温和艾灸治疗寒湿痹阻型类风湿关节炎的疗效及对免疫学的影响
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摘要
目的:探讨温和艾灸寒湿痹阻型类风湿关节炎(RA)的疗效和对免疫学的影响。方法:选取2014年12月至2016年11月成都市新都区人民医院收治的寒湿痹阻型类风湿关节炎患者176例作为研究对象,按入组先后顺序平均分为对照组和观察组,每组88例,对照组常规西医治疗,观察组在对照组基础上加用温和艾灸治疗,观察不同方法治疗3个月后的疗效、红细胞沉降率(ESR)、C反应蛋白(CRP)、类风湿因子(RF)、免疫球蛋白G(Ig G)、免疫球蛋白G(Ig A)、免疫球蛋白M(Ig M)、补体C3、补体C4水平等免疫学指标和中医症状积分、不良反应。结果:对照组临床痊愈率15. 91%、总有效率78. 41%,观察组临床痊愈率23. 86%、总有效率89. 77%,观察组优于对照组(P <0. 05);治疗前2组ESR、CRP、RF、Ig A、Ig G、Ig M、C3、C4水平比较,差异无统计学意义(P <0. 05);治疗3个月后较治疗前以上指标2组差异有统计学意义(P <0. 05),治疗3个月后观察组以上指标优于对照组(P <0. 05);治疗前2组休息痛、晨僵持续时间、关节肿胀指数、HAQ指数、DAS28评分比较,差异无统计学意义(P> 0. 05);治疗3个月后较治疗前以上评分2组均显著下降,差异有统计学意义(P <0. 05),治疗3个月后观察组以上评分显著优于对照组,差异有统计学意义(P <0. 05)。对照组腹痛腹泻、恶心呕吐、畏寒乏力、过敏性皮疹、脱发、口腔溃疡发生率分别为17. 05%、23. 86%、9. 09%、25%、5. 68%、12. 5%,观察组分别为10. 23%、13. 64%、6. 82%、11. 36%、3. 41%、3. 41%,观察组在腹痛腹泻、恶心呕吐、过敏性皮疹、口腔溃疡发生率上显著低于对照组,差异有统计学意义(P <0. 05)。结论:温和艾灸能提高寒湿痹阻型类风湿关节炎免疫功能,改善症状,提高疗效,且不良反应小。
Objective: To investigate the effects of mild moxibustion on curative efficacy cold dampness blockage type rheumatoid arthritis( RA) and on clinical immune index. Methods: A total of 176 cold dampness blockage type rheumatoid arthritis patients treated in Chengdu Xindu District People' s Hospital from December 2014 to November 2016 were selected and divided into the control group and the observation group according to the order with 88 cases in each group. The control group received conventional western medicine treatment,and the study group was treated with mild moxibustion on the basis of the same treatment in the control group. After 3 months treatment,the clinical efficacy,erythrocyte sedimentation rate( ESR),C reactive protein( CRP),rheumatoid factor( RF),immunoglobulin G( IgG),immunoglobulin G( IgA),immunoglobulin G( IgM) and the effects of complement C3,C4 content of immune index and TCM symptom score and adverse reaction of different treatments were compared. Results: The clinical cure rate and total clinical efficacy in the control group were 15. 91% and 78. 41%. The clinical cure rate and total clinical efficacy in the observation were 23. 86% and 89. 77%. The study group was superior to the control group( P < 0. 05). Before the treatment,there was no significant difference among the immune indicators including the levels of ESR,CRP,RF,IgA,IgG,IgM,C3,C4 between the 2 groups( P > 0. 05). After 3 months of treatment,there was significant difference in the above indexes of the 2 groups before and after treatment( P < 0. 05). Compared with before treatment,the above indexes of the observation group were superior to those of the control group( P < 0. 05). Before the treatment,the difference of the symptom scores such as rest pain,morning stiffness duration and the swelling index,HAQ index,DAS28 score in the 2 groups was not statistically significant ( P > 0. 05). After 3 months of treatment,compared with before treatment,the scores of the 2 groups were significantly decreased,and there was significant difference( P < 0. 05). After 3 months of treatment,the above scores in the study group were superior to those of the control group( P < 0. 05). The incidence rates of adverse reactions,such as abdominal pain and diarrhea,nausea and vomiting,chills,fatigue,allergic rash,alopecia,oral ulcer in the control group were 17. 05%,23. 86%,9. 09%,25%,5. 68%,12. 5%,and the above incidence rate in the observation group were 10. 23%,13. 64%,6. 82%,11. 36%,3. 41%,3. 41%. The incidence rates of diarrhea,nausea and vomiting,abdominal pain allergic rash,oral ulcer in the observation group was significantly lower than those of the control group( P < 0. 05). Conclusion: Mild moxibustion can improve the immune function against arthritis with cold dampness blockage syndrome,rheumatoid improve symptoms and the curative efficacy,which also has less adverse reactions.
Objective: To investigate the effects of mild moxibustion on curative efficacy cold dampness blockage type rheumatoid arthritis( RA) and on clinical immune index. Methods: A total of 176 cold dampness blockage type rheumatoid arthritis patients treated in Chengdu Xindu District People' s Hospital from December 2014 to November 2016 were selected and divided into the control group and the observation group according to the order with 88 cases in each group. The control group received conventional western medicine treatment,and the study group was treated with mild moxibustion on the basis of the same treatment in the control group. After 3 months treatment,the clinical efficacy,erythrocyte sedimentation rate( ESR),C reactive protein( CRP),rheumatoid factor( RF),immunoglobulin G( IgG),immunoglobulin G( IgA),immunoglobulin G( IgM) and the effects of complement C3,C4 content of immune index and TCM symptom score and adverse reaction of different treatments were compared. Results: The clinical cure rate and total clinical efficacy in the control group were 15. 91% and 78. 41%. The clinical cure rate and total clinical efficacy in the observation were 23. 86% and 89. 77%. The study group was superior to the control group( P < 0. 05). Before the treatment,there was no significant difference among the immune indicators including the levels of ESR,CRP,RF,IgA,IgG,IgM,C3,C4 between the 2 groups( P > 0. 05). After 3 months of treatment,there was significant difference in the above indexes of the 2 groups before and after treatment( P < 0. 05). Compared with before treatment,the above indexes of the observation group were superior to those of the control group( P < 0. 05). Before the treatment,the difference of the symptom scores such as rest pain,morning stiffness duration and the swelling index,HAQ index,DAS28 score in the 2 groups was not statistically significant ( P > 0. 05). After 3 months of treatment,compared with before treatment,the scores of the 2 groups were significantly decreased,and there was significant difference( P < 0. 05). After 3 months of treatment,the above scores in the study group were superior to those of the control group( P < 0. 05). The incidence rates of adverse reactions,such as abdominal pain and diarrhea,nausea and vomiting,chills,fatigue,allergic rash,alopecia,oral ulcer in the control group were 17. 05%,23. 86%,9. 09%,25%,5. 68%,12. 5%,and the above incidence rate in the observation group were 10. 23%,13. 64%,6. 82%,11. 36%,3. 41%,3. 41%. The incidence rates of diarrhea,nausea and vomiting,abdominal pain allergic rash,oral ulcer in the observation group was significantly lower than those of the control group( P < 0. 05). Conclusion: Mild moxibustion can improve the immune function against arthritis with cold dampness blockage syndrome,rheumatoid improve symptoms and the curative efficacy,which also has less adverse reactions.
引文
[1]吴锦萍.温针灸配合中药熏蒸治疗寒湿痹阻型类风湿关节炎的临床疗效分析[J].医药前沿,2017,7(18):40-41.
[2]孟宇航.董氏奇穴加艾灸治疗类风湿关节炎临床观察[J].风湿病与关节炎,2017,6(12):27-29,37.
[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]中华人民共和国卫生部.中药(新药)临床研究指导原则[S].北京:中国医药科技出版社,1995:135.
[5]李东超,温贵如,王辉.骨通贴膏联合温针灸对老年类风湿关节炎患者红细胞沉降率、C-反应蛋白及关节功能的影响[J].河北中医,2017,39(7):1011-1015.
[6]付晓波.中药汤剂配合针灸疗法治疗老年类风湿关节炎30例的效果观察[J].基层医学论坛,2017,21(26):3577-3578.
[7]张琼予,靳贞红,吴旭,等.复方五藤膏穴位贴敷合并艾灸治疗类风湿关节炎患者的临床效果研究[J].中国保健营养,2017,27(11):17.
[8]蔡国伟,李佳,李静.温针灸对类风湿关节炎大鼠血清及滑膜组织ICAM-1的影响[J].湖北中医药大学学报,2017,19(5):22-26.
[9]刘波.类风湿关节炎患者经针刺配合艾灸督脉治疗的效果观察[J].齐齐哈尔医学院学报,2016,37(29):3676-3677.
[10]徐萍,李凤霞,陶洪,等.针刺加艾灸结合疗法对类风湿性关节炎的近远期疗效[J].现代生物医学进展,2016,16(15):2942-2945,2898.
[11]严家欣,王攀攀,张荣华.类风湿关节患者的中医证型与生存质量相关性分析[J].暨南大学学报:自然科学与医学版,2017,38(4):343-349.
[12]夏晓红,钟峰,胡玲,等.不同疗程温和灸对活动期类风湿关节炎患者临床疗效的影响[J].中国中医药咨讯,2015,3(3):167-169.
[13]陈奕臻.隔物温和灸治疗肾阳亏虚型类风湿关节炎的临床观察[D].武汉:湖北中医药大学,2016.
[14]李璐.艾灸加药物方案治疗类风湿关节炎患者的临床研究[J].现代诊断与治疗,2016,27(7):1204-1206.
[15]巴燕·艾克海提,刘云霞,曾斌芳.温针灸配合西药治疗寒湿痹阻型类风湿关节炎临床观察[J].北京中医药大学学报:中医临床版,2013,20(3):28-31.
[16]苗柳,袁强,崔建美,等.麝香乌龙丸联合来氟米特片治疗寒湿痹阻型类风湿关节炎59例临床观察[J].中医杂志,2016,57(19):1666-1669.
[17]曹艳红,胡建东.湿热痹阻与寒湿痹阻型类风湿关节炎相关细胞因子客观化研究[J].湖南中医药大学学报,2016,36(10):67-71.
[18]黄裳,李建武.隔物温和灸对寒湿痹阻型类风湿关节炎的临床观察[J].针灸临床杂志,2015,7(7):61-63.
[19]谢敏,田亮,赵磊.药物铺灸疗法治疗寒湿痹阻型类风湿关节炎的临床研究[J].按摩与康复医学,2016,7(24):47-48.
[20]马明坤,温学红,肖继,等.类风湿关节炎患者中医证型与实验室指标的相关性研究[J].医学综述,2016,19(16):3063-3065.
[2]孟宇航.董氏奇穴加艾灸治疗类风湿关节炎临床观察[J].风湿病与关节炎,2017,6(12):27-29,37.
[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]中华人民共和国卫生部.中药(新药)临床研究指导原则[S].北京:中国医药科技出版社,1995:135.
[5]李东超,温贵如,王辉.骨通贴膏联合温针灸对老年类风湿关节炎患者红细胞沉降率、C-反应蛋白及关节功能的影响[J].河北中医,2017,39(7):1011-1015.
[6]付晓波.中药汤剂配合针灸疗法治疗老年类风湿关节炎30例的效果观察[J].基层医学论坛,2017,21(26):3577-3578.
[7]张琼予,靳贞红,吴旭,等.复方五藤膏穴位贴敷合并艾灸治疗类风湿关节炎患者的临床效果研究[J].中国保健营养,2017,27(11):17.
[8]蔡国伟,李佳,李静.温针灸对类风湿关节炎大鼠血清及滑膜组织ICAM-1的影响[J].湖北中医药大学学报,2017,19(5):22-26.
[9]刘波.类风湿关节炎患者经针刺配合艾灸督脉治疗的效果观察[J].齐齐哈尔医学院学报,2016,37(29):3676-3677.
[10]徐萍,李凤霞,陶洪,等.针刺加艾灸结合疗法对类风湿性关节炎的近远期疗效[J].现代生物医学进展,2016,16(15):2942-2945,2898.
[11]严家欣,王攀攀,张荣华.类风湿关节患者的中医证型与生存质量相关性分析[J].暨南大学学报:自然科学与医学版,2017,38(4):343-349.
[12]夏晓红,钟峰,胡玲,等.不同疗程温和灸对活动期类风湿关节炎患者临床疗效的影响[J].中国中医药咨讯,2015,3(3):167-169.
[13]陈奕臻.隔物温和灸治疗肾阳亏虚型类风湿关节炎的临床观察[D].武汉:湖北中医药大学,2016.
[14]李璐.艾灸加药物方案治疗类风湿关节炎患者的临床研究[J].现代诊断与治疗,2016,27(7):1204-1206.
[15]巴燕·艾克海提,刘云霞,曾斌芳.温针灸配合西药治疗寒湿痹阻型类风湿关节炎临床观察[J].北京中医药大学学报:中医临床版,2013,20(3):28-31.
[16]苗柳,袁强,崔建美,等.麝香乌龙丸联合来氟米特片治疗寒湿痹阻型类风湿关节炎59例临床观察[J].中医杂志,2016,57(19):1666-1669.
[17]曹艳红,胡建东.湿热痹阻与寒湿痹阻型类风湿关节炎相关细胞因子客观化研究[J].湖南中医药大学学报,2016,36(10):67-71.
[18]黄裳,李建武.隔物温和灸对寒湿痹阻型类风湿关节炎的临床观察[J].针灸临床杂志,2015,7(7):61-63.
[19]谢敏,田亮,赵磊.药物铺灸疗法治疗寒湿痹阻型类风湿关节炎的临床研究[J].按摩与康复医学,2016,7(24):47-48.
[20]马明坤,温学红,肖继,等.类风湿关节炎患者中医证型与实验室指标的相关性研究[J].医学综述,2016,19(16):3063-3065.