独活寄生汤配合温针灸治疗风寒湿痹型膝骨关节炎患者的疗效及对血清疼痛介质、炎症介质、白三烯的影响

Efficacy of Duhuo Jisheng Tang Combined with Warm Acupuncture in Treating Patients with Wind-cold Dampness-type Knee Osteoarthritis and Effect on Serum Pain Mediators,Inflammatory Mediators and Leukotrienes

目的：观察独活寄生汤配合温针灸治疗风寒湿痹型膝骨关节炎（KOA）膝关节疗效及对血清疼痛介质、炎症介质、白三烯（LT）的影响。方法：将94例风寒湿痹型KOA患者随机分为对照组（30例）,独活寄生汤组（34例）及联合组（30例）,对照组给与硫酸氨基葡萄糖胶囊0.5 g/次,3次/d口服;独活寄生汤组给予独活寄生汤150 m L,2次/d口服;联合组在独活寄生汤组治疗基础上给予温针灸治疗,疗程均为4周;观察入组患者治疗前后膝关节视觉模拟评分（VAS）,自制膝关节肿胀评分及总有效率变化;酶联免疫吸附法（ELISA）检测各组患者血清中疼痛介质[前列腺素E2（PGE2）,P物质（SP）,多巴胺（DA）,五羟色胺（5-HT）],炎症介质[肿瘤坏死因子-α（TNF-α）,白细胞介素-1β（IL-1β）]及白三烯B4,白三烯C4,白三烯D4（LTB4,LTC4,LTD4）的表达。结果：治疗后联合组VAS,膝关节肿胀评分及对KOA疼痛疗效明显高于对照组和独活寄生汤组（P〈0.05）;与对照组治疗后相比,独活寄生汤组及联合组患者血清PGE2,SP,DA,5-HT,TNF-α,IL-1β,LTB4,LTC4,LTD4含量降低（P〈0.05）,与独活寄生汤组治疗后相比,联合组患者血清PGE2,SP,DA,5-HT,TNF-α,IL-1β,LTB4,LTC4,LTD4含量降低趋势更加明显（P〈0.05）。结论：独活寄生汤配合温针灸可有效治疗风寒湿痹型KOA患者膝关节肿痛,其机制可能与降低LTB4,LTC4,LTD4及炎症介质含量有关。

Objective： To observe the efficacy of Duhuo Jisheng Tang combined with warm acupuncture in treating patients with wind-cold dampness-type knee osteoarthritis（ KOA） and explore its effect on serum pain mediators,inflammatory mediators and leukotrienes. Method： The 94 patients with wind-cold dampness-type KOA were randomly divided into control group（ 30 cases）,Duhuo Jisheng Tang group（ 34 cases）,and the combined group（ 30 cases）. The control group was given with glucosamine sulfate capsules 0. 5 g/time,tid by oral administration. The patients in Duhuo Jisheng Tang group received Duhuo Jisheng Tang 150 m L/times,bid by oral administration. And the combined group additionally received warm acupuncture on the basis of Duhuo Jisheng Tang. The course of treatment was 4 weeks in all groups. The knee joint visual analogue scale（ VAS）,self-made knee joint swelling score and total effective rate were observed both before and after treatment; enzyme-linked immunosorbent assay（ ELISA） was used to detect the serum pain mediators [prostaglandin E2（ PGE2）,substance P（ SP）,dopamine（ DA）,5-hydroxytryptamine（ 5-HT） ],inflammatory mediators [tumor necrosis factor-α（ TNF-α）,interleukin-1β（ IL-1β） ] and leukotrienes [leukotriene（ LT） B4,LTC4,LTD4] in all groups.Result： After treatment,the VAS scores,knee swelling scores and the efficacy for pain in combined group were significantly higher than those in control group and Duhuo Jisheng Tang group（ P〈0. 05）. As compared with control group,the levels of serum PGE2,SP,DA,5-HT,TNF-α,IL-1β and allogeneic leukotrienes we lower in the Duhuo Jisheng Tang group and combined group（ P〈0. 05）. The decreases in levels of serum PGE2,SP,DA,5-HT,TNF-α,IL-1β,LTB4,LTC4 and LTD4 in combined group were more obvious than those in Duhuo Jisheng Tang group after treatment（ P〈0. 05）. Conclusion： Warm acupuncture combined with Duhuo Jisheng Tang could effectively treat the knee joint pain for wind-cold dampness-type KOA,and the mechanism may be related to the reduction of LTB4,LTC4,LTD4 and inflammatory mediators.