基于真实世界温针灸治疗类风湿性关节炎的疗效分析  

Effectiveness Analysis of Rheumatoid Arthritis Based on Real-World Warm Acupuncture

作　　者：郭凤霞[1] 崔伟锋[2] 叶静 GUO Fengxia;CUI Weifeng;YE Jing(Anyang Hospital of Traditional Chinese Medicine,Anyang 455000,Henan,China;Henan Academy of Traditional Chinese Medicine,Zhengzhou 450004,Henan,China;Henan University of Traditional Chinese Medicine,Zhengzhou 450046,Henan,China)

机构地区：[1]安阳市中医院,河南安阳455000 [2]河南省中医药研究院,河南郑州450004 [3]河南中医药大学,河南郑州450046

出　　处：《辽宁中医杂志》2021年第5期168-171,共4页Liaoning Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(81273877);河南省科技攻关项目(162102310063)。

摘　　要：目的探讨基于临床数据的真实世界中温针灸治疗类风湿性关节炎的临床疗效。方法用前瞻性队列研究方法,分析2017年9月—2019年12月经该院治疗的300例类风湿性关节炎患者;按是否接受温针灸治疗,分为温针灸组和非温针灸组。计算治疗4周后的中医整体疗效、简化的临床疾病活动指数(SDAI)及临床的疾病活动指数(CDAI),判定疗效。采用倾向评分法(PS)来平衡混杂因素,使用倾向评分匹配法评价其疗效,并分别采用分层回归法、PS逆处理概率加权法(IPTW)、倾向评分标准化加权法对评价结果进行敏感性分析。结果温针灸组与非温针灸组总有效率匹配前分别为93%(93/100)、85%(170/200),组间比较OR=2.34,P=0.020<0.05;匹配后,有效率分别为93%(93/100)、83%(83/100),OR=2.72,P=0.002<0.05;CPR、CDAI、SDAI治疗后都有明显降低,且均为温针灸组优于非温针灸,P<0.05。敏感性分析,倾向评分分层法和加权法均P<0.05,提示温针灸有治疗类风湿性关节炎作用,研究的结果具有较强稳定性。结论在真实世界临床实践中温针灸对于有类风湿性关节炎有治疗作用,值得临床上推广应用。Objective To investigate the clinical efficacy of real-world warm acupuncture for rheumatoid arthritis based on clinical data.Methods A prospective cohort study was used to analyze 300 patients with rheumatoid arthritis treated in our hospital from September 2017 to December 2019.They were divided into warm acupuncture and non-warm acupuncture groups according to whether they received warm acupuncture. The overall effect of traditional Chinese medicine,simplified clinical disease activity index( SDAI) and clinical disease activity index( CDAI) were calculated after 4 weeks of treatment,and the effect was determined. The propensity score method( PS) was used to balance confounding factors,the propensity score matching method was used to evaluate its efficacy,and the stratified regression method,PS inverse processing probability weighting method( IPTW) and propensity score standardized weighting method were used to evaluate the results. Results The total effective rates of the warm acupuncture group and the non-warm acupuncture group were 93%( 93/100) and 85%( 170/200),respectively,and the comparison between the groups was significant( OR = 2. 34,P = 0. 020 < 0. 05). After matching,the effective rates were 93%( 93/100),83%( 83/100)( OR = 2. 72,P = 0. 002 < 0. 05). CPR,CDAI and SDAI all decreased significantly after treatment,and all were better in the warm acupuncture group than those in the non-warm acupuncture group( P < 0. 05). The sensitivity analysis,the propensity score stratification method and the weighted method P values were all less than 0. 05,suggesting that warm acupuncture had the effect of treating rheumatoid arthritis,and the results of the study had strong stability. Conclusion In the real world clinical practice,warm acupuncture has therapeutic effect on rheumatoid arthritis,and it is worthy of clinical application.

关 键 词：类风湿性关节炎症 真实世界 倾向评分 温针灸 

分 类 号：R593.22[医药卫生—内科学]