关节腔富血小板血浆联合动态敏化针药方案治疗膝关节骨性关节炎的疗效及相关性分析  

Therapeutic Effect and Correlation Analysis of Joint Cavity Platelet Rich Plasma Combined with Dynamic Sensitization Acupuncture and Medication Regimen in Treatment of KOA

作　　者：李小兰 杨从敏 刘涛 吴畏 LI Xiaolan;YANG Congmin;LIU Tao;WU Wei(Western Theater Command General Hospital,Chengdu 610000,China)

机构地区：[1]西部战区总医院,四川成都610000

出　　处：《针灸临床杂志》2024年第3期22-27,共6页Journal of Clinical Acupuncture and Moxibustion

摘　　要：目的:观察关节腔富血小板血浆联合动态敏化针药方案治疗膝关节骨性关节炎(KOA)的临床效果。方法:选择2020年8月—2022年12月在本院收治的KOA患者,随机分为富血小板血浆组(PRP组)和联合组。PRP组进行关节腔富血小板血浆注射治疗,患者每2周注射1次,共注射3次;联合组在PRP组基础上,采取动态敏化针药方案,即每2周动态探查痛敏穴位和热敏穴位,并分别采用电针法和雷火灸针对性连续治疗6周。观察指标为VAS评分、Lequesne指数、WOMAC评分、临床疗效和实验室指标(血清IL-6、SOD、FGF-2、OPG及关节液CXCL12)。结果:联合组在VAS评分和Lequesne指数均低于PRP组,差异有统计学意义(P<0.05);联合组在治疗前后的VAS评分和Lequesne指数差值均高于PRP组(P<0.05)。在WOMAC评分方面,联合组在WOMAC的“疼痛”“僵硬”“日常活动”均低于PRP组,差异有统计学意义(P<0.05)。在临床疗效方面,联合组总有效率100%(55/55),愈显率83.63%(46/55),均高于PRP组,差异有统计学意义(P<0.05)。在实验室指标方面,联合组在血清IL-6、SOD、FGF-2、OPG与关节液CXCL12共5项均优于PRP组,差异有统计学意义(P<0.05)。相关性分析显示VAS评分与IL-6和CXCL12呈正相关(P<0.05),与SOD、FGF-2以及OPG呈负相关(P<0.05)。Lequesne指数与CXCL12呈正相关(P<0.05),与SOD、FGF-2呈负相关(P<0.05),与IL-6、OPG无相关性(P>0.05)。结论:关节腔富血小板血浆注射联合动态敏化针药方案对膝关节骨性关节炎疗效显著,值得进一步推广和应用。Objective:To observe the clinical effect of joint cavity platelet rich plasma(PRP) combined with dynamic sensitization acupuncture and medication regimen in treatment of knee osteoarthritis(KOA).Methods:KOA patients were randomly divided into the PRP group and the combination group.The PRP group received platelet rich plasma injection in the joint cavity,once every 2 weeks for a total of 3 times;on which basis,the combination group was also treated with dynamic sensitization acupuncture and medication regimen,the pain sensitive points and thermal sensitive points were dynamically explored once every 2 weeks,and electro-acupuncture(EA) and thunder-fire moxibustion were respectively applied correspondingly for 6 consecutive weeks.VAS score,Lequesne index,WOMAC score,clinical efficacy,and laboratory serum indicators of IL-6,SOD,FGF-2 and OPG,as well as joint fluid of CXCL12 were observed in the two groups.Results:The VAS score and the Lequesne index were lower in the combination group than those in the PRP group(P<0.05);the differences in the VAS score and the Lequesne index before and after the treatment were higher in the combination group than those in the PRP group(P<0.05).In terms of the WOMAC scores,the combination group showed lower levels of ‘pain',‘stiffness' and ‘daily activities' than those in the PRP group(P<0.05).The total effective rate was 100%(55/55) and remarkable effective rate was 83.63%(46/55) in the combination group,which were higher than those in the PRP group(P<0.05).In terms of the laboratory indicators,the serum levels of IL-6,SOD,FGF-2 and OPG,as well as the synovial fluid CXCL12 were significantly improved in the combination group than those in the PRP group(P<0.05).Correlation analysis showed a positive correlation between VAS score and IL-6 and CXCL12(P<0.05),and a negatively correlation between SOD,FGF-2 and OPG(P<0.05).The Lequesne index was positively correlated with CXCL12(P<0.05),and was negatively correlated with SOD and FGF-2(P<0.05),but showed no correlation with IL-6 and

关 键 词：关节腔富血小板血浆 动态敏化针药方案 膝关节骨性关节炎 痛敏 热敏 电针 雷火灸 

分 类 号：R246.2[医药卫生—针灸推拿学]