防风膝痹汤结合温针灸辨证治疗痛痹型膝关节骨性关节炎患者的疗效观察
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摘要
目的:分析防风膝痹汤结合温针灸辨证治疗痛痹型膝关节骨性关节炎患者的临床效果。方法:选择2016年3月至2017年3月90例在本院确诊治疗的痛痹型膝关节骨性关节炎患者,按随机数字表法随机均分为两组。对照组服用双氯芬酸钠缓释片(扶他林)治疗,观察组采用防风膝痹汤结合温针灸治疗,两组均治疗20天。比较两组患者临床治疗效果,治疗前后骨关节炎调查量表(WOMAC)评分及关节液中炎症因子肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及白细胞介素-1β(IL-1β)表达水平的变化。结果:观察组有总有效率91. 11%明显高于对照组总有效率73. 33%,两组比较差异有统计学意义(P <0. 05)。经过治疗后,患者的IL-6、IL-1β、TNF-α水平均显著降低;观察组治疗后炎症因子水平明显低于对照组(P <0. 05)。观察组治疗后WOMAC积分表中疼痛程度、僵硬程度及生理功能情况评分均显著低于对照组,两组积分比较有统计学差异(P <0. 05)。结论:中医针灸结合防风痛痹汤能有效降低痛痹型膝关节骨性关节炎患者膝关节腔液中炎性细胞因子的表达水平,改善患者临床症状。
Objective: The clinical effect of Fangfeng Xibi Decoction combined with needle warming moxibustion in the treatment of knee osteoarthritis patients. Methods: Methods: From March 2016 to March 2017,90 cases diagnosed in our hospital were randomly divided into two groups. The control group took Diclofenac Sodium Sustained Release Tablets( Votalin) treatment and the observation group was treated with Fangfeng Xibi Decoction combined with needle warming moxibustion. Two groups were treated for 20 days. The clinical therapeutic effect,the score of osteoarthritis Survey( WOMAC) before and after treatment and the changes of inflammatory factors,tumor necrosis factor alpha,interleukin-6 and interleukin-1 beta expression levels in synovial fluid were compared between the two groups. Results: The total effective rate of the observation group was 91. 11%,significantly higher than that of the control group( 73. 33%) and the difference between the two groups was statistically significant( P < 0. 05). After treatment,the levels of IL-6,IL-1 and TNF-α in the observation group were significantly lower. The levels of inflammatory factors in the observation group were significantly lower than those in the control group( P < 0. 05). The scores of pain degree,stiffness degree and physiological function of the WOMAC integral table in the observation group were significantly lower than those in the control group and the difference between the two groups was statistically significant( P < 0. 05). Conclusion: Fangfeng Xibi Decoction combined with needle warming moxibustion can effectively reduce the expression levels of inflammatory cytokines in knee joint cavity fluid of patients with knee osteoarthritis and improve the symptoms.
Objective: The clinical effect of Fangfeng Xibi Decoction combined with needle warming moxibustion in the treatment of knee osteoarthritis patients. Methods: Methods: From March 2016 to March 2017,90 cases diagnosed in our hospital were randomly divided into two groups. The control group took Diclofenac Sodium Sustained Release Tablets( Votalin) treatment and the observation group was treated with Fangfeng Xibi Decoction combined with needle warming moxibustion. Two groups were treated for 20 days. The clinical therapeutic effect,the score of osteoarthritis Survey( WOMAC) before and after treatment and the changes of inflammatory factors,tumor necrosis factor alpha,interleukin-6 and interleukin-1 beta expression levels in synovial fluid were compared between the two groups. Results: The total effective rate of the observation group was 91. 11%,significantly higher than that of the control group( 73. 33%) and the difference between the two groups was statistically significant( P < 0. 05). After treatment,the levels of IL-6,IL-1 and TNF-α in the observation group were significantly lower. The levels of inflammatory factors in the observation group were significantly lower than those in the control group( P < 0. 05). The scores of pain degree,stiffness degree and physiological function of the WOMAC integral table in the observation group were significantly lower than those in the control group and the difference between the two groups was statistically significant( P < 0. 05). Conclusion: Fangfeng Xibi Decoction combined with needle warming moxibustion can effectively reduce the expression levels of inflammatory cytokines in knee joint cavity fluid of patients with knee osteoarthritis and improve the symptoms.
引文
[1]吴宁,綦雪峰,张宪发,等.玻璃酸钠配合中药熏洗治疗膝关节骨关节炎疗效的Meta分析[J].激光杂志,2012,33(3):55-57.
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[10]胡鸢,唐金树,侯树勋,等.脉冲射频术治疗膝关节骨关节炎的临床疗效观察[J].中国疼痛医学杂志,2016,22(7):514-518.
[11]董立英,谢宝杰,周玲,等. MRI在膝关节骨关节炎诊断中的临床价值[J].山东医药,2013,53(32):36-37.
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[13]蔺攀,左伟,张希彦,等.关节腔注射玻璃酸钠治疗膝关节骨关节炎的疗效观察[J].山东医药,2013,53(17):100-101.
[14]杨利,魏蓉,魏云,等.中药外敷治疗膝关节骨关节炎临床观察[J].中国中医急症,2016,25(1):120-121.
[15]赵昌盛,钟群杰,林剑浩,等.中国膝关节骨关节炎流行病学调查现状[J].广东医学,2016,37(13):2050-2052.
[16]Elena L,Rochelle PW. Impact of Obesity and Knee Osteoarthritis on Morbidity and Mortality in Older Americans[J]. Ann Intern Med,2011,154(4):217-226.
[17]丁璟琳,俞力行,缪睿,等.中医康复治疗原发性膝关节骨关节炎急性发作疗效观察[J].中国中医急症,2014,23(1):164-165.
[18]刘搏宇,李宏宇,金先跃,等.独活寄生汤联合体外冲击波治疗膝关节骨关节炎的效果[J].广东医学,2015,36(23):3709-3711.
[19]杨丽荣.补肾通痹汤治疗类风湿性关节炎40例临床观察[C]//中国康复医学会疗养康复专业委员会第二十四届学术会议论文集. 2014:226-228.
[20]曲宏民,周学娟,曲桢宇,等.太乙痛痹贴治疗早中期膝关节骨性关节炎64例[J].中医外治杂志,2015,24(3):25.
[21]黄阿勇,栗国强,曹连波,等.活血痹痛膏治疗血瘀寒湿阻络型腰椎骨性关节炎60例疗效观察[J].中医杂志,2016,57(1):46-50.
[2]黄伟毅,魏秋实,孙伟珊,等.丹红注射液治疗膝关节骨关节炎的疗效[J].广东医学,2012,33(20):3147-3149.
[3]Jeffrey B. Driban,Charles B. Eaton,Grace H. Knee Injuries Are Associated with Accelerated Knee Osteoarthritis Progression:Data from the Osteoarthritis Initiative[J]. Arthritis Care Res(Hoboken),2014,66(11):1673-1679.
[4]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.
[5]中华中医药学会.中医骨伤科常见病诊疗指南[M].北京:中国中医药出版社,2012:132-135.
[6]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:349-352.
[7]安刚,刘剑秋,付英姿,等.中医治疗老年膝关节骨关节炎49例[J].中国老年学杂志,2013,33(9):2132-2133.
[8]MOYER R F,HUNTER D J. Osteoarthritis in 2014:changing how we define and treat patients with OA[J]. Nat Rev Rheumatol,2015,11(2):65-66.
[9]张驰,谢羽婕,熊林波,等.电针为主综合其他方法治疗膝关节骨关节炎研究进展[J].中国老年学杂志,2011,31(14):2801-2803.
[10]胡鸢,唐金树,侯树勋,等.脉冲射频术治疗膝关节骨关节炎的临床疗效观察[J].中国疼痛医学杂志,2016,22(7):514-518.
[11]董立英,谢宝杰,周玲,等. MRI在膝关节骨关节炎诊断中的临床价值[J].山东医药,2013,53(32):36-37.
[12]Alex NB,Janneke NB. What Are the Prognostic Factors for Radiographic Progression of Knee Osteoarthritis? A Meta-analysis[J].Clin Orthop Relat Res,2015,473(9):2969-2989.
[13]蔺攀,左伟,张希彦,等.关节腔注射玻璃酸钠治疗膝关节骨关节炎的疗效观察[J].山东医药,2013,53(17):100-101.
[14]杨利,魏蓉,魏云,等.中药外敷治疗膝关节骨关节炎临床观察[J].中国中医急症,2016,25(1):120-121.
[15]赵昌盛,钟群杰,林剑浩,等.中国膝关节骨关节炎流行病学调查现状[J].广东医学,2016,37(13):2050-2052.
[16]Elena L,Rochelle PW. Impact of Obesity and Knee Osteoarthritis on Morbidity and Mortality in Older Americans[J]. Ann Intern Med,2011,154(4):217-226.
[17]丁璟琳,俞力行,缪睿,等.中医康复治疗原发性膝关节骨关节炎急性发作疗效观察[J].中国中医急症,2014,23(1):164-165.
[18]刘搏宇,李宏宇,金先跃,等.独活寄生汤联合体外冲击波治疗膝关节骨关节炎的效果[J].广东医学,2015,36(23):3709-3711.
[19]杨丽荣.补肾通痹汤治疗类风湿性关节炎40例临床观察[C]//中国康复医学会疗养康复专业委员会第二十四届学术会议论文集. 2014:226-228.
[20]曲宏民,周学娟,曲桢宇,等.太乙痛痹贴治疗早中期膝关节骨性关节炎64例[J].中医外治杂志,2015,24(3):25.
[21]黄阿勇,栗国强,曹连波,等.活血痹痛膏治疗血瘀寒湿阻络型腰椎骨性关节炎60例疗效观察[J].中医杂志,2016,57(1):46-50.