热敏灸治疗早中期膝骨关节炎寒湿痹阻证临床研究  

Clinical Study on Heat Sensitive Moxibustion in the Treatment of Cold and Dampness Obstruction Syndrome of Knee Osteoarthritis in the Early and Middle Stages

作　　者：任桂珍 田雪秋[2] 张莲[3] 李丽[2] 曲博 牟开今[3] REN Guizhen;TIAN Xueqiu;ZHANG Lian;LI Li;QU Bo;MU Kaijin(Changchun University of Traditional Chinese Medicine,Changchun 130021,Jilin,China;Jilin College of Traditional Chinese Medicine,Changchun 130021,Jilin,China;Affiliated Hospital of Changchun University of Traditional Chinese Medicine,Changchun 130021,Jilin,China)

机构地区：[1]长春中医药大学,吉林长春130021 [2]吉林省中医药科学院,吉林长春130021 [3]长春中医药大学附属医院,吉林长春130021

出　　处：《辽宁中医药大学学报》2023年第6期205-209,共5页Journal of Liaoning University of Traditional Chinese Medicine

基　　金：吉林省中医药科技项目(2020114);吉林省卫生健康适宜技术项目(2019FP031)。

摘　　要：目的 评价热敏灸治疗早中期寒湿痹阻型膝骨关节炎的临床疗效,探讨本疗法抗炎护骨临床作用机制。方法 选取100例膝骨关节炎患者,随机分为对照组和治疗组,每组各50例,对照组采用基础治疗方案加常规艾灸疗法,治疗组采用基础治疗方案加腧穴敏化的热敏灸疗法,疗程30 d。观察两组视觉模拟评分(visual analogue scales,VAS)、膝骨关节病情严重指数(index of severity for osteoarthritis,ISOA)评分、西安大略和麦克马斯特大学骨关节炎指数(Western Ontario and Mcmaster Universities Osteoarthritis Index,WOMAC)评分、中医证候评分,对其评分差异进行比较。检测两组血液中炎性因子白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)及骨标三项总Ⅰ型胶原氨基端延长肽(TPINP)、骨钙素N端中分子片段(N-MID)、Ⅰ型胶原羧基端肽β特殊序列(β-CTX)的水平,对其水平差异进行比较。结果 治疗后,治疗组临床总有效率88%,对照组临床总有效率80%,差异无统计学意义(P>0.05)。治疗前两组VAS评分、WOMAC评分、中医证候评分差异无统计学意义(P>0.05),但ISOA评分差异有统计学意义(P<0.05)。治疗后,两组VAS评分、WOMAC评分差异无统计学意义(P>0.05),两组疗效相当;治疗后在膝关节疼痛、形寒肢冷、屈伸不利、中医证候总体评分差异有统计学意义(P<0.05),治疗组优于对照组。治疗前两组炎性因子、骨标三项水平差异无统计学意义(P>0.05);治疗后,IL-1β、TNF-α水平差异有统计学意义(P<0.05),治疗组优于对照组;TPINP、N-MID、β-CTX水平差异无统计学意义(P>0.05),两组疗效相当。结论热敏灸疗法治疗早中期寒湿痹阻型膝骨关节炎在改善患者膝关节疼痛、形寒肢冷、屈伸不利等方面优于传统常规艾灸疗法;热敏灸疗法治疗膝骨关节炎30 d具有降低患者血液中TNF-α、IL-1β水平而起到抗炎作用的疗效,但未见改变骨标三项TPINP、N-MID、β-CTX水平的护Objective To evaluate the clinical efficacy of heat sensitive moxibustion in the treatment of knee osteoarthritis with cold and dampness obstruction syndrome in early and middle stage,and to explore the mechanism of anti-inflammatory and osteoprotective clinical effect of this therapy.Methods 100 patients with knee osteoarthritis were randomly divided into control group and treatment group with 50 cases in each group.The control group was treated with basic treatment scheme plus conventional moxibustion,and the treatment group was treated with basic treatment scheme plus acupoint sensitized thermal moxibustion for 30 days.Visual analogue scales(VAS),index of severity for osteoarthritis(ISOA),Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC),and TCM symptom scores were compared for differences in their scores.IL-1β,tumor necrosis factor(TNF-α)and three items of total type I collagen amino terminal lengthening peptide(TPINP),osteocalcin N-terminal middle molecular fragment(N-MID),and type I collagen carboxyl terminal peptideβspecial sequence(β-CTX)were detected in the blood of the two groups and compared the level differences.Results After treatment,the total clinical effective rate was 88%in the treatment group and 80%in the control group,with no significant difference(P>0.05).There was no significant difference in VAS score,WOMAC score and TCM syndrome score between the two groups before treatment(P>0.05),but there was significant difference in ISOA score(P<0.05).After treatment,there was no significant difference in VAS score and WOMAC score between the two groups(P>0.05).The two groups were equally effective;After treatment,there were significant differences in knee joint pain,cold shape and limb,unfavorable flexion and extension,and the overall score of TCM syndromes(P<0.05),and the treatment group was better than the control group;There was no significant difference in the levels of inflammatory factors and bone markers between the two groups before treatment(P>0.05);After treatment,th

关 键 词：膝骨关节炎 寒湿痹阻证 早中期 热敏灸 临床研究 

分 类 号：R684.3[医药卫生—骨科学]