藏药药浴联合针刺治疗类风湿关节炎的临床疗效及对血清基质金属蛋白酶-3、免疫球蛋白G、类风湿因子水平的影响  

Clinical efficacy of Tibetan medicine bath combined with acupuncture for rheumatoid arthritis and how to impact on serum matrix metalloproteinase-3,immunoglobulin G and rheumatoid factor

作　　者：付善灵 刘雅芳 连捷[2] 程伟[3] FU Shanling;LIU Yafang;LIAN Jie;CHENG Wei(Graduate School of Heilongjiang University of Chinese Medicine,Harbin,Heilongjiang 150040;Department of Neurology,The Second People's Hospital of Dalian,Dalian,Liaoning 116013;Harbin University of Commerce,Harbin,Heilongjiang 150028)

机构地区：[1]黑龙江中医药大学研究生院,黑龙江哈尔滨150040 [2]辽宁省大连市第二人民医院神经内科,辽宁大连116013 [3]哈尔滨商业大学,黑龙江哈尔滨150028

出　　处：《河北中医》2022年第12期1994-1998,共5页Hebei Journal of Traditional Chinese Medicine

基　　金：黑龙江省哲学社会科学工作办公室2020年度黑龙江省哲学社会科学研究规划项目(编号:20SSE340)。

摘　　要：目的观察藏药药浴联合针刺治疗类风湿关节炎(RA)的临床疗效及对血清基质金属蛋白酶-3(MMP-3)、免疫球蛋白G(IgG)、类风湿因子(RF)水平的影响。方法将111例RA患者按照随机数字表法分为2组,针刺组37例予针刺治疗,中药组37例予针刺联合中药药浴治疗,藏药组37例予针刺联合五味甘露药浴治疗,3组均10 d为1个疗程,治疗3个疗程。比较3组疗效;比较3组治疗前后血清MMP-3、IgG、RF水平变化;比较3组治疗前后关节疼痛数、关节肿胀数、晨僵时间变化;比较3组治疗前后中医证候评分变化;比较3组不良反应发生率。结果针刺组总有效率67.57%(25/37),中药组总有效率72.97%(27/37),藏药组总有效率94.59%(35/37),藏药组疗效优于针刺组、中药组(P<0.05),针刺组与中药组疗效相当(P>0.05)。3组治疗后血清MMP-3、IgG、RF水平均较本组治疗前降低(P<0.05),治疗后中药组、藏药组血清MMP-3、IgG、RF水平均低于针刺组(P<0.05),藏药组治疗后血清MMP-3、IgG、RF水平均低于中药组(P<0.05)。3组治疗后关节疼痛数、关节肿胀数、晨僵时间均较本组治疗前降低(P<0.05),治疗后中药组、藏药组关节疼痛数、关节肿胀数、晨僵时间均低于针刺组(P<0.05),藏药组治疗后关节疼痛数、关节肿胀数、晨僵时间均低于中药组(P<0.05)。3组治疗后关节疼痛、关节肿胀、关节屈伸不利、关节发热、晨僵、口渴评分及总评分均较本组治疗前降低(P<0.05),治疗后中药组、藏药组关节疼痛、关节肿胀、关节屈伸不利、关节发热、晨僵、口渴评分及总评分均低于针刺组(P<0.05),藏药组治疗后关节疼痛、关节肿胀、关节屈伸不利、关节发热、晨僵、口渴评分及总评分均低于中药组(P<0.05)。针刺组不良反应发生率16.22%(6/37),中药组不良反应发生率8.11%(3/37),藏药组不良反应发生率10.81%(4/37),3组不良反应发生率比较差异均无统计学意义(P>0.05)。结论藏�Objective To observe the clinical efficacy of Tibetan medicine bath combined with acupuncture for rheumatoid arthritis(RA)and how to impact on serum matrix metalloproteinase-3(MMP-3),immunoglobulin G(IgG)and rheumatoid factor(RF).Methods Totally 111 RA patients were randomly assigned at a ratio of 1∶1∶1 to receive acupuncture(acupuncture group),traditional Chinese medicine+acupuncture(TCM group),and Tibetan medicine bath+TCM+acupuncture group(Tibetan medicine group)for 3 courses(1 course for 10 days).The aim was to compare MMP-3,IgG,RF,the number of tender joints(TJ)and swollen joints(SJ),duration of morning stiffness,TCM syndrome score;the curative effect and adverse incidence were assessed.Results The overall effective rate in was 67.57%(25/37),72.97%(27/37)and 94.59%(35/37)in acupuncture group,TCM group,and Tibetan medicine group,respectively,the curative effect being better in Tibetan medicine group than the other two groups(P<0.05);the curative effect was similar between acupuncture group and TCM group(P>0.05).After treatment,MMP-3,IgG,RF in groups were decreased,Tibetan medicine group was the lowest,followed by TCM group and acupuncture group(all P<0.05);the number of TJ and SJ,the duration of morning stiffness in groups were decreased,the order of the three groups from high to low was:acupuncture group,TCM group,Tibetan medicine group(all P<0.05);the scores of TJ,SJ,limitation of joint flexion and extension,joint fever,morning stiffness,thirst,and their total scores in groups were decreased,which in the comparison of the three groups,Tibetan medicine group was superior to TCM group,and TCM group were superior to acupuncture group(all P<0.05).No differences were statistically significant in adverse incidence among three groups(16.22%[6/37]vs 8.11%[3/37]vs 10.81%[4/37];P>0.05).Conclusion For RA patients,Tibetan medicine bath combined with acupuncture can reduce serum MMP-3,IgG,RF,improve clinical symptoms,with high safety.

关 键 词：关节炎 类风湿 中药疗法 针刺疗法 

分 类 号：R593.22[医药卫生—内科学] R244[医药卫生—临床医学] R245.31