消瘀散贴膏联合针刀治疗膝骨关节炎的疗效及对炎症因子的影响

Clinical Effect of Xiaoyusan Plaster Combined with Acupotomy on Knee Osteoarthritis and Its Effect on Inflammatory Factors

目的观察消瘀散贴膏外敷联合针刀治疗膝骨关节炎(KOA)的临床疗效及对炎症因子的影响,规范消瘀散贴膏外敷联合针刀治疗KOA的临床诊疗方案。方法采用临床随机对照试验的方法,纳入KOA患者150例,按照随机数表法分为A组(针刀联合消瘀散贴膏外敷组)、B组(消瘀散贴膏外敷组)、C组(扶他林组),按照1∶1∶1比例安排例数,每组患者50例。1周为1个疗程,连续治疗2个疗程,治疗前后分别采用WOMAC量表、VAS量表进行相应评价。采用ELISA法测定炎症因子IL-1β、TNF-α、IGF-1的变化。同时监测患者的不良反应。结论最终共129例患者完成试验,统计结果表明:(1)治疗后,3组患者的WOMAC评分均下降(P<0.05),且A组的评分比B、C组均低(P<0.05);(2)治疗后,3组患者的VAS评分均下降(P<0.05),且A组的评分比B、C组均低(P<0.05);(3)3组治疗后的IL-1β、TNF-α表达水平均下降(P<0.05),且A组的IL-1β比B组更低(P<0.05);3组治疗后的IGF-1表达水平上升,A组上升更加明显,但差异均无统计学意义(P>0.05);(4)3组患者均无明显不良事件发生,A组出现3例皮肤过敏不适;B组出现2例皮肤过敏不适;C组出现3例皮肤过敏不适,3组间不良反应发生比较无差异(P>0.05)。结论消瘀散贴膏外敷联合针刀治疗膝骨关节炎临床疗效显著,且安全性高,值得在临床上推广应用。

Objective To observe the clinical efficacy of acupotomy combined with XiaoyusanPlaster on the treatment of knee osteoarthritis(KOA)and its effect on inflammatory factors,and standardize the clinical diagnosis and treatment program of acupotomy combined with XiaoyusanPlaster on the treatment of KOA.Methods A total of 150 KOA patients were enrolled in a randomized controlled clinical trial.They were randomly divided into group A(XiaoyusanPlaster combined with acupotomy group),group B(XiaoyusanPlaster group)and group C(Votalin group).The number of cases was arranged according to the ratio of 1:1:1,50 cases in each group.One week was a course of treatment,and there were two courses of treatmentcontinuously.Before and aftertreatment,WOMAC scale and VAS scale were used to evaluate the changes.The changes of inflammatory factors IL-1 beta,TNF-alpha and IGF-1 were measured by ELISA.At the same time,adverse reactions of patients were monitored.Results A total of 129 patients completed the trial.(1)After treatment,the WOMAC scores of the three groups decreased(P<0.05),and the scores of group A were lower than those of group B and C(P<0.05).(2)After treatment,the VAS scores of the three groups decreased(P<0.05),and the scores of group A were lower than those of group B and C(P<0.05).(3)After treatment,the expression levels of IL-1 beta and TNF-alpha decreased in all three groups(P<0.05),and the level of IL-1 beta in group A was lower than that in group B(P<0.05).The expression level of IGF-1 increased after treatment in three groups,and increased more significantly in group A,but the difference was not statistically significant(P>0.05).(4)There were no obvious adverse events in the three groups.There were 3 cases of skin allergy in group A,2 cases of skin allergy in group B and 3 cases of skin allergy in group C.There was no difference in adverse reactions among the three groups(P>0.05).Conclusion XiaoyusanPlaster combined with acupotomy is effective and safe on the treatment of knee osteoarthritis,which is worthy of clinical application.