烧山火针刺法联合甲氨蝶呤治疗类风湿关节炎活动期的效果及其对患者炎症因子和免疫功能的影响  

Efficacy of mountain-burning fire acupuncture combined with methotrexate in the treatment of rheumatoid arthritis in active stage and its effect on inflammatory factors and inflammatory function

作　　者：陈建飞[1] 武慧群 李凌鑫[3] 罗伟贤[1] 任连军[1] CHEN Jian-fei;WU Hui-qun;LI Ling-xin;LUO Wei-xian;REN Lian-jun(Department of Traditional Chinese Medicine,Zhengzhou First People's Hospital,Zhengzhou 450000,Henan,CHINA;Department of Rehabilitation Medicine,the First Affiliated Hospital of Baotou Medical College,Inner Mongolia University of Science and Technology,Baotou 014010,Inner Mongolia,CHINA;Department of Rehabilitation Medicine,West China Hospital,Sichuan University,Chengdu 610044,Sichuan,CHINA)

机构地区：[1]郑州市第一人民医院中医科,河南郑州450000 [2]内蒙古科技大学包头医学院第一附属医院康复医学科,内蒙古包头014010 [3]四川大学华西医院康复医学科,四川成都610044

出　　处：《海南医学》2024年第2期200-205,共6页Hainan Medical Journal

基　　金：四川省成都市科技局技术创新研发项目(编号:2019-YF05-00061-SN)。

摘　　要：目的 观察烧山火针刺法联合甲氨蝶呤治疗类风湿关节炎(RA)活动期的效果,并探讨其抗炎和调节免疫作用机制。方法 选取2020年2月至2022年10月郑州市第一人民医院收治的60例RA活动期患者纳入研究,按照随机数表法分为常规组和联合组各30例。常规组患者给予甲氨蝶呤治疗,联合组患者给予烧山火针刺法联合甲氨蝶呤治疗,均治疗两周。于治疗两周后比较两组患者的治疗效果,以及治疗前后的中医证候评分、28个关节疾病活动(DAS28)评分、疼痛(VAS)评分、炎性指标[血沉(ESR)、C反应蛋白(CRP)、肿瘤坏死因子-α (TNF-α)、类风湿因子(RF)、抗环瓜氨酸肽(CCP)抗体]、免疫指标(Treg细胞、Th17细胞、Treg/Th17细胞),同时比较两组患者治疗期间的不良反应发生情况。结果 联合组患者的治疗总有效率为93.33%,明显高于常规组的73.33%,差异有统计学意义(P<0.05);联合组患者治疗两周后的中医证候关节肿胀、冷痛、压痛、晨僵、屈伸不利评分分别为(0.72±0.18)分、(0.70±0.20)分、(0.81±0.22)分、(0.68±0.15)分、(0.77±0.19)分,明显低于常规组的(1.03±0.24)分、(0.96±0.23)分、(1.14±0.26)分、(0.91±0.21)分、(1.09±0.23)分,差异均有统计学意义(P<0.05);联合组患者治疗两周后的DAS28、VAS评分分别为(2.18±0.33)分、(2.46±0.22)分,明显低于常规组的(3.26±0.47)分、(2.89±0.27)分,差异均有统计学意义(P<0.05);联合组患者治疗两周后的ESR、抗CCP抗体、RF、CRP、TNF-α水平分别为(16.23±2.29) mm/h、(172.30±30.14) IU/mL、(130.85±15.42) IU/mL、(10.20±1.68) mg/L、(18.95±4.38) pg/mL,明显低于常规组的(21.84±3.41) mm/h、(205.68±36.77) IU/mL、(157.62±24.10) IU/mL、(13.65±2.06) mg/L、(24.51±6.02) pg/mL,差异均有统计学意义(P<0.05);联合组患者治疗两周的外周血Treg细胞百分比、Treg/Th17比值分别为(2.61±0.35)%、2.44±0.37,明显高于常规组的(2.17±0.28)%、1.68±0.32,Th17细胞百分比Objective To investigate the effect of mountain-burning fire acupuncture combined with metho-trexate in the treatment of rheumatoid arthritis(RA),and to analyze its anti-inflammatory and immune-regulating mecha-nism.Methods Sixty patients with active RA admitted to Zhengzhou First People's Hospital from February 2020 to Oc-tober 2022 were selected and divided into the conventional group and the combined group according to the random num-ber table method,with 30 cases in each group.The patients in the conventional group were treated with methotrexate,and the patients in the combined group were treated with mountain-burning fire acupuncture combined with methotrex-ate,for 2 weeks.After treatment,the therapeutic effects of the two groups were compared,as well as the TCM syndrome score,28 joint disease activity(DAS28)score,pain(Visual Analogue Scale,VAS)score,inflammatory indicators[eryth-rocyte sedimentation rate(ESR)and C-reactive protein(CRP),tumor necrosis factorα(TNF-α),rheumatoid factor(RF),anti-cyclic citrullinated peptide(CCP)antibody],immune indexes(Treg cells,Th17 cells,Treg/Th17 cells)be-fore and after treatment.The incidences of adverse reactions during treatment were also compared between the two groups.Results The total effective rate of the combined group was 93.33%,which was significantly higher than 73.33%of the conventional group(P<0.05).After 2 weeks of treatment,the scores of joint swelling,cold pain,tenderness,morn-ing stiffness,and poor flexion and extension in the combined group were(0.72±0.18)points,(0.70±0.20)points,(0.81±0.22)points,(0.68±0.15)points,and(0.77±0.19)points,respectively,significantly lower than(1.03±0.24)points,(0.96±0.23)points,(1.14±0.26)points,(0.91±0.21)points,and(1.09±0.23)points in the conventional group(P<0.05).After 2 weeks of treatment,the DAS28 and VAS scores of the combined group were(2.18±0.33)points and(2.46±0.22)points,respectively,which were significantly lower than(3.26±0.47)points and(2.89±0.27)points of the conven-tional group(P<0.05).After 2 w

关 键 词：类风湿关节炎活动期 烧山火针刺法 甲氨蝶呤 治疗效果 炎症因子 免疫功能 

分 类 号：R593.22[医药卫生—内科学]