特定腧穴施以“三重法”治疗类风湿关节炎:随机对照研究（英文）
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摘要
目的:探讨针具针法组合之疗法提高类风湿关节炎的临床疗效及机理。方法:随机将类风湿关节炎患者60例分为观察组和对照组,每组30例。对照组予双氯芬酸钠缓释片口服,每次0.3 g,日2次;甲氨蝶呤片口服,每次10 mg,1周1次:叶酸片口服,每次5 mg, 1周1次。观察组在西药治疗同时,在特定腧穴施以针具针法组合之重刺络、重拔罐、重艾灸之三重法治疗,3日治疗1次,连续治疗10次。两组治疗30天后观察疗效。分别观察两组治疗前后类风湿因子(RF)、超敏C反应蛋白(hs-CRP)、血沉(ESR)、关节症状体征积分及疾病活动性评分(DAS-28)的变化情况。结果:RF方面,观察组和对照组治疗前后差异均有统计学意义(观察组248.01±79.81 vs 31.17±29.01,对照组254.11±72.16vs 66.42±37.07,均P<0.05),治疗后观察组显著低于对照组(P<0.05)。hs-CRP方面,观察组和对照组治疗前后差异均有统计学意义(观察组26.12±9.22 vs8.98±7.66,对照组23.18±7.18vs16.01±5.02,均P<0.05),治疗后观察组显著低于对照组(P<0.05)。ESR方面,观察组和对照组治疗前后差异均有统计学意义(观察组30.56±11.38 vs 12.58±5.91,对照组35.52±9.67 vs21.47±6.91,均P<0.05),治疗后观察组显著低于对照组(P<0.05)。DAS-28方面,观察组和对照组治疗前后差异均有统计学意义(观察组8.89±2.01 vs 3.01±0.74,对照组8.14±1.38 vs4.12±0.96,均P<0.05),治疗后观察组显著低于对照组(P<0.05)。症状分级量化评分方面,观察组和对照组治疗前后差异均有统计学意义(观察组7.87±1.69vs3.82±1.96,对照组7.77±1.68 vs 5.01±11.23,均P<0.05),治疗后观察组显著低于对照组(P<0.05)。观察组总有效率为96.67%(29/30),对照组总有效率为80.0%(24/30),两组比较差异有统计学意义(P<0.01)。结论:药物结合特定腧穴施以"三重法"能够显著改善类风湿患者的关节症状,降低炎性反应指标,显著提高临床疗效。
Objective: To explore the clinical therapeutic effects and the mechanism on rheumatic arthritis(RA)treated with the combination of the instruments and techniques of acupuncture and moxibusiton.Methods: A total of 60 RA patients were randomized into an observation group and a control group,30 cases in each one. In the control group, diclofenac sodium sustained release tablets were prescribed for oral administration, 0.3 g each time, twice a day, methotrexate tablets(MTX) for oral administration,10 mg each time, once a week and folic acid tablets for oral administration, 5 mg each time, once a week. In the observation group, besides the treatment with western medicines, simultaneously, the specific acupoints were selected and stimulated with the triple strong-stimulation therapy, in which, the strong bloodletting technique, the strong cupping technique and the strong moxibustion technique were combined together, with different instruments of acupuncture and moxibustion adopted. The treatment was given once every 3 days, consecutively for 10 times. In 30 days of treatment, the therapeutic effects were observed in the two groups. Separately, before and after treatment, the rheumatoid factors(RF),hypersensitive-C reactive protein(hs-CRP) and erythrocyte sedimentation rate(ESR), the scores of joint symptoms and physical signs as well as the disease activity score(DAS-28) were observed in the two groups.Results: Regarding RF, there were statistical significant differences before and after treatment in the observation group and the control group(the observation group 248.01 ± 79.81 vs 31.17 ± 29.01,the control group 254.11 ± 72.16 vs 66.42 ± 37.07, both P < 0.05). The result in the observation group was lower significantly than the control group after treatment(P < 0.05). Regarding hs-CRP, there were statistical significant differences before and after treatment in the observation group and the control group(the observation group 26.12 ± 9.22 vs 8.98 ± 7.66, the control group 23.18 ± 7.18 vs 16.01 ± 5.02, both P < 0.05). The result in the observation group was lower significantly than the control group after treatment(P < 0.05). Regarding ESR, there were statistical significant differences before and after treatment in the observation group and the control group(the observation group 30.56 ± 11.38 vs 12.58 ± 5.91,the control group 35.52 ± 9.67 vs 21.47 ± 6.91, both P < 0.05). The result in the observation group was lower significantly than the control group after treatment(P < 0.05). Regarding DAS-28, there were statistical significant differences before and after treatment in the observation group and the control group(the observation group 8.89 ± 2.01 vs 3.01 ± 0.74, the control group 8.14 ± 1.38 vs 4.12 ± 0.96, both P < 0.05). The result in the observation group was lower significantly than the control group after treatment(P < 0.05). Regarding the quantitative grading score of symptom, there were statistical significant differences before and after treatment in the observation group and the control group(the observation group 7.87 士 1.69 vs 3.82 ±1.96, the control group 7.77 ± 1.68 vs 5.01 ± 11.23, both P < 0.05). The result in the observation group was lower significantly than the control group after treatment(P < 0.05).The total effective rate was 96.67%(29/30) in the observation group and was 80.0%(24/30) in the control group, indicating the statistical significant difference between the two groups(P < 0.01).Conclusion: Based on western medications, the triple strong-stimulation therapy of acupuncture and moxibustion at specific acupoints significantly relieves the joint symptoms, reduces the inflammatory reaction indicators and improves the clinical therapeutic effects on RA in the patients.
Objective: To explore the clinical therapeutic effects and the mechanism on rheumatic arthritis(RA)treated with the combination of the instruments and techniques of acupuncture and moxibusiton.Methods: A total of 60 RA patients were randomized into an observation group and a control group,30 cases in each one. In the control group, diclofenac sodium sustained release tablets were prescribed for oral administration, 0.3 g each time, twice a day, methotrexate tablets(MTX) for oral administration,10 mg each time, once a week and folic acid tablets for oral administration, 5 mg each time, once a week. In the observation group, besides the treatment with western medicines, simultaneously, the specific acupoints were selected and stimulated with the triple strong-stimulation therapy, in which, the strong bloodletting technique, the strong cupping technique and the strong moxibustion technique were combined together, with different instruments of acupuncture and moxibustion adopted. The treatment was given once every 3 days, consecutively for 10 times. In 30 days of treatment, the therapeutic effects were observed in the two groups. Separately, before and after treatment, the rheumatoid factors(RF),hypersensitive-C reactive protein(hs-CRP) and erythrocyte sedimentation rate(ESR), the scores of joint symptoms and physical signs as well as the disease activity score(DAS-28) were observed in the two groups.Results: Regarding RF, there were statistical significant differences before and after treatment in the observation group and the control group(the observation group 248.01 ± 79.81 vs 31.17 ± 29.01,the control group 254.11 ± 72.16 vs 66.42 ± 37.07, both P < 0.05). The result in the observation group was lower significantly than the control group after treatment(P < 0.05). Regarding hs-CRP, there were statistical significant differences before and after treatment in the observation group and the control group(the observation group 26.12 ± 9.22 vs 8.98 ± 7.66, the control group 23.18 ± 7.18 vs 16.01 ± 5.02, both P < 0.05). The result in the observation group was lower significantly than the control group after treatment(P < 0.05). Regarding ESR, there were statistical significant differences before and after treatment in the observation group and the control group(the observation group 30.56 ± 11.38 vs 12.58 ± 5.91,the control group 35.52 ± 9.67 vs 21.47 ± 6.91, both P < 0.05). The result in the observation group was lower significantly than the control group after treatment(P < 0.05). Regarding DAS-28, there were statistical significant differences before and after treatment in the observation group and the control group(the observation group 8.89 ± 2.01 vs 3.01 ± 0.74, the control group 8.14 ± 1.38 vs 4.12 ± 0.96, both P < 0.05). The result in the observation group was lower significantly than the control group after treatment(P < 0.05). Regarding the quantitative grading score of symptom, there were statistical significant differences before and after treatment in the observation group and the control group(the observation group 7.87 士 1.69 vs 3.82 ±1.96, the control group 7.77 ± 1.68 vs 5.01 ± 11.23, both P < 0.05). The result in the observation group was lower significantly than the control group after treatment(P < 0.05).The total effective rate was 96.67%(29/30) in the observation group and was 80.0%(24/30) in the control group, indicating the statistical significant difference between the two groups(P < 0.01).Conclusion: Based on western medications, the triple strong-stimulation therapy of acupuncture and moxibustion at specific acupoints significantly relieves the joint symptoms, reduces the inflammatory reaction indicators and improves the clinical therapeutic effects on RA in the patients.
引文
[1] Villeneuve E, Nam J, Emery P. 2010 ACR-EULAR classification criteria for rheumatoid arthritis. Rev Bras Reumatol 2010;50(5):481-3.
[2] Zheng XY. Guidelines and principles for clinical research of new drugs of traditional Chinese medicine:trial. Beijing:China Medical Science Press; 2002.p. 115-19.
[3] Prevoo ML, Van't Hof MA, Kuper HH. Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum1995:38(1):44-8.
[4] Li Y. Qi WC. Comparison of the therapeutic effects on rheumatoid arthritis treated with leflunomide combined with 99Tc-MDP or metrotrexate. Contemp Med 2009;15(7):123-4.
[5] Cao WZ. Triple strong stimulation therapy":the innovative approach to the improvement of acupuncture effects on pain. Jiangxi J Trad Chin Med2012;43(1):50-3.
[6] Cao WZ, Li AM, Dai RW, Zhang ZG. Compilation and development of the property of Dazhui(GV 14). J Sichuan Trad Chin Med 2012(12):32-4.
[7] Chen LD, Li J. Zhou JB. Significance of IL-17, IL-18, IL-6 and TNF-αin the patients with rheumatoid arthritis. Contemp Med 2010;16(7):13-14.
[8] Wu JW, Tang XF. Clinical significance in the expressions of serm TNF-a,IL-17 and CRP in the patients with rheumatoid arthritis. Chongqing Med2012;41(30):3211-12.
[9] Chen KH, Li RB, Gan Y, Li K, Tan L, Yang JH. et al. Efficacy of treatment of moxibustion to rheumatoid arthritis patients and its impact to blood levels of IL6,CRP and RF. Int J Lab Med 2014(21):2897-8.
[10] Hao F, Hu L, Wu ZJ, Luo L, Cai RL, He L, et al. Clinical study on relations between quantity and effect of moxibustion on ginger in treating active rheumatoid arthritis. Lishizhen Med Mater Med Res 2013;24(3):677-80.
[11] Qin SF. Observations on the therapeutic effect of thunder-fire moxibustion on allergic rhinitis. Shanghai J Acupunct Moxibustion 2011;30(11):765-7.
[12] Yue BA, Bi YF. 172 cases of rheumatoid arthritis treated with long-snake moxibustion therapy. Shaanxi J Trad Chin Med 2007;28(11):1536-7.
[13] Ding F. Simple moxibustion therapy in treatment of rheumatoid arthritis. J Clin Acupunct Moxibustion 2007;23(10):40-1.
[14] Li JW, Liu JM, Ma ZY, Xiang YY, Feng YB, Xiang SY, et al. Clinical observation on treatment of rheumatoid arthritis with cake-separated mild moxibustion combined with western medicine. Chin Acupunct Moxibustion 2006;26(3):192-4.
[15] Gong FY. 33 cases of rheumatoid arthritis treated with herbal medicine-isolated moxibustion therapy. J Clin Acupunct Moxibustion 2007;23(5)42-42.
[16] Tong HY. U XB. Clinical research of knee osteoarthritis treated with isolated mild moxibustion. J Clin Acupunct Moxibustion 2006;22(12):10-12.
[2] Zheng XY. Guidelines and principles for clinical research of new drugs of traditional Chinese medicine:trial. Beijing:China Medical Science Press; 2002.p. 115-19.
[3] Prevoo ML, Van't Hof MA, Kuper HH. Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum1995:38(1):44-8.
[4] Li Y. Qi WC. Comparison of the therapeutic effects on rheumatoid arthritis treated with leflunomide combined with 99Tc-MDP or metrotrexate. Contemp Med 2009;15(7):123-4.
[5] Cao WZ. Triple strong stimulation therapy":the innovative approach to the improvement of acupuncture effects on pain. Jiangxi J Trad Chin Med2012;43(1):50-3.
[6] Cao WZ, Li AM, Dai RW, Zhang ZG. Compilation and development of the property of Dazhui(GV 14). J Sichuan Trad Chin Med 2012(12):32-4.
[7] Chen LD, Li J. Zhou JB. Significance of IL-17, IL-18, IL-6 and TNF-αin the patients with rheumatoid arthritis. Contemp Med 2010;16(7):13-14.
[8] Wu JW, Tang XF. Clinical significance in the expressions of serm TNF-a,IL-17 and CRP in the patients with rheumatoid arthritis. Chongqing Med2012;41(30):3211-12.
[9] Chen KH, Li RB, Gan Y, Li K, Tan L, Yang JH. et al. Efficacy of treatment of moxibustion to rheumatoid arthritis patients and its impact to blood levels of IL6,CRP and RF. Int J Lab Med 2014(21):2897-8.
[10] Hao F, Hu L, Wu ZJ, Luo L, Cai RL, He L, et al. Clinical study on relations between quantity and effect of moxibustion on ginger in treating active rheumatoid arthritis. Lishizhen Med Mater Med Res 2013;24(3):677-80.
[11] Qin SF. Observations on the therapeutic effect of thunder-fire moxibustion on allergic rhinitis. Shanghai J Acupunct Moxibustion 2011;30(11):765-7.
[12] Yue BA, Bi YF. 172 cases of rheumatoid arthritis treated with long-snake moxibustion therapy. Shaanxi J Trad Chin Med 2007;28(11):1536-7.
[13] Ding F. Simple moxibustion therapy in treatment of rheumatoid arthritis. J Clin Acupunct Moxibustion 2007;23(10):40-1.
[14] Li JW, Liu JM, Ma ZY, Xiang YY, Feng YB, Xiang SY, et al. Clinical observation on treatment of rheumatoid arthritis with cake-separated mild moxibustion combined with western medicine. Chin Acupunct Moxibustion 2006;26(3):192-4.
[15] Gong FY. 33 cases of rheumatoid arthritis treated with herbal medicine-isolated moxibustion therapy. J Clin Acupunct Moxibustion 2007;23(5)42-42.
[16] Tong HY. U XB. Clinical research of knee osteoarthritis treated with isolated mild moxibustion. J Clin Acupunct Moxibustion 2006;22(12):10-12.