从膝骨性关节炎相关穴位压痛阈规律探讨从脾肾论治策略

To Explore the Strategy of Treating Knee Osteoarthritis from Spleen and Kidney Based on the Pain-Threshold Regularities of KOA-Related Pain Acupoints

目的经络"内连脏腑,外络枝节",因此,脏腑疾病在体表会以不同形式表现其病理变化,其表现形式有温度变化、压痛阈变化、形态学变化等。压痛阈值变化为常见的变化之一。本研究以经络辨证为指导,分析膝骨性关节炎(Knee Osteoarthritie,KOA)相关穴位压痛阈规律,探讨从脾肾论治膝骨关节炎策略。方法运用《膝骨性关节炎穴位敏化信息提取表》采集KOA受试者的一般病情资料,用美国WAGNER公司生产的电子压痛仪测量足三里、阴陵泉、委阳、阴谷等腧穴的压痛阈值,由四川大学华西公共卫生学院采用Epidata3.1软件,根据病例报告表的项目建立本试验专用的数据库系统进行数据录入,运用SPSS 22.0软件对一般病情资料及压痛阈值进行描述性统计分析。结果(1)老年人群的压痛阈值均高于中年人群。(2)中老年各腧穴压痛阈大小由高到低为:足三里>阴谷>委阳>阴陵泉。(3)中年人群:与肾相关腧穴压痛阈值与脾相关腧穴压痛阈值的差异无统计学意义;老年人群:与肾相关腧穴压痛阈>与脾相关腧穴压痛阈,P<0.05,差异有统计学差异。结论脾和肾在KOA发生发展过程中占主导地位的时间不同。治疗老年人的骨关节病变时应注重从肾论治,而治疗中年人的骨关节疾病则应注重脾肾同调,以从脾诊治为主。此研究结果可能对提高辨证论治膝骨性关节炎的疗效具有指导意义。

Object To explore the strategy of treating knee osteoarthritis(KOA)from spleen and kidney based on the regularities of KOA-related acupoint pain sensitization.Method The data of KOA subjects were collected by Information Extraction Table of Acupoint Sensitization of Knee Osteoarthritis".The threshold of pressure of Zusanli(ST36),Yinlingquan(SP9),Weiyang(BL39)and Yingu(KI10)acupoints was measured by electronic pressure meter produced by WAGNER Company.Epidata 3.1 software was used by Huaxi School of Public Health of Sichuan University to establish data for this experiment according to the items of case report table.The database system was used to input data,and SPSS 22.0 software was used to make descriptive statistical analysis of general data and pain pressure threshold.Results(1)The threshold of pain pressure in the elderly was higher than that in the middle-aged.(2)The threshold of pain pressure of each acupoint in middle-aged and old people ranged from high to low:Zu Sanli(ST36)>Yin Gu(KI10)>Wei Yang(BL39)>Yin Lingquan(SP9).③Middle-aged population:there was no significant difference between pressure pain threthold of kidney-related acupoints and spleen-related acupoints;elderly population:kidney-related acupoint pressure pain threshold>spleen-related acupoint pressure pain threshold(P<0.05),the difference was statistically significant.Conclusion Spleen and kidney play different roles on different age span of KOA.The treatment of osteoarthropathy should focus on the treatment of kidney in the eldly,but on the coherence of spleen and kidney in middle aged population,mainly for diagnosis and treatment of spleen.The results of this study may be of guiding significance for improving the curative effect of dialectical treatment of knee osteoarthritis.