针刀松解术对类风湿关节炎肘关节僵硬患者关节液MMP-3、MMP-9、TIMP-1的影响  

The Effect of Acupotomy on Synovial MMP-3, MMP-9 and TIMP-1 in Rheumatoid Arthritis Patients with Elbow Joint Stiffness

作　　者：万碧江 肖倩[1,2] 许莹 黄伟 陈丽川[2] 段波[2] WAN Bi-jiang;XIAO Qian;XU Ying;HUANG Wei;CHEN Li-chuan;DUAN Bo(Hubei University of Traditional Chinese Medicine School of Acupuncture and Orthopaedics/Hubei Cooperative Innovation Center of Acupuncture and Moxibustion for Preventive Treatment of Diseases,Wuhan,Hubei 430061,China;Rheumatology Department,Wuhan Hospital of Traditional Chinese Medicine,Wuhan,Hubei 430014,China)

机构地区：[1]湖北中医药大学/针灸治未病湖北省协同创新中心,武汉430061 [2]武汉市中医医院风湿科,武汉430014

出　　处：《上海针灸杂志》2019年第1期89-93,共5页Shanghai Journal of Acupuncture and Moxibustion

基　　金：武汉市临床医学科研项目(WZ14C01)

摘　　要：目的观察针刀松解术对类风湿关节炎肘关节僵硬患者关节液中基质金属蛋白酶-3(MMP-3)、基质金属蛋白酶-9(MMP-9)、基质金属蛋白酶抑制剂-1(TIMP-1)含量变化,探讨针刀松解术调控关节软骨细胞外基质降解的作用机制。方法将60例类风湿关节炎肘关节僵硬患者分为A组、B组和C组,每组20例。A组采用中西药基础治疗方案治疗,B组在A组的基础上采用电针治疗,C组在A组的基础上采用针刀松解术治疗。观察3组治疗前后关节液中MMP-3、MMP-9及TIMP-1含量变化,并比较临床疗效。结果 C组总有效率为95.0%,B总有效率中80.0%,A组总有效率60.0%,3组总有效率比较,差异有统计学意义(P<0.05)。3组治疗前关节液中MMP-3、MMP-9及TIMP-1含量比较差异无统计学意义(P>0.05)。3组治疗后关节液中MMP-3、MMP-9含量较治疗前降低(P<0.05),TIMP-1含量较治疗前升高(P<0.05);C组治疗后关节液中MMP-3、MMP-9含量低于A组和B组(P<0.05),TIMP-1含量高于A组和B组(P<0.05)。结论在中西药治疗基础上,针刀松解术治疗类风湿关节炎肘关节僵硬患者临床疗效显著;可调节RA患者关节中MMP-1与TIMP-1的比例关系,降低MMP-1的表达,增加TIMP-1的表达,有效调控关节软骨细胞外基质的降解。Objective To investigate the effect of acupotomy on synovial matrix me talloproteinase-3(MMP-3),matrix metalloproteinase-9(MMP-9)and tissue inhibitor of metalloproteinase-1(TIMP-1)contents in rheumatoid arthritis patients with elbow joint stiffness and explore its mechanism of action in regulating the degradation of extracellular matrix of articular cartilage.Method Sixty rheumatoid arthritis patients with elbow joint stiffness were randomized to groups A,B and C,with 20 cases in each group.Group A received basic Chinese and Western medication treatment.Groups B and C received acupuncture and acupotomy,respectively,in addition to the basic treatment.Synovial MMP-3,MMP-9 and TIMP-1 contents were measured in the three groups before and after treatment.The clinical therapeutic effects were compared.Result The total efficacy rate was 95.0%in group A,80.0%in group B and 60.0%in group C.There was a statistically significant difference in the total efficacy rate among the three groups(P<0.01).There were no statistically significant pre-treatment differences in synovial MMP-3,MMP-9 and TIMP-1 contents between the three groups(P>0.05).Synovial MMP-3 and MMP-9 contents decreased and TIMP-1 content increased in the three groups after treatment compared with before(P<0.05).Synovial MMP-3 and MMP-9 contents were lower and TIMP-1 content was higher in group C than in groups A and B(P<0.05).Conclusion On the basis of Chinese and Western medication treatment,acupotomy has clinically a marked therapeutic effect in rheumatoid arthritis patients with elbow joint stiffness.It can regulate the proportion of MMP-1 to TIMP-1 in RA joints,decrease MMP-1 expression,increase TIMP-1 expression and effectively modulate the degradation of extracellular matrix of articular cartilage.

关 键 词：针刺疗法 电针 针药并用 小刀针 关节炎 类风湿 肘关节 

分 类 号：R246.2[医药卫生—针灸推拿学]