子午流注蜂针对强直性脊柱炎的疗效及机制研究  

Effects and mechanism of bee-venom-acupuncture based on Midnight-Noon Ebb-Flow doctrine on ankylosing spondylitis

作　　者：温伟强[1] 黄胜光[1] 陈辉[1] 谭宁[1] 周汝云[1] 朱辉军[1] 

机构地区：[1]广东医学院附属南山医院中医风湿科,广东深圳518052

出　　处：《湖南中医药大学学报》2012年第7期67-71,共5页Journal of Hunan University of Chinese Medicine

基　　金：深圳市科技计划资助项目(201003264)

摘　　要：目的观察子午流注蜂针对强直性脊柱炎(ankylosing spondylitis,AS)的疗效、安全性及对患者血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、性激素水平的影响,探讨其产生疗效的机制。方法将120例AS患者随机分为3组,治疗组40例采用子午流注加辨证取穴蜂针治疗,对照1组40例用辨证取穴蜂针治疗,对照2组40例用柳氮磺胺吡啶(sulfasalazine,SSZ)、双氯芬酸钠治疗;3组均以4周为1个疗程,3个疗程后观察疗效,观测患者Bath强直性脊柱炎病情活动性指数(Bath AS disease activity index,BAS-DAI)、Bath强直性脊柱炎功能指数(Bath AS functionalindex,BASFI)、晨僵时间、全身疼痛和脊柱疼痛Likert 4级积分、患者和医生的总体评价积分,测定血沉(erythrose-di mentation,ESR)、C反应蛋白(C-reactive protein,CRP)、血清IL-6、TNF-α、性激素水平,同时观察药物的不良反应。结果治疗组和对照1组、对照2组总有效率分别为82.5%和72.5%、70.0%,对照组与治疗组比较差异有统计学意义(P<0.05);3组治疗前后BAS-DAI、BASFI、晨僵时间、全身疼痛和脊柱疼痛Likert 4级积分、患者和医生的总体评价积分等观察指标有明显改善,ESR、CRP、IL-6、TNF-α、睾酮(T)明显下降,治疗前后差异有统计学意义(P<0.05);治疗组的指标下降值与对照组相比,差异有统计学意义(P<0.05),3组治疗前后雌二醇(E2)、促卵泡激素(FSH)均有上升趋势,3组泌乳素(PRL)、孕酮(P)、促黄体生成素(LH)治疗前后比较有下降趋势,但差异均无统计学意义(P>0.05)。不良反应的发生率治疗组为10%,对照1组为12.5%,对照2组为30%。结论子午流注蜂针治疗AS疗效显著,且不良反应较少。其疗效可能与其抑制患者血清IL-6、TNF-α、T有关。Objective To observe the effects and safety of bee-venom-acupuncture based on Midnight-Noon Ebb-Flow doctrine on ankylosing spondylitis （AS）, and its impacts on IL-6, TNF-α and sex hormone levels, and to explore its mechanisms. Methods 120 AS patients were random- ly divided into 3 groups： 40 patients in treatment group were treated with bee-venom-acupuncture based on Midnight -Noon Ebb -Flow doctrine and syndrome differentiation; 40 patients in control group A were treated with bee-acupuncture based on syndrome differentiation; and 40 patients in the control group B were treated with sulfasalazine（SSZ） and diclofenac sodium. A treatment course was 4 weeks. Before and after 3 courses, indexes were observed and recorded, such as Bath AS disease activity index （BAS-DAI）, Bath AS functional index （BASFI）, duration of morning stiffness, Likert＇ 4-grade score of whole body pain and spinal pain, evaluation by doctors and pa- tients, the erythrosedi mentation （ESR）, C-reactive protein （CRP）, and the levels of IL-6, TNF-α and sex hormones. Adverse effects of medicines were also observed. Results The total effective rate was 82.5%, 72.5% and 70.0% in treatment group, control group A and control group B respectively; the statistic differences were significant （P〈0.05）. In 3 groups, indexes of BASDAI, BASFI, duration of morning stiffness, Likert＇ 4-grade score of whole body pain and spinal pain, evaluation by doctors and patients were improved obviously after treatments; ESR, CRP, IL-6, TNF-α and Testosterone were significantly decreased after treatments; the differences had statistic significance （P〈0.05）. Com- pared with the date of controls, the treatment group also showed better results after treatments; the differences between treatment group and control groups had significance （P〈0.05）. In 3 groups, Estradiol and Follicle-stimulating hormones were increased after treatments; Prolactin, Progesterone and Luteinizing hormones were decreased after treatments; but before a

关 键 词：强直性脊柱炎 子午流注 蜂针治疗 白细胞介素 肿瘤坏死因子-Α 性激素 临床观察 

分 类 号：R246.4[医药卫生—针灸推拿学]