耳穴疗法治疗膝骨关节炎的疗效观察及对骨代谢和炎症因子的影响  

Efficacy observation of ear point therapy in treating knee osteoarthritis and the effects on bone metabolism and inflammatory factors

作　　者：王艳 贾晓慧 芦织 王贞芳 WANG Yan;JIA Xiaohui;LU Zhi;WANG Zhenfang(Shandang Qingdao Hospital of Integrated Traditional and Chinese Medicine(The Fifth People’s Hospital of Qingdao),Qingdao 266002,China)

机构地区：[1]山东青岛中西医结合医院(青岛市第五人民医院),青岛266002

出　　处：《上海针灸杂志》2024年第11期1170-1176,共7页Shanghai Journal of Acupuncture and Moxibustion

基　　金：青岛市中医药科技项目(2021-zyym09)。

摘　　要：目的观察耳穴疗法联合中药塌渍治疗膝骨关节炎的临床疗效及对骨代谢和炎症因子的影响。方法将100例膝骨关节炎患者,随机分为对照组和研究组,每组50例。对照组采用中药塌渍治疗,研究组在对照组的基础上采用耳穴疗法(耳穴贴压联合耳部铜砭刮痧)治疗。比较两组临床疗效及治疗前后中医证候积分、血清骨代谢指标[Ⅱ型胶原C-端肽(C-terminal telopeptides of typeⅡcollagen,CTX-Ⅱ)、骨钙素(bone Gla-protein,BGP)、骨保护素(osteoprotectin,OPG)]、炎性因子[白细胞介素-1(interleukin-1,IL-1)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、基质金属蛋白酶-3(matrix metalloproteinase-3,MMP-3)]水平、滑膜血流超声信号等级、疼痛视觉模拟量表(visual analog scale,VAS)评分、膝骨关节炎严重性指数(index of severity for osteoarthritis,ISOA)评分和关节炎影响评估表2(arthritis impact measurement scale 2,AIMS2)评分。结果研究组总有效率为90.0%,高于对照组的74.0%(P<0.05)。治疗1、2个疗程后及治疗后,研究组膝关节酸痛、屈伸不利、四肢寒冷、舌淡苔白积分低于对照组(P<0.05);研究组血清BGP、OPG水平较对照组升高(P<0.05),CTX-Ⅱ水平较对照组降低(P<0.05);研究组血清TNF-α、IL-1、MMP-3水平低于对照组(P<0.05)。治疗后,两组滑膜血流超声信号等级优于治疗前(P<0.05),且研究组优于对照组(P<0.05);两组VAS、ISOA、AIMS2评分低于治疗前(P<0.05),且研究组低于对照组(P<0.05)。结论耳穴疗法联合中药塌渍治疗能改善膝骨关节炎患者临床症状,缓解疼痛,抑制炎症反应,改善骨代谢,从而维持良好生活质量。Objective To observe the clinical efficacy of ear point therapy with a copper needle and Chinese medication smearing in treating knee osteoarthritis(KOA)and the effects on bone metabolism and inflammatory factors.Method One hundred patients suffering from KOA pain were randomly allocated to a control group and a research group,each consisting of 50 cases.The control group was treated with Chinese medication smearing,and the research group additionally received ear point therapy(ear point sticking and ear Guasha with a copper needle).The clinical efficacy was compared between the two groups,and the symptom score of traditional Chinese medicine(TCM),serum bone metabolism indicators[C-terminal telopeptides of typeⅡcollagen(CTX-Ⅱ),bone Gla-protein(BGP),and osteoprotectin(OPG)],inflammatory factors[interleukin-1(IL-1),tumor necrosis factor-α(TNF-α),and matrix metalloproteinase-3(MMP-3)],synovial blood flow signal grading revealed by ultrasound,pain visual analog scale(VAS)score,index of severity for osteoarthritis(ISOA),and arthritis impact measurement scale 2(AIMS2)score were also compared before and after the treatment.Result The total effective rate was 90.0%in the research group,higher than 74.0%in the control group(P<0.05).After 1 and 2 treatment courses and by the end of the treatment,the research group was lower than the control group in comparing the scores of dull aching in the knee joint,difficulty bending and stretching,cold limbs,and pale tongue with white coating(P<0.05);the serum BGP and OPG levels were higher in the research group than in the control group(P<0.05),and the CTX-Ⅱlevel was lower in the research group(P<0.05);the research group had lower levels of TNF-α,IL-1,and MMP-3 than the control group(P<0.05).After the treatment,the ultrasound synovial blood flow signal grade was better in both groups(P<0.05)and was better in the research group than in the control group(P<0.05);the VAS,ISOA,and AIMS2 scores dropped in both groups after the intervention(P<0.05)and were lower in the research gr

关 键 词：耳穴贴压 刮痧疗法 穴位贴敷法 TDP 骨关节炎 膝 疼痛 骨代谢 关节功能 

分 类 号：R246.2[医药卫生—针灸推拿学]