艾灸联合西药治疗肝肾亏虚型类风湿关节炎临床疗效及机制探讨  

Clinical effect and mechanism of moxibustion combined with western medication for rheumatoid arthritis of liver-kidney deficiency

作　　者：张敏 赵晨 蒋玲 朱艳[2] ZHANG Min;ZHAO Chen;JIANG Ling;ZHU Yan(Graduate School of Anhui University of CM,Hefei,230000,China;First Department of Geriatrics,Second Affiliated Hospital of Anhui University of CM,Hefei 230061)

机构地区：[1]安徽中医药大学研究生院,合肥230000 [2]安徽中医药大学第二附属医院老年病一科,合肥230061

出　　处：《中国针灸》2021年第5期489-492,524,共5页Chinese Acupuncture & Moxibustion

基　　金：国家自然科学基金资助项目:81403484;安徽省高校自然科学基金项目:KJ2019A0448;安徽中医药大学国家级项目培育基金计划项目:2019py01。

摘　　要：目的:观察艾灸联合西药治疗肝肾亏虚型类风湿关节炎(RA)的疗效,探讨艾灸治疗RA的作用机制。方法:将60例肝肾亏虚型RA患者随机分成观察组和对照组,每组30例。对照组口服来氟米特片,每日1次;观察组在对照组基础上,于三阴交、肾俞、足三里及阿是穴行艾灸治疗,隔日1次,每周3次,两组均治疗8周。比较两组患者治疗前后中医证候评分、健康评估问卷(HAQ)评分、类风湿关节炎病情活动度评价表(DAS-28)评分及血清钙离子(Ca^(2+))、血沉(ESR)、超敏C反应蛋白(hs-CRP)、类风湿因子(RF)水平,并评定两组临床疗效。结果:治疗后两组患者中医证候评分、HAQ评分、DAS-28评分均较治疗前降低(P<0.01),且观察组低于对照组(P<0.01)。治疗后,两组患者血清Ca^(2+)水平较治疗前升高(P<0.01),ESR、hs-CRP水平较治疗前降低(P<0.01),观察组RF水平较治疗前降低(P<0.01);治疗后,观察组血清Ca^(2+)水平高于对照组(P<0.01),ESR、RF水平低于对照组(P<0.01)。观察组总有效率为83.3%(25/30),高于对照组的60.0%(18/30,P<0.05)。结论:艾灸联合西药能有效减轻RA患者临床症状、提高其生活质量,疗效优于单纯西药治疗,艾灸治疗机制可能与调节免疫炎性反应以及影响钙平衡,进而抑制骨破坏有关。Objective To observe the clinical effect of moxibustion combined with western medication for rheumatoid arthritis(RA) of liver-kidney deficiency, and explore the mechanism of moxibustion for RA. Methods A total of 60 patients with RA of liver-kidney deficiency were randomly divided into an observation group and a control group, 30 cases in each group. In the control group,leflunomide tablets were taken orally, once a day. On the base of the treatment as the control group, moxibustion was applied at Sanyinjiao(SP 6), Shenshu(BL 23), Zusanli(ST 36) and ashi points in the observation group, once every other day, three times a week. Totally 8 weeks were required in both groups. Before and after treatment, the TCM syndrome score, health assessment questionnaire(HAQ) score, 28-joint disease activity score(DAS-28) and serum levels of calcium ion(Ca^(2+)), erythrocyte sedimentation rate(ESR), high-sensitivity C-reactive protein(hs-CRP) and rheumatoid factors(RF) were compared, and the clinicial efficacy was evaluated in the two groups. Results After treatment, the TCM syndrome scores, HAQ scores and DAS-28 scores were decreased in the two groups(P<0.01), and those in the observation group were lower than the control group(P<0.01). After treatment, the serum levels of Ca^(2+) were increased(P<0.01), ESR and hs-CRP were decreased in the two groups(P<0.01), and the serum level of RF was decreased in the observation group(P<0.01). The serum level of Ca^(2+) in the observation group was higher than the control group(P<0.01), ESR and RF were lower than the control group(P<0.01). The total effective rate was 83.3%(25/30) in the observation group,higher than 60.0%(18/30) in the control group(P<0.05). Conclusion Moxibustion combined with western medication can effectively relieve clinical symptoms, improve quality of life in RA patients, the curative effect is better than simple western medication. And its mechanism may be related to the regulation of serum level of Ca^(2+) and immune inflammatory response to inhibit bone destruc

关 键 词：类风湿关节炎 艾灸 血清钙离子 随机对照试验 

分 类 号：R246.1[医药卫生—针灸推拿学]