摘要
目的:观察中药熏蒸疗法治疗关节炎的临床疗效,并对该疗法的抗炎作用做初步探讨。方法:动物实验于2004-03/04在广州军区总医院动物实验中心完成,选择40只大鼠随机分为5组,每组8只,正常组、模型组、蒸馏水熏蒸组(水熏组)、高浓度熏蒸组(高熏组)、低浓度熏蒸组(低熏组)。复制佐剂性关节炎大鼠模型。造模后开始进行分组实验处理,正常组和模型组常规喂养,不做熏蒸处理;水熏组予(39±1)℃蒸馏水熏蒸;高浓度熏蒸组予(39±1)℃6.67%中药液熏蒸;低浓度熏蒸组予(39±1)℃3.33%中药液熏蒸,连续10d,观察熏蒸治疗对佐剂性关节炎大鼠关节肿胀、关节病理及炎症介质的影响。临床观察以随机开放性原则,采用治疗前后自身对照的方法,选择2002-11/2003-11住院的关节炎患者30例为观察对象,用自拟熏蒸方药(羌活20g,独活20g,防风15g,桂枝15g,细辛10g,川芎20g,海风藤30g,徐长卿30g,姜黄20g,苏木20g,冰片1g)熏蒸治疗,每次20min,1次/d,10次为1个疗程。1个疗程后分析治疗前后患者临床症状及急性炎性指标、炎症介质的变化。结果:纳入大鼠40只,致炎后3d低熏组有1只大鼠死亡,模型组有2只大鼠造模不成功,故未纳入观察分析,实际进入结果分析数为37只。纳入关节炎患者共30例,16例类风湿性关节炎患者因有2例治疗后血液标本处理失败,致治疗后例数为14例。①实验研究结果:熏蒸治疗能显著改善佐剂性关节炎大鼠关节肿胀状况,减轻病变关节局部炎性病理改变,显著降低佐剂性关节炎大鼠血液中前列腺素E2和一氧化氮水平。蒸馏水熏蒸也可改善佐剂性关节炎大鼠足肿状况,降低血液中炎性介质水平,但起效较慢。②临床研究结果:总有效率达90%,显效率为30%;患者的疼痛指数、压痛指数、肿胀指数、关节功能指数、活动障碍指数、整体功能指数、疼痛关节数和晨僵时间均比治疗前降低;治疗后各项急性炎症指标及炎症因子水平均明显下降(P<0.01):血沉由(79±43)mm/h降至(47±38)mm/h,C反应蛋白由(71±72)mg/L降至(26±38)mg/L,血小板由(341±111)×109L-1降至(309±111)×109L-1;白细胞介素1β由(5.82±0.94)μg/L降至(4.19±0.63)μg/L,一氧化氮由(101.52±52.06)μmol/L降至(62.12±30.21)μmol/L。结论:中药熏蒸疗法有抗炎消肿作用,其机制可能与降低血液中多种炎症介质的水平有关,同时蒸气的温热作用也是熏蒸疗法抗炎消肿的重要因素之一。
AIM: To observe the clinical effects of traditional Chinese medicine fumigation and steaming therapy in the treatment of arthritis, and to explore primarily the anti-inflammation mechanism. METHODS: The animal experiment was performed at the center of animal experiment, General Hospital of Guangzhou Military Area Cormnand, from March to April 2004. Forty rats were selected and divided into 5 groups by random with 8 rats in each group: normal group, model group, distilled water fumigation group (water fumigation group), high dose of fumigation and steaming therapy group (high fumigation group), low dose of fumigation and steaming therapy group (low fumigation group). The rat models with adjuvant arthritis were reproduced. The rats were divided into groups and disposed after building the models. Those in the normal group and model group were feted routinely without fumigation and steaming therapy. Those in the water fumigation group were treated with (39±1)℃ distilled water and fumigation. Those in the high fumigation group were given (39±1)℃ 6.67% herh liquor and fumigation. Those in the low fumigation group were offered (39±1)℃ 3.33% herh liquor and fumigation for 10 days. The effects of fumigation and steaming therapy on the swelling and pathology of joint, and inflammatory mediator in rats with adjuvant arthritis were observed. According to the randomized patent principlC 30 inpatients with 'arthritis were selected from November 2002 to November 2003 ms observation objects with the self controlled method before and after treatment. The fumigation and steaming therapy was conducted with the self-made fumigationand steaming prescription (20 g forbes notopterygium rhizomer of root, 20 g angelica root, 15 g divaricate saposhnikovia root, 15 g cassia twig, 10 g asarum, 20 g Szechwan lovge rhizome, 30 g kadsura pepper stem, 30 g paniculate swallowwort root, 20 g tumeric, 20 g sappan wood, 1 g borneo camphor), 20 minutes every time, once a day, 10 times as a course. After a course the changes of the clinical symptom, acute inflammation index and inflammatory mediators before and after the treatment were analyzed. RESULTS: Forty rats were included. One rat died at the 3^ad day induced by inflammation in the low fumigation group, and the huilding of models of two rats in the model group was failure, thus, the three rats were excluded, and the actual included number in the result analysis was 37. Thirty arthritics and 14 cases with atrophic arthritis, because of 2 patients whose disposal of blood preparation failed of the 16 patients, were involved. ① Result of experimental research: The fumigation and steaming therapy could ameliorate significantly the swelling of joints, relieve the pathological changes in the joints and degrade the level of prostaglandin E2 and nitrogen monoxide in rats with adjuvant arthritis. The distilled water fumigation also could improve the foot swelling, decrease the level of inflammatory mediator in blood in the rats with adjuvant arthritis, but the acting effect was slow. ② Result of clinical research: The total effective rate was 90%, the significant effective rate was 30%. The ache index, tenderness index, swelling index, joint function index, activity obstacle index, allomeric function index, number of ached joint and time of morningstiffness decreased compared to those before treatment. The acute inflammation index of every item and the level of inflammatory factors after treatment decreased significantly (P 〈 0.01 ): The erythrocyte reduced from (79±43) mm per hour to (47±38) mm per hour; The C-reactive protein decreased from (71±72) mg/L to (26±38) rag/L; The blood platelet reduced from (341±111)×10^9L^-1to (309±111)×10^9L^-1; The interleukin 1β lessened from (5.82±0.94)μg/L to (4.19±0.63) μg/L; The nitrogen monoxide diminished from (lO1.52±52.06)μmol/L to (62.12±30.21) μmol/L. CONCLUSION: The traditional Chinese medicine fumigation and steaming therapy has the effects of anti-inflammmation and lightening swelling, and its mechanism may have relation with reducing the level of various inflammatory mediators. Meanwhile, the lukewarm effect of vapor is also one of the important factors on anti-inflammation and dissipating swelling of fumigation and steaming therapy.
出处
《中国临床康复》
CSCD
北大核心
2005年第34期116-118,共3页
Chinese Journal of Clinical Rehabilitation
基金
广东省中医药管理局项目(103152)~~