热敏灸治疗膝骨关节炎患者60例临床观察  

Clinical Observation on 60 Cases of Knee Osteoarthritis Treated with Heat-Sensitive Moxibustion

作　　者：田鹿 谢洪武 刘梅花[3] 张晶[1] 徐绍忠 李长君 寇志雄 TIAN Lu;XIE Hongwu;LIU Meihua;ZHANG Jing;XU Shaozhong;LI Changjun;KOU Zhixiong(Jiangxi University of Traditional Chinese Medicine,Nanchang,330004;The Second Affiliated Hospital of Nanchang University,Nanchang;The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine;Sanya Hospital of Traditional Chinese Medicine,HainanProvince)

机构地区：[1]江西中医药大学,江西省南昌市330004 [2]南昌大学第二附属医院 [3]江西中医药大学附属医院 [4]海南省三亚市中医院

出　　处：《中医杂志》2025年第5期492-500,共9页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(82360993);南昌大学第二附属医院科研项目(B3563)。

摘　　要：目的探讨热敏灸治疗膝骨关节炎镇痛的中枢神经调控机制。方法将探查到的热敏灸不得气者30例组成不得气组,同时纳入热敏灸得气者30例组成得气组。两组患者均在左侧鹤顶穴施灸,得气组患者出现腧穴得气感后,在距皮肤3 cm左右处定灸10 min;不得气组患者在距皮肤3 cm左右处定灸10 min,两组均每天1次,持续10天。治疗前后运用视觉模拟疼痛量表(VAS)评分评价膝关节疼痛情况。分别于第1天施灸前和第10天施灸后对受试者进行rs-fMRI扫描。采用Matlab软件SPM 12模块对两组患者治疗前后的fALFF图进行处理。结果治疗后得气组与不得气组患者VAS评分均显著低于治疗前(P<0.05或P<0.01),且得气组VAS评分低于不得气组(P<0.01)。与治疗前比较,得气组治疗后患者显著激活的脑区有前额叶(t=6.28)、白质(t=6.36)、左侧颞叶(t=9.33),显著抑制的脑区有枕叶(t=-9.86)和右侧大脑(t=-4.54,P<0.01);不得气组患者治疗后存在显著改变的脑区有左侧枕叶(t=-6.42)、左侧额内侧回(t=-4.35)、左侧额中回(t=-4.74)、右侧额上回(t=-4.82)、右侧颞上回(t=-6.61)及右侧小脑后叶(t=-8.64),并且均处于抑制状态(P<0.01)。与不得气组相比,得气组治疗后显著激活的脑区有外核(t=5.77)、白质(t=3.58)、右侧大脑(t=5.84)、左侧小脑(t=5.35)、左侧大脑(t=4.32),显著抑制的脑区有前额叶(t=-4.16)、枕叶(t=-4.87)、中央前回(t=-4.46,P<0.01)。结论热敏灸治疗膝骨关节炎得气状态下镇痛效果更好,其中枢神经调控机制可能与膝骨关节炎患者额叶、颞叶、枕叶、外核、白质、右侧大脑、左侧小脑、左侧大脑和中央前回参与对疼痛信号的调节有关。Objective To explore the central neuroregulation mechanism of heat-sensitive moxibustion for knee osteoarthritis on pain relief.Methods Thirty patients who did not have experience of Deqi(得气)during heat-sensitive moxibustion treatment were assigned to the"non-Deqi group",while another 30 patients who had experience of Deqi were assigned to the"Deqi group".Both groups received moxibustion at the left Heding(EX-LE2)acupoint.In the Deqi group,after the patients experienced sensation of Deqi at the acupoint,moxibustion was applied at approximately 3 cm from the skin for 10 minutes;in the non-Deqi group,moxibustion was also applied at approximately 3 cm from the skin for 10 minutes.Both groups received treatment once daily for 10 consecutive days.Knee joint pain was assessed before and after treatment using the visual analog scale(VAS).Resting-state functional magnetic resonance imaging(rs-fMRI)scans were performed on all participants before the first treatment session and after the final session on the 10th day.The fractional amplitude of low-frequency fluctuations(fALFF)maps before and after treatment were processed using the SPM12 module by MATLAB.Results After treatment,VAS scores in both groups were significantly lower than before treatment(P<0.05 or P<0.01),with the Deqi group showing significantly lower VAS scores than the non-Deqi group(P<0.01).Compared to before treatment,the Deqi group exhibited significant activation in the prefrontal cortex(t=6.28),white matter(t=6.36),and left temporal lobe(t=9.33),while significant inhibition was observed in the occipital lobe(t=-9.86)and right cerebrum(t=-4.54,P<0.01);in the non-Deqi group,significant changes after treatment were observed in the left occipital lobe(t=-6.42),left medial frontal gyrus(t=-4.35),left middle frontal gyrus(t=-4.74),right superior frontal gyrus(t=-4.82),right superior temporal gyrus(t=-6.61),and right cerebellar posterior lobe(t=-8.64),all of which were in inhibited states(P<0.01).Compared to the non-Deqi group,the Deqi group exhibited sig

关 键 词：膝骨关节炎 热敏灸 得气 功能性磁共振 神经调控 

分 类 号：R24[医药卫生—中医临床基础]