不同针灸方法治疗类风湿关节炎寒湿痹阻证的临床研究  

Therapeutic Effects of Different Acupuncture and Moxibustion Methods in Treatment of Rheumatoid Arthritis due to Cold Dampness Obstruction

作　　者：黄湘玉 王维维 晏姣 HUANG Xiangyu;WANG Weiwei;YAN Jiao(Chinese People's Liberation Army Western Theater Command General Hospital,Chengdu 610000,China)

机构地区：[1]中国人民解放军西部战区总医院,四川成都610000

出　　处：《针灸临床杂志》2024年第9期31-36,共6页Journal of Clinical Acupuncture and Moxibustion

基　　金：四川省中医药管理局科研课题面上项目,编号:2021ky459。

摘　　要：目的:观察不同温热类针灸方法(温针灸、火针和雷火灸)治疗类风湿关节炎的疗效。方法:选择2022年12月—2023年7月于本院中医科住院的RA患者126例,采用随机数字表法分为温针灸组、火针组和雷火灸组。3组均接受常规治疗,温针灸组进行温针灸治疗,火针组进行火针治疗,雷火灸组进行雷火灸治疗,3组均治疗。在治疗前、治疗2周、4周和6周后采用视觉模拟评分法(VAS)、疾病活动性评分(DAS28)分别评估3组患者的疼痛程度和疾病活动程度,并在治疗前后检测C反应蛋白(CRP)、血沉(ESR)、类风湿因子(RF)、Nod样受体蛋白3(NLRP3)及血管生成素样蛋白2(ANGPTL2)的水平;同时行双手X线检查、常规超声检查及超声触诊组织成像量化(VTIQ)检查,分别获取Sharp评分、滑膜增生厚度及SWVmean值。结果:与治疗前比较,3组治疗2周、治疗4周和治疗6周的VAS和DAS28评分均低于治疗前,差异具有统计学意义(P<0.05);温针灸组在治疗4周和6周的VAS评分和治疗6周的DAS28评分均低于其余两组,差异具有统计学意义(P<0.05)。治疗后,温针灸组NLRP3、ANGPTL2低于其余两组,CRP、ESR低于火针组,差异具有统计学意义(P<0.05),与雷火灸组比较差异无统计学意义(P>0.05),RF比较3组间差异无统计学意义(P>0.05)。治疗后,温针灸组滑膜厚度和SWVmean低于其余两组,X线Sharp评分仅低于火针组,差异具有统计学意义(P<0.05),与雷火灸组比较差异无统计学意义(P>0.05)。结论:温针灸、火针和雷火灸均可以缓解类风湿关节炎患者的疼痛,抑制疾病活动性,减轻滑膜厚度和炎性反应,改善骨破坏,其中又以温针灸效果最佳。Objective:To observe the therapeutic effects of different warm acupuncture and moxibustion methods(needle-warming moxibustion,fire needling,thunder-fire moxibustion)in treatment of rheumatoid arthritis(RA).Methods:126 RA patients were randomly divided into the needle-warming moxibustion group,the fire needling group and the thunder-fire moxibustion group.All the three groups received routine treatment.The needle-warming moxibustion group was treated with needle-warming moxibustion,the fire needling group was treated with fire needling,and the thunder-fire moxibustion group was treated with thunder-fire moxibustion.All three groups were treated for 6 weeks.The three groups of patients were evaluated for pain and disease activity by using Visual Analog Scale(VAS)and Disease Activity Scale(DAS28)before the treatment,after 2 weeks,4 weeks and 6 weeks of treatment,respectively.The levels of C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),rheumatoid factor(RF),Nod like receptor protein 3(NLRP3),and angiopoietin like protein 2(ANGPTL2)were measured before and after the treatment in the three groups.Simultaneously,both hands X-ray examination,routine ultrasound examination,and ultrasound palpation tissue imaging quantification(VTIQ)examination were performed to obtain Sharp score,synovial hyperplasia thickness and SWVmean value.Results:The scores of VAS and DAS28 were lower after 2 weeks,4 weeks and 6 weeks of treatment than those before the treatment in the three groups(P<0.05).The VAS scores of the needle-warming moxibustion group were lower than those of the other two groups after 4 weeks and 6 weeks of treatment,and the DAS28 score of the needle-warming moxibustion group was lower than that of the other two groups after 6 weeks of treatment(P<0.05).The levels of NLRP3 and ANGPTL2 were lower in the needle-warming moxibustion group than those in the other two groups(P<0.05);the levels of CRP and ESR were lower in the needle-warming moxibustion group than those in the fire needling group(P<0.05),and there we

关 键 词：类风湿关节炎 温针灸 火针 雷火灸 滑膜厚度 超声触诊组织成像量化 

分 类 号：R246.2[医药卫生—针灸推拿学]