输络结合刺法为主治疗类风湿关节炎疗效观察
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摘要
目的:观察输络结合刺法与常规针刺法治疗类风湿性关节炎(rheumatoid arthritis,RA)的疗效差异。方法:将70例患者随机分为观察组(35例)与对照组(35例,脱落4例)。两组均取大椎、身柱、至阳、筋缩、肝俞、肾俞、秩边、委中、太溪、天宗等穴,观察组于天宗、秩边穴采用输刺,并在肿胀部位采用刺络放血疗法,余穴采用平补平泻手法;对照组均采用平补平泻手法,隔日治疗1次,每周治疗3次,共治疗12周。观察两组患者治疗前后关节压痛个数、肿胀个数、关节疼痛视觉模拟评分(VAS)、美国健康评估问卷(HAQ)评分,以及血沉(ESR)、C反应蛋白(CRP)的变化,并采用美国风湿病学会(ACR)类风湿关节炎好转标准评定两组疗效。结果:两组治疗后关节压痛个数、肿胀个数、VAS评分及HAQ评分均较治疗前改善(均P<0.01),且观察组均优于对照组(均P<0.05);两组治疗后ESR、CRP均较治疗前降低(均P<0.01),但组间比较差异无统计学意义(均P>0.05);观察组ACR20、ACR50达标率分别为94.3%(33/35)、31.4%(11/35),均优于对照组的67.7%(21/31)、6.5%(2/31)(P<0.01,P<0.05)。结论:输络结合刺法与常规针刺法治疗RA均有效,输络结合刺法疗效优于常规针刺法。
Objective To observe the difference in the therapeutic effects on rheumatoid arthritis(RA) between the combined shu-deep needling and bloodletting technique and the regular needling technique. Methods A total of 70 patients were randomized into an observation group(35 cases) and a control group(35 cases, 4 cases dropped-out). Dazhui(GV 14), Shenzhu(GV 12), Zhiyang(GV 9), Jinsuo(GV 8), Ganshu(BL 18), Shenshu(BL 23), Zhibian(BL 54), Weizhong(BL 40), Taixi(KI 3) and Tianzong(SI 11), etc. were selected in the two groups. Additionally, in the observation group the shu-deep needling technique was adopted at Tianzong(SI 11) and Zhibian(BL 54), the bloodletting technique at the local swollen area and the even-needling technique at the rest acupoints. In the control group, the even-needling technique was applied to all of the acupoints. Acupuncture treatment was given once every two days, 3 times a week and for 12 weeks totally. The numbers of tender points at the knee joint, the numbers of swollen sites at the knee joint, the visual analogue scale(VAS) score and the American health assessment questionnaire(HAQ) score were observed in the two groups before and after treatment, as well as the changes in erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP). The American College of Rheumatology(ACR) criteria was adopted to evaluate the therapeutic effects of the two groups. Results After treatment, the numbers of tender points, the numbers of swollen sites, VAS score and HAQ score were all improved as compared with those before treatment in the two groups(all P<0.01), and the results in the observation group were better than those in the control group(all P<0.05). After treatment, ESR and CRP levels were all reduced as compared with those before treatment in the two groups(all P<0.01), but there was no significant differences between the two groups(both P>0.05). The standard-reaching rates of ACR 20 and ACR 50 in the observation group were 94.3%(33/35) and 31.4%(11/35) respectively, which were better than 67.7%(21/31) and 6.5%(2/31) in the controlgroup(P<0.01, P<0.05). Conclusion The acupuncture with the shu-deep and bloodletting techniques and the acupuncture with regular needling technique are all effective on RA. The therapeutic effects of the acupuncture treatment with the shu-deep and bloodletting techniques are better than that with regular needling technique.
Objective To observe the difference in the therapeutic effects on rheumatoid arthritis(RA) between the combined shu-deep needling and bloodletting technique and the regular needling technique. Methods A total of 70 patients were randomized into an observation group(35 cases) and a control group(35 cases, 4 cases dropped-out). Dazhui(GV 14), Shenzhu(GV 12), Zhiyang(GV 9), Jinsuo(GV 8), Ganshu(BL 18), Shenshu(BL 23), Zhibian(BL 54), Weizhong(BL 40), Taixi(KI 3) and Tianzong(SI 11), etc. were selected in the two groups. Additionally, in the observation group the shu-deep needling technique was adopted at Tianzong(SI 11) and Zhibian(BL 54), the bloodletting technique at the local swollen area and the even-needling technique at the rest acupoints. In the control group, the even-needling technique was applied to all of the acupoints. Acupuncture treatment was given once every two days, 3 times a week and for 12 weeks totally. The numbers of tender points at the knee joint, the numbers of swollen sites at the knee joint, the visual analogue scale(VAS) score and the American health assessment questionnaire(HAQ) score were observed in the two groups before and after treatment, as well as the changes in erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP). The American College of Rheumatology(ACR) criteria was adopted to evaluate the therapeutic effects of the two groups. Results After treatment, the numbers of tender points, the numbers of swollen sites, VAS score and HAQ score were all improved as compared with those before treatment in the two groups(all P<0.01), and the results in the observation group were better than those in the control group(all P<0.05). After treatment, ESR and CRP levels were all reduced as compared with those before treatment in the two groups(all P<0.01), but there was no significant differences between the two groups(both P>0.05). The standard-reaching rates of ACR 20 and ACR 50 in the observation group were 94.3%(33/35) and 31.4%(11/35) respectively, which were better than 67.7%(21/31) and 6.5%(2/31) in the controlgroup(P<0.01, P<0.05). Conclusion The acupuncture with the shu-deep and bloodletting techniques and the acupuncture with regular needling technique are all effective on RA. The therapeutic effects of the acupuncture treatment with the shu-deep and bloodletting techniques are better than that with regular needling technique.
引文
[1]栗占国,张奉春,鲍春德.类风湿性关节炎[M].北京:人民卫生出版社,2009:6-8.
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[5]羊春华,武平,周玉梅,等.针灸在治疗类风湿关节炎中的临床应用探讨[J].针灸临床杂志,2014,30(10):80-81.
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[9]Cader MZ,Filer A,Hazlehurst J,et al.Performance of the2010ACR/EULAR criteria for rheumatoid arthritis:comparison with 1987 ACR criteria in a very early synovitis cohort[J].Ann Rheum Dis,2011,70(6):949-955.
[10]Kaneko Y,Kuwana M,Kameda H,et al.Sensitivity and specificity of 2010 rheumatoid arthritis classification criteria[J].Rheumatology(Oxford),2011,50(7):1268-1274.
[11]类风湿关节炎专题:健康评估问卷评分[J].中医健康养生,2015(12):61
[12]Van Gestel AM,Prevoo ML,Van't Hof MA,et al.Development and validation of the European League Against Rheumatism response criteria for rheumatoid arthritis.Comparison with the preliminary American College of Rheumatology and the world Health Organization/International League Against Rheumatism Criteria[J].Arthritis Rheum,1996,39(1):34-40.
[13]欧阳八四,车建丽,高洁,等.电针与单纯针刺对类风湿关节炎患者外周血与关节滑液中白介素改变作用的观察[J].中国针灸,2010,30(10):840-844.
[14]周嘉陵,朱琦.针灸治疗类风湿关节炎的临床研究[J].中华风湿病学杂志,2000,64(3):169-171.
[15]林俊,黄红,丁光宏,等.穴区肥大细胞功能与针刺缓解急性佐剂性关节炎大鼠疼痛效应的关系[J].针刺研究,2007,32(1):16-19.
[16]陈小凯,吴虹,李旅萍,等.刺络放血法治疗颈椎病对ICAM-1影响的临床观察[J].亚太传统医药,2008,4(3):60-63.
[17]刘岚青,寇任重,文亚,等.针刺镇痛中针刺深度相关因素分析[J].中医杂志2017,58(20):1731-1735.
[2]曾小峰,朱松林,谭爱春,等.我国类风湿关节炎疾病负担和生存质量研究的系统评价[J].中国循证医学杂志,2013,13(3):300-307.
[3]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.
[4]侯雷,马武开.类风湿关节炎中医证候分类临床文献研究[J].中国中西医结合杂志,2014,34(3):279-283.
[5]羊春华,武平,周玉梅,等.针灸在治疗类风湿关节炎中的临床应用探讨[J].针灸临床杂志,2014,30(10):80-81.
[6]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.
[7]陆再英,钟南山.内科学[M].7版.北京:人民卫生出版社,2008:1.
[8]van der Linden MP,Knevel R,Huizinga TW,et al.Classification of rheumatoid arthritis:comparison of the 1987 American College of Rheumatology criteria and the 2010 American College of Rheumatology/European League Against Rheumatism criteria[J].Arthritis Rheum,2011,63(1):337-342.
[9]Cader MZ,Filer A,Hazlehurst J,et al.Performance of the2010ACR/EULAR criteria for rheumatoid arthritis:comparison with 1987 ACR criteria in a very early synovitis cohort[J].Ann Rheum Dis,2011,70(6):949-955.
[10]Kaneko Y,Kuwana M,Kameda H,et al.Sensitivity and specificity of 2010 rheumatoid arthritis classification criteria[J].Rheumatology(Oxford),2011,50(7):1268-1274.
[11]类风湿关节炎专题:健康评估问卷评分[J].中医健康养生,2015(12):61
[12]Van Gestel AM,Prevoo ML,Van't Hof MA,et al.Development and validation of the European League Against Rheumatism response criteria for rheumatoid arthritis.Comparison with the preliminary American College of Rheumatology and the world Health Organization/International League Against Rheumatism Criteria[J].Arthritis Rheum,1996,39(1):34-40.
[13]欧阳八四,车建丽,高洁,等.电针与单纯针刺对类风湿关节炎患者外周血与关节滑液中白介素改变作用的观察[J].中国针灸,2010,30(10):840-844.
[14]周嘉陵,朱琦.针灸治疗类风湿关节炎的临床研究[J].中华风湿病学杂志,2000,64(3):169-171.
[15]林俊,黄红,丁光宏,等.穴区肥大细胞功能与针刺缓解急性佐剂性关节炎大鼠疼痛效应的关系[J].针刺研究,2007,32(1):16-19.
[16]陈小凯,吴虹,李旅萍,等.刺络放血法治疗颈椎病对ICAM-1影响的临床观察[J].亚太传统医药,2008,4(3):60-63.
[17]刘岚青,寇任重,文亚,等.针刺镇痛中针刺深度相关因素分析[J].中医杂志2017,58(20):1731-1735.