穴位埋线联合西药对活动期类风湿关节炎患者的临床观察

The effect of acupoint catgut embedding therapy combine western medicine on active rheumatoid arthritis

目的观察穴位埋线联合西药对活动期类风湿关节炎患者的临床疗效及对血沉、C-反应蛋白、类风湿因子及抗-CCP抗体的影响。方法将100例类风湿关节炎(RA)患者随机分为治疗组和对照组,每组患者各50例。两组患者均予以甲氨蝶呤片15mg/w、醋酸泼尼松片5mg/d,两组患者共服药8w,治疗组在此基础上,予以穴位埋线治疗。观察并比较两组患者治疗前后关节疼痛个数和肿胀数、患者晨僵时间、中医症状积分、血沉、C-反应蛋白、类风湿因子及抗-CCP抗体及类风湿关节炎疾病活动度。结果 (1)治疗1个月时,两组患者临床症状及中医症状积分均较同组治疗前有明显改善(P<0.05)。治疗组患者在中医症状积分和关节疼痛数改善方面优于对照组(P<0.05),但关节肿胀数及晨僵时间两组差异无统计学意义(P>0.05),两组临床症状改善相当。在治疗2个月时,两组患者临床症状及中医症状积分均较同组治疗1个月时改善明显(P<0.05)。治疗组患者在关节肿胀数、中医症状积分及关节疼痛数等方面均优于对照组(P<0.05),治疗组与对照组患者在晨僵时间改善方面,差异无统计学意义(P>0.05);(2)两组患者在治疗2个月时,各实验室指标均较同组治疗前有明显改善(P<0.05)。治疗组与对照组组间比较发现,两组患者血沉(ESR)、类风湿因子(RF)及C-反应蛋白(C-CRP)差异无统计学意义(P>0.05),但两组患者抗CCP抗体水平差异具有统计学意义(P<0.05),治疗组改善优于对照组;(3)治疗结束时,治疗组有40例患者RA疾病活动度处于缓解期,对照组有34例,治疗组患者临床疾病活动度缓解率优于对照组(P<0.05)。结论穴位埋线联合西药治疗相比单纯西药治疗RA,能够较快地控制患者的疾病活动,缓解患者病变关节疼痛和肿胀,降低血清抗CCP抗体含量,改善患者生活质量。今后应加强对于本病的远期临床观察,更加规范临床研究设计,以期为临床治疗本病提供更多选择。

Objective To investigate the effect of acupoint catgut embedding therapy in combination with western medication on active rheumatoid arthritis （RA） and the influence on the blood sedimentation, C- reactive protein, rheumatoid factor and anti-CCP antibody. Methods 100 cases were enrolled in June 2014 -February 2016 from the department of Traditional Chinese Internal Medicine in Chinese Traditional Medical Hospital of Zhang Jiakou City. 100 patients were randomly divided into treatment group and con-trol group, with each group 50 patients. Two groups of patients were continuously administrated with methotrexate tablets 15 mg/week, prednisone acetate tablets 5 mg/day for 8 weeks, based on which, the experimental group was subjected to acupuncture point of treatment. Observed and compared was the number and swelling of joint pain, the patients with morning stiffness time, TCM syndrome, ESR, C-re-active protein, rheumatoid factor and anti-CCP antibody and rheumatoid arthritis disease activity before and after treatment. Results （1） at the time of treatment for 1 month, there was significant difference be-tween the two groups of patients in terms of clinical symptoms and symptoms of traditional Chinese medi-cine compared with the same group before treatment （P 〈0.05）. However, no significant difference be-tween the two groups was observed （P 〉0.05）. （2） At the time of treatment for 2 months, there was sig-nificant difference between the two groups of patients in terms of clinical symptoms and symptoms of tra-ditional Chinese medicine （P 〈0.05）. No significant difference was observed between the treatment group and the control group in the case of ESR, RF and CRP between the two groups （P 〉0.05）. However, there was significant difference of the anti-CCP antibody between the two groups （P 〈0.05）. （3） At the end of the treatment, 40 patients with RA disease activity were in the remission period in therapy group whereas 34 cases in the control group were in the remission period, in terms of remission rate of clinical ac-tivity the treatment group was significantly superior to the control group （P 〈0.05）. Conclusion Com-pared with the single western medication of RA, acupoint catgut embedding combined with western medi-cation was shown to be able to quickly control the patients disease activity, relieving pain and swelling of patients with joint pain, reducing serum anti-CCP antibody content, improving patient quality of life. In the future, Long-term clinical observation is needed to the disease, more standardized clinical research de-sign will be warranted, providing alternatives to the clinical treatment of the disease.