电针对肝肾阴虚型类风湿关节炎患者关节功能的影响

Effects of Electroacupuncture on Joint Function in Rheumatoid Arthritis Patients of Liver-and Kidney-Yin Deficiency Type

目的:比较电针加西药与单纯西药治疗对肝肾阴虚型类风湿关节炎患者证候改善、局部关节功能影响的差异。方法:68例肝肾阴虚型类风湿关节炎患者随机分为电针加西药组及西药组,每组各34例。两组患者均口服甲氨蝶呤及来氟米特,电针加西药组电针双侧肝俞、肾俞、悬钟、足三里、太冲、合谷,共治疗12周。治疗前后进行休息痛、关节肿胀数、压痛数评价,患者和医生对疾病活动性进行整体评价,进行健康评估量表、中医证候评分、28个关节活动指数(DAS 28)、ACR 20达到的人数比较,治疗前后对患者红细胞沉降率(ESR)、血清C反应蛋白(CRP)进行检测。结果:电针加西药组与西药组在治疗后休息痛、关节肿胀数、压痛数、血清CRP含量、患者和医生对疾病活动性的整体评价及健康评估问卷、DAS 28方面与治疗前比较,均明显改善(P<0.05,P<0.01),西药组ESR较治疗前明显下降(P<0.05),电针加西药组中医证候评分较治疗前下降(P<0.05)。治疗后,电针加西药组在休息痛、关节肿胀数和压痛数、中医证候评分、健康评估问卷方面优于西药组(P<0.05)。中医临床疗效比较,电针加西药组总有效率为90.90%(30/33),优于西药组的66.67%(22/33,P<0.05)。结论:电针对肝肾阴虚型类风湿关节炎患者在改善整体肝肾阴虚证候及局部关节功能方面效果显著,电针配合西药治疗能减少药物不良反应。

Objective To compare the effects between electroacupuncture（EA）plus western medicine and simple western medicine in improving clinical symptoms and local joint function of rheumatoid arthritis（RA）patients with yin deficiency of Liver and Kidney.Methods A total of 68 RA patients of yin deficiency of Liver and Kidney were equally randomized into EA＋medication group and medication group（n=34in each group）.Both groups were given once-a-week methotrexate（7.5mg/time）and once-a-day leflunomide（10mg/time）,while EA＋medication group was additionally treated by EA at bilateral Ganshu（BL 18）,Shenshu（BL 23）,Xuanzhong（GB 39）,Zusanli（ST 36）,Taichong（LR 3）,Hegu（LI 4）3times/week.The treatment lasted for 12 weeks.The visual analogue scale（VAS,for assessing rest pain）,swollen joint count（SJC）,tender joint count（TJC）,patient＇s global assessment（PGA）,physician＇s global assessment（PhGA）,traditional Chinese medicine（TCM）symptom scoring,28 joints activity index（disease activity score,DAS 28）,American College of Rheumatology 20（ACR 20,i.e.20% of clinical improving rate）,and health assessment questionnaire（HAQ）were assessed and erythrocyte sedimentation rate（ESR）,serum C-reactive protein（CRP）levels were examined for comparison.Results Statistical differences were observed in before-after-treatment comparisons in both groups in reducing rest pain,SJC,TJC,serum CRP content,PGA and PhGA,HAQ scoring and DAS 28（P0.05,P0.01）.The ESR in the medication group and TCM symptom scoring of the EA＋medication group were also significantly decreased after the treatment（P0.05）.The effects of the EA＋medication group were superior to those of the medication group in reducing rest pain,SJC,TJC,TCM symptom and HAQ score,and the total effetive rate（P0.05,90.9% vs 66.67%）.Adverse reactions as pharyngeal obstruction sensation,anorexia,abdominal distension,etc.can be reduced by EA therapy coordinated with western medicine.Conclusion EA is effective in relieving symptom and joint function in RA patients with yin deficiency of Liver and Kidney.