温针灸配合独活寄生汤治疗风寒湿痹型膝骨关节炎患者的临床随机对照研究及体液中ASF1a、SIRT1水平变化  

Clinical Randomized Controlled Study of Warming Acupuncture Combined with Duhuo Jisheng Decoction in Treatment of Patients with Wind-cold Dampness-type Knee Osteoarthritis and Changes of ASF1a and SIRT1 in Joint Fluid

作　　者：张其镇[1] 苗雨[1] 王大力[1] 李建[1] 陈少青[2] 李华南[1] ZHANG Qizhen;MIAO Yu;WANG Dali;LI Jian;CHEN Shaoqing;LI Huanan(The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin 300193,China;The Inner Mongolia National University Affiliated Hospital,Tongliao 028000,Inner Mongolia,China)

机构地区：[1]天津中医药大学第一附属医院,天津300193 [2]内蒙古民族大学附属医院,内蒙古通辽028000

出　　处：《辽宁中医杂志》2018年第12期2624-2628,共5页Liaoning Journal of Traditional Chinese Medicine

基　　金：内蒙古自然科学基金(2016MS08125)

摘　　要：目的:观察温针灸配合独活寄生汤治疗风寒湿痹型膝骨关节炎(KOA)的临床疗效及关节液、血清中ASF1a、SIRT1mRNA表达水平变化,为临床应用提供参考。方法:将102例风寒湿痹型KOA患者随机分为独活寄生汤组(n=34)、温针灸组(n=38)及联合组(n=30),独活寄生汤组给予独活寄生汤150mL/次,2次/d口服,温针灸组给予温针灸治疗,联合组在独活寄生汤组治疗基础上给予温针灸治疗,疗程均为4周;观察入组患者治疗前后膝关节视觉模拟评分(VAS)、西安大略麦马斯特大学骨关节炎指数评分(WOMAC)、中医症状积分、自制膝关节肿胀评分及总有效率变化;采用Real-timePCR检测入组患者治疗前后血清、关节液中ASF1a、SIRT1表达。结果:3组患者治疗后VAS、WOMAC、中医症状积分、自制膝关节肿胀评分均较治疗前降低,联合组疗效最为明显(P<0.01);3组患者治疗后较治疗前血清SIRT1mRNA表达增加、ASF1amRNA表达减少,联合组患者血清中ASF1a、SIRT1改变趋势最为明显(P<0.01);3组患者治疗后较治疗前关节液ASF1amRNA表达上升、SIRT1mRN表达下降(P<0.01)。结论:温针灸配合独活寄生汤治疗风寒湿痹型KOA有良好的疗效,其机制可能与抗软骨细胞衰,促进软骨细胞合成有关。Objective:To observe the clinical efficacy of warming acupuncture combined with Duhuo Jisheng Decoction in the treatment of patients with wind-cold dampness-type knee osteoarthritis(KOA) and the changes of ASF1 a and SIRT1 mRNA expression in synovial fluid and serum and provide the reference for clinical application.Methods:A total of 102 cases of wind-cold dampness-type knee osteoarthritis(KOA) patients were randomly divided into the Duhuo Jisheng Decoction group(n=34),the warm acupuncture group(n=38) and the combined group(n=30).The patients in Duhuo Jisheng Decoction group were given Duhuo Jisheng Decoction 150 mL/times,2 times/d orally.The warm acupuncture group was given warm acupuncture treatment and the combined group was treated with warm acupuncture on the basis of Duhuo Jisheng Decoction.The course of treatment was 4 weeks.We observed the groups′ knee joint visual analogue scale(VAS),the western Ontario McMaster university marks osteoarthritis index(WOMAC),TCM symptoms integral,self-made knee joint swelling score and total effective rate before and after treatment.The expressions of ASF1 a and SIRT1 in serum and synovial fluid were measured by Real-time PCR.Results:After treatment,VAS,WOMAC and TCM symptom scores and self-made knee joint swelling score were lower than those before treatment.The combined group was the most effective(P<0.01).The expression of SIRT1 mRNA was increased and ASF1 a mRNA expression was decreased in the three groups after treatment,and the trend of ASF1 a and SIRT1 in the serum of the combined group was the most significant(P<0.01).The expression of ASF1 a mRNA in the synovial fluid was increased and SIRT1 mRN expression was decreased after treatment(P<0.01).Conclusion:Warming acupuncture combined with Duhuo Jisheng Decoction in the treatment of wind-cold dampness-type KOA has a good effect.The mechanism may be associated with anti-chondrocyte failure and promoting chondrocyte synthesis.

关 键 词：膝骨关节炎 独活寄生汤 温针灸 反沉默因子1a 沉默信息调节因子1 

分 类 号：R285[医药卫生—中药学]