富血小板血浆注射联合温针灸治疗膝骨关节炎寒湿痹阻证的临床研究  

Platelet-rich plasma injection combined with warm acupuncture and moxibustion for treating patients with knee osteoarthritis and cold dampness obstruction syndrome

作　　者：尚祥 王飞[1] 杨琪琪 姜天鑫 张芬 吴三兵 杨永晖 李飞 SHANG Xiang;WANG Fei;YANG Qiqi;JIANG Tianxin;ZHANG Fen;WU Sanbing;YANG Yonghui;LI Fei(Anhui University of Chinese Medicine,Hefei 230012,China;The Second Affiliated Hospital of Anhui University of Chinese Medicine,Hefei 230061,China)

机构地区：[1]安徽中医药大学,合肥230012 [2]安徽中医药大学第二附属医院

出　　处：《北京中医药大学学报》2025年第2期270-279,共10页Journal of Beijing University of Traditional Chinese Medicine

基　　金：安徽省自然科学基金面上项目(No.2308085MH297);安徽省级区域中医康复中心建设项目(皖中医药服务秘[2022]34号);安徽省级临床重点专科建设项目(皖卫传[2022]297号)。

摘　　要：目的 观察富血小板血浆(PRP)注射联合温针灸治疗膝骨关节炎寒湿痹阻证的临床疗效。方法 收集2023年1月—2024年3月于安徽中医药大学第二附属医院康复科和骨伤科就诊的膝骨关节炎寒湿痹阻证患者,纳入符合纳排标准者128例,按照随机数字表法分为试验组(64例)和对照组(64例)。其中试验组予以PRP注射联合温针灸治疗,对照组予以生理盐水注射联合温针灸治疗,PRP及生理盐水注射,每2周1次,共4次;温针灸治疗,1次/d,6次/周,连续4周。分别在治疗前及治疗开始后的第4、8周及第16周随访时观察2组患者西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分、中医证候积分、视觉模拟评分(VAS)、Lysholm评分;比较2组患者治疗前及治疗8周后血清白细胞介素-6(IL-6)、基质金属蛋白酶-3(MMP-3)、肿瘤坏死因子-α(TNF-α)、骨保护素(OPG)、骨钙素(BGP)、软骨寡聚基质蛋白(COMP)水平;比较2组患者临床疗效及安全性指标。结果 2组患者性别、年龄、病程、体质量指数等基线资料比较,差异无统计学意义。与治疗前比较,治疗后2组患者在4、8、16周WOMAC总分及子量表评分、中医证候总积分及各症状分数、VAS评分降低,Lysholm评分升高;治疗后血清IL-6、MMP-3、TNF-α、COMP水平降低,血清OPG、BPG水平升高(均P<0.05)。治疗后,与对照组比较,试验组患者在4、8、16周WOMAC总分及子量表评分、中医证候总积分及各症状分数、VAS评分降低,Lysholm评分升高;治疗后血清IL-6、MMP-3、TNF-α、COMP水平均降低,血清OPG、BPG水平升高(P<0.05)。试验组治疗总有效率为91.94%,高于对照组81.97%(P<0.05)。结论 PRP注射联合温针灸能够改善膝骨关节炎寒湿痹阻证患者的各项中医证候,改善膝关节的功能及骨代谢水平,减轻炎症反应。Objective To determine the clinical efficacy of platelet-rich plasma(PRP) injection combined with warm acupuncture and moxibustion for treating patients with knee osteoarthritis and cold dampness obstruction syndrome.Methods One hundred and twenty-eight patients with knee osteoarthritis and cold dampness obstruction syndrome who visited the Rehabilitation Department and Orthopedics Department of the Second Affiliated Hospital of Anhui University of Chinese Medicine from January 2023 to March 2024 and who met the inclusion and exclusion criteria were randomly divided into an experimental(n=64) and control group(n=64) using the random number table method.The experimental group was treated with PRP injection combined with warm acupuncture and moxibustion,whereas the control group was treated with normal saline injection combined with warm acupuncture and moxibustion treatment.PRP and normal saline injections were administered once every two weeks,a total of four times.Patients were treated with warm acupuncture and moxibustion once a day,six times a week,for four consecutive weeks.The Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC),Traditional Chinese Medicine(TCM) syndrome,visual analog scale(VAS),and Lysholm scores were determined before treatment,at week 4 and week 8 of treatment,and week 16 of follow-up.Serum interleukin-6(IL-6),matrix metalloproteinase-3(MMP-3),tumor necrosis factor-α(TNF-α),osteoprotegerin(OPG),bone gla protein(BGP),and cartilage oligomeric matrix protein(COMP) levels were compared between the two groups before and after 8 weeks of treatment.The clinical efficacy and safety indicators between the two groups were also compared.Results There was no statistical difference in baseline data such as gender,age,disease duration,and body mass index between the two groups of patients.Compared with before treatment,both groups showed decreased WOMAC total and subscale,TCM syndrome total score and symptom scores,and VAS scores,and an increase in Lysholm scores at 4,8,and 16 weeks

关 键 词：膝骨关节炎 富血小板血浆 西安大略和麦克马斯特大学骨关节炎指数评分 炎症因子 骨代谢 

分 类 号：R274.9[医药卫生—中西医结合]