中炎症相关物质的表达[J].中国组织工程研究,2015,19(15):2336-2340.
[22]魏合伟,罗玉明,郑维蓬.膝骨关节炎中医证型与炎性因子IL-6、TNF-α表达相关性的研究[J].辽宁中医杂志,2015,42(7):1167-1169.
[23]Catterall JB,Stabler TV,Flannery CR,et al.Changes in serum and synovial fluid biomarkers after acute injury(NCT00332254)[J].Arthritis Res Ther,2010,12(6):R229.
[24]Pearle AD,Scanzello CR,George S,et al.Elevated high-sensitivity C-reactive protein levels are associated with local inflammatory findings in patients with osteoarthritis[J].Osteoarthritis Cartilage,2007,15(5):516-523.
[2]王晓玲,王芗斌,侯美金,等.温针灸治疗膝骨关节炎:随机对照研究[J].中国针灸,2017,37(5):457-462.
[3]涂雪松,刘晓安,胡利霞,等.温针灸治疗膝关节骨性关节炎的临床随机对照研究[J].针灸临床杂志,2016,32(6):38-40.
[4]梅江,杨子入,李辉,等.温针灸治疗早中期膝骨关节炎疗效观察[J].上海针灸杂志,2014,33(1):52-54.
[5]王建国,何丽娟.温针灸治疗膝骨关节炎疗效观察[J].中国针灸,2007,27(3):191-192.
[6]中华人民共和国国务院.医疗机构管理条例[S].北京:中国法制出版社,1994.
[7]中华医学会骨科学分会.骨关节炎诊治指南(2007年版)[J].中华骨科杂志,2007,27(10):793-796.
[8]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994.
[9]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:119-123.
[10]Stratford PW,Kennedy DM.Does parallel item content on WOMAC’s pain and function subscales limit its ability to detect change in functional status[J].BNC Musculoskelet Disord,2004,5:17.
[11]Walther M,Harms H,Krenn V,et al.Synovial tissue of the hip at power doppler US:correlation between vascularity and power doppler US signal[J].Radiology,2002,225(1):225-231.
[12]Roos EM,Kl?ssbo M,Lohmander LS.WOMAC osteoarthritis index.Reliability,validity,and responsiveness in patients with arthroscopically assessed osteoarthritis.Western Ontario and MacMaster Universities[J].Scand Rheumatol J,1999,28(4):210-215.
[13]Giwnewer U,Rubin G,Orbach H,et al.Treatment for osteoarthritis of the knee[J].Harefuah,2016,155(7):403-406.
[14]耿洪岳.温针灸治疗膝关节骨性关节炎效果观察[J].实用中医药杂志,2018,34(7):836-837.
[15]郭凯云,陈东林.温针灸治疗膝骨关节炎的系统评价[J].中医正骨,2018,30(7):17-20.
[16]徐欣,洪昆达,吴明霞,等.温针灸对肾虚髓亏型膝骨性关节炎关节滑液MMP-3与细胞因子的影响[J].福建中医学院学报,2009,19(6):42-45.
[17]Grigolo B,Roseti L,Fiorini M,et al.Enhanced lipid peroxidation in synoviocytes from patients with osteoarthritis[J].J Rheumatol,2003,30(2):345-347.
[18]Vuolteenaho K1,Moilanen T,H?m?l?inen M,et al.Regulation of nitric oxide production in osteoarthritic and rheumatoid cartilage.Role of endogenous IL-1 inhibitors[J].Scand J Rheumatol,2003,32(1):19-24.
[19]朱冰梅,陆懋宣,刘杰,等.艾灸涌泉穴延缓衰老机制的探讨[J].四川生理科学杂志,1995,17(S1):138-139.
[20]陈丽宜,陈红云,潘建科,等.改良冰敷法配合按摩涌泉穴在膝关节创伤性滑膜炎中的运用[J].现代医院,2013,13(10):8-9.
[21]任海亮,马剑雄,马信龙,等.膝骨关节炎时关节滑液中炎症相关物质的表达[J].中国组织工程研究,2015,19(15):2336-2340.
[22]魏合伟,罗玉明,郑维蓬.膝骨关节炎中医证型与炎性因子IL-6、TNF-α表达相关性的研究[J].辽宁中医杂志,2015,42(7):1167-1169.
[23]Catterall JB,Stabler TV,Flannery CR,et al.Changes in serum and synovial fluid biomarkers after acute injury(NCT00332254)[J].Arthritis Res Ther,2010,12(6):R229.
[24]Pearle AD,Scanzello CR,George S,et al.Elevated high-sensitivity C-reactive protein levels are associated with local inflammatory findings in patients with osteoarthritis[J].Osteoarthritis Cartilage,2007,15(5):516-523.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |