调督通脉针灸治疗临床前类风湿关节炎临床研究及影响临床疗效的因素分析  

Effect and influencing factors for Tiaodu Tongmai acupuncture therapy on preclinical rheumatoid arthritis

作　　者：张秀荣[1] 崔欣美[1] 赵海燕[2] 戴缙[2] 付佳新 王博[1] ZHANG Xiurong;CUI Xinmei;ZHAO Haiyan;DAI Jin;FU Jiaxin;WANG Bo(Department of Rheumatology,the Fourth Affiliated Hospital of Heilongjiang University of Chinese Medicine,Harbin,Heilongjiang 150016;Department of Rheumatology,the Second Affiliated Hospital of Heilongjiang University of Chinese Medicine,Harbin,Heilongjiang 150000)

机构地区：[1]黑龙江中医药大学附属第四医院风湿科,黑龙江哈尔滨150016 [2]黑龙江中医药大学附属第二医院风湿科,黑龙江哈尔滨150000

出　　处：《河北中医》2024年第12期2065-2070,2074,共7页Hebei Journal of Traditional Chinese Medicine

基　　金：黑龙江省中医药科研项目(编号:ZHY2022-206)。

摘　　要：目的观察调督通脉针灸法对临床前类风湿关节炎(pre-RA)的治疗效果,并对影响临床疗效的因素进行分析。方法选择2022年1月至2022年12月黑龙江中医药大学附属第四医院风湿科150例pre-RA患者为研究对象,按照随机数字表法分为2组,每组75例。采用倾向性评分匹配法进行1∶1匹配,共匹配成功50对。对照组50例予常规针刺治疗,治疗组50例予调督通脉针灸法治疗,均治疗12周。比较2组临床疗效及治疗前后免疫球蛋白A(IgA)、IgG、IgM、C反应蛋白(CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、红细胞沉降率(ESR)、抗环瓜氨酸肽(CCP)抗体、类风湿因子(RF)、关节晨僵时间、关节肿胀数量、关节疼痛评分变化。并构建广义估计方程(GEE)模型,分析pre-RA治疗效果的影响因素。结果治疗组总有效率92.00%(46/50),对照组总有效率74.00%(37/50),治疗组总有效率显著高于对照组(P<0.05)。治疗12周后,2组IgA、IgG、IgM、CRP、IL-6、TNF-α、ESR、抗CCP抗体、RF水平及晨僵时间、关节肿胀数及关节疼痛评分均较本组治疗前降低(P<0.05),且治疗组均低于对照组(P<0.05)。患者年龄、病程、治疗方法和治疗时间显著影响pre-RA的治疗效果(P<0.05),治疗方法与病程在相乘模型(OR=1.642,95%CI:1.188~2.352)和相加模型[相对超额危险度(RERI)=8.292,95%CI:2.342~14.269;交互作用归因比(AP)=0.638,95%CI:0.238~1.087;交互作用指数(S)=3.236,95%CI:1.746~5.263]中存在交互作用,表现为协同作用。结论调督通脉针灸法治疗pre-RA对患者临床症状、类风湿因子、炎症相关因子水平的改善效果及临床疗效优于常规针刺治疗,患者年龄、病程、治疗方法和治疗时间显著影响pre-RA的治疗效果,并且治疗方法与病程在相乘模型和相加模型中均存在交互作用,表现为协同作用。Objective To observe the effect of Tiaodu Tongmai acupuncture therapy on preclinical rheumatoid arthritis(pre-RA)and define the influencing factors.Methods A total of 150 pre-RA patients admitted to the Department of Rheumatology,the Fourth Affiliated Hospital of Heilongjiang University of Chinese Medicine from January 2022 to December 2022 were randomly assigned into the control group(n=75)and the treatment group(n=75).A 1∶1 propensity-matched analysis was performed to match patients,and 50 pairs were successfully matched.Patients in the control group and the treatment group were treated with conventional acupuncture and Tiaodu Tongmai acupuncture therapy,respectively.Treated for 12 weeks,the aim was to compare immunoglobulin A(IgA),IgG,IgM,C-reactive protein(CRP),interleukin 6(IL-6),tumor necrosis factor alpha(TNF-α),erythrocyte sedimentation rate(ESR),anti-cyclic citrullinated peptide(CCP)antibody,rheumatoid factor(RF),duration of morning stiffness,number of joint swelling,joint pain score,as well as joint pain score.The generalized estimating equation(GEE)model was conducted to evaluate the influencing factors for pre-RA.Results The overall effective rate in the treatment group was significantly higher than that in the control group(92.00%[46/50]vs 74.00%[37/50],P<0.05).IgA,IgG,IgM,CRP,IL-6,TNF-α,ESR,anti-CCP antibody,RF,duration of morning stiffness,number of joint swelling,joint pain score at week 12 in the both groups were significantly decreased(P<0.05),the decreases in the treatment group were more prevalent compared with the control group(P<0.05).Age,disease course,treatment method and treatment duration significantly affected the therapeutic effect of pre-RA(P<0.05).There was an interaction between the treatment method and disease course in the multiplicative model(OR 1.642,95%CI 1.188~2.352)and the additive model(relative excess risk[RERI]8.292,95%CI 2.342~14.269;attribution ratio[AP]0.638,95%CI 0.238~1.087;synergy index[SI]3.236,95%CI 1.746~5.263),showing a synergistic effect.Conclusion The thera

关 键 词：关节炎 类风湿 针刺疗法 灸法 

分 类 号：R593.22[医药卫生—内科学] R245.31[医药卫生—临床医学] R245.8