基于双重差分模型分析太极旋灸对风寒湿痹型膝痹患者膝关节功能的影响  

Effect of Tai Chi Revolving Moxibustion on Knee Joint Function in Patients with Wind-Cold-Damp Type Knee Arthralgia Based on Differences-in-Differences Model

作　　者：尹罗娟[1] 余静 谢先敏 谢心军[1] 唐庆妮 YIN Luojuan;YU Jing;XIE Xianmin;XIE Xinjun;TANG Qingni(The First Affiliated Hospital of Hunan University of Chinese Medicine,Changsha Hunan China 410007)

机构地区：[1]湖南中医药大学第一附属医院,湖南长沙410007

出　　处：《中医学报》2023年第2期408-414,共7页Acta Chinese Medicine

基　　金：湖南省中医药管理局科研计划项目(2020073)。

摘　　要：目的:探讨基于双重差分(differences-in-differences,DID)模型分析太极旋灸对膝痹患者膝关节功能的影响。方法:58例风寒湿痹型膝痹患者按照随机数字表法平均分为普通艾灸组和太极旋灸组。普通艾灸组给予传统艾灸和隔物灸治疗;太极旋灸组给予太极旋灸治疗;比较两组患者治疗前后中医证候评分、炎症因子水平、不同时间点疼痛情况,采用DID模型对比两组患者不同时间点(治疗前,治疗后1周、1、3、6个月)膝关节功能。结果:(1)随访6个月,无1例失访,太极旋灸组治疗后关节僵硬、关节肿胀、屈伸不利、冷痛重着中医证候积分均低于普通艾灸组(P<0.05)。(2)治疗后,太极旋灸组白细胞介素-1β(interleukin-1β,IL-1β)水平为(39.90±10.19)ng·L^(-1)、白细胞介素17(interleukin-17,IL-17)水平为(225.39±22.36)ng·L^(-1),低于普通艾灸组[(45.90±9.46)ng·L^(-1)、(255.15±17.40)ng·L^(-1)](P<0.05)。(3)太极旋灸组治疗后1周、1个月、3个月和6个月视觉模拟量表(visual analogue scale,VAS)评分分别为(4.34±1.09)分、(3.82±0.79)分、(2.80±0.88)分、(2.20±0.53)分,低于普通艾灸组[(5.58±1.27)分、(4.45±0.92)分、(3.38±0.85)分、(2.80±0.47)分](P<0.05)。(4)太极旋灸组治疗后1周、1个月、3个月和6个月纽约特种外科医院(hospital for special surgery knee score,HSS)评分分别为(68.25±7.85)分、(76.25±8.26)分、(79.95±6.98)分、(80.21±6.89)分,高于普通艾灸组[(61.95±8.98)分、(68.98±7.25)分、(73.52±7.23)分、(76.01±7.01)分](P<0.05);DID模型显示,治疗后,患者膝关节功能HHS评分上升109.05%(P<0.05),治疗方式与总体治疗效果呈正效应,时间越长,HHS评分越高(P<0.05)。结论:太极旋灸治疗风寒湿痹型膝痹能下调患者炎症因子水平,缓解疼痛,改善膝关节功能和临床症状。Objective:To investigate the effect of Tai Chi revolving moxibustion on knee joint function in knee paralysis patients based on the differences-in-differences(DID) model.Methods:58 patients with wind-cold-dampness type knee arthralgia were equally divided into the ordinary moxibustion group and the Tai Chi revolving moxibustion group according to the random number table method.The ordinary moxibustion group received traditional moxibustion and sandwiched moxibustion.The Tai Chi revolving moxibustion group received Tai Chi revolving moxibustion.The scores of TCM syndromes,levels of inflammatory factors,and pain at different time points were compared between the two groups before and after treatment.And DID model was used to compare the knee joint function of the two groups at different time points(before treatment,1 week,1,3,and 6 months after treatment).Results:(1)After 6 months of follow-up,no case was lost to follow-up.After treatment,the TCM syndrome scores of joint stiffness,joint swelling,poor flexion and extension,and severe cold pain in the Tai Chi revolving moxibustion group were lower than those in the ordinary moxibustion group(P<0.05).(2)After treatment,the level of interleukin 1β(IL-1β) in the Tai Chi revolving moxibustion group was(39.90±10.19) ng·L^(-1),and the level of interleukin 17(IL-17) was( 225.39±22.36) ng·L^(-1),which was lower than that of the ordinary moxibustion group [(45.90±9.46) ng·L^(-1),(255.15±17.40) ng·L^(-1)](P<0.05).(3)The scores of the visual analog scale(VAS) in the Tai Chi revolving moxibustion group were(4.34±1.09) points,(3.82±0.79) points,(2.80±0.88) points,(2.20±0.53) points at 1 week,1 month,3 months and 6 months after treatment respectively,which lower than the ordinary moxibustion group [(5.58±1.27) points,(4.45±0.92) points,(3.38±0.85) points,(2.80±0.47) points](P<0.05).(4)The scores of the hospital for special surgery knee score(HSS) in the Tai Chi revolving moxibustion group were(68.25±7.85) points,(76.25±8.26) points,(79.95±6.98) points,(80.21±

关 键 词：膝痹 风寒湿痹证 太极旋灸 膝关节功能 双重差分模型 

分 类 号：R274.984.3[医药卫生—中西医结合]