性别对膝骨关节炎针刺治疗疗效的影响:一项多中心随机对照研究的二次分析  

Influence of sex on the therapeutic effect of acupuncture on knee osteoarthritis:a secondary analysis of data from a multi-center randomized controlled study

作　　者：郝晓万 屠建锋 王丽琼[1] 于芳婷 林璐璐[1] 李洪萍 石广霞 刘存志 HAO Xiaowan;TU Jianfeng;WANG Liqiong;YU Fangting;LIN Lulu;LI Hongping;SHI Guangxia;LIU Cunzhi(International Acupuncture and Moxibustion Innovation Institute,Beijing University of Chinese Medicine,Beijing 100029,China;School of Acupuncture-Moxibustion and Tuina,Beijing University of Chinese Medicine,Beijing 100029,China;Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University,Beijing 100010,China)

机构地区：[1]北京中医药大学国际针灸创新研究院,北京100029 [2]北京中医药大学针灸推拿学院 [3]首都医科大学附属北京中医医院

出　　处：《北京中医药大学学报》2023年第1期125-131,共7页Journal of Beijing University of Traditional Chinese Medicine

基　　金：北京市科学技术委员会科技计划项目(No.D171100003217003);第四届中国科协青年人才托举工程项目(No.2018QNRC001);中央高校基本科研业务费专项(No.2022-JYB-XJSJJ030)。

摘　　要：目的探讨膝骨关节炎针刺治疗疗效在不同性别之间是否存在差异。方法对一项多中心、随机对照试验数据进行二次分析。试验将442例膝骨关节炎患者随机分为手针组(145例)、电针组(151例)、假针刺组(146例)。手针组以犊鼻、内膝眼、曲泉、膝阳关、阿是穴为主穴,按照循经配穴法选择3个配穴,电针仪不输出电流;电针组取穴同手针组,电针仪输出2/100 Hz疏密波;假针刺组选择8个非经非穴点浅刺,电针仪不输出电流。每次针刺干预30 min,每周3次,共8周。分别在治疗前后记录西安大略和麦克马斯特大学骨关节炎指数(WOMAC)功能评分、疼痛数字评价量表(NRS)评分。针刺有效应答定义为WOMAC功能评分至少下降6分,且NRS评分至少下降2分。结果手针组中男性有效应答率58.8%,女性59.6%,不同性别有效应答率差异无统计学意义(P>0.05);电针组中男性有效应答率62.5%,女性59.7%,不同性别有效应答率差异无统计学意义(P>0.05);假针刺组中男性针刺有效应答率52.5%,女性45.3%,不同性别有效应答率差异无统计学意义(P>0.05)。结论针刺治疗膝骨关节炎疗效与性别无关,不同性别患者发生不良反应事件的情况都很少,提示针刺作为一种非药物疗法,具有较好的疗效以及安全性。Objective To investigate whether there is sex difference in the acupuncture treatment of knee osteoarthritis.Methods A secondary analysis of data from a multicenter randomized controlled trial was performed.A total of 442 patients with knee osteoarthritis were randomly divided into the acupuncture group(n=145),electroacupuncture group(n=151),and sham acupuncture group(n=146).For the acupuncture group,obligatory acupoints were selected,including ST35,EX-LE4,LV8,GB33,and ashi points,with three matching acupoints along the channel,and the electroacupuncture instrument was connected without any current.The same acupoints were selected for the electroacupuncture group,but the 2/100 Hz dilatational wave was connected.For the sham acupuncture group,eight shallow points that were unrelated to any channel or acupoint were selected,and the electroacupuncture instrument was not connected to a current.For all groups,the intervention lasted 30 min per session,three times a week,for eight weeks in total.The Western Ontario and McMaster University Osteoarthritis Index(WOMAC)and the Numerical Rating Scale(NRS)were used for assessment before and after treatment.An effective acupuncture response was defined as a decrease of at least 6 points in the functional index of WOMAC and a decrease of at least 2 points in the NRS.Results In the acupuncture group,the effective response rate was 58.8%and 59.6%for males and females,respectively(P>0.05).In the electroacupuncture group,the effective response rate was 62.5%and 59.7%for males and females,respectively(P>0.05).In the sham acupuncture group,the effective response rate was 52.5%and 45.3%for males and females,respectively(P>0.05).Conclusion The efficacy of acupuncture in the treatment of knee osteoarthritis is probably unrelated to sex,and the incidence of adverse events seems to be very low regardless of sex,suggesting that acupuncture,as a non-drug therapy,tends is effective and safe.

关 键 词：膝骨关节炎 针刺 有效应答率 性别 

分 类 号：R269.843[医药卫生—中西医结合]