骨通贴膏联合温针灸对老年类风湿关节炎患者红细胞沉降率、C-反应蛋白及关节功能的影响

Effects of Gutong paste combined with warm acupuncture on erythrocyte sedimentation rate,C-reactive protein and joint function in elderly patients with rheumatoid arthritis

目的观察骨通贴膏联合温针灸对老年类风湿关节炎(RA)患者红细胞沉降率(ESR)、血清C反应蛋白(CRP)、白细胞介素-1(IL-1)、IL-10水平及关节功能影响。方法将76例老年RA患者随机分为2组。2组均予甲氨蝶呤片、来氟米特片及塞来昔布胶囊口服治疗,对照组38例加温针灸疗法,治疗组38例在对照组治疗基础上加骨通贴膏关节疼痛部位敷贴治疗。2组均10 d为1个疗程,共治疗6个疗程。比较2组治疗前后主要相关症状、体征,ESR,血清CRP、IL-1及IL-10水平变化;统计2组不良反应发生率及临床疗效。结果治疗组总有效率92.11%,对照组73.68%,2组总有效率比较差异有统计学意义(P<0.05),治疗组临床疗效优于对照组。2组治疗后膝关节疼痛视觉模拟评分(VAS)、晨僵时间、关节压痛数、关节压痛指数、关节肿胀数、关节肿胀指数、20 m步行时间、ESR及血清CPR、IL-1水平均较本组治疗前降低或减少(P<0.05),双手平均握力及IL-10水平增加(P<0.05),且2组组间比较差异亦均有统计学意义(P<0.05)。治疗组不良反应发生率为2.63%,对照组5.26%,2组不良反应发生率比较差异无统计学意义(P>0.05)。结论骨通贴膏联合温针灸疗法治疗老年RA临床疗效显著,安全性较高,能够下调ESR、CRP、IL-1水平,上调IL-10,改善关节功能,适宜临床应用推广。

Objective To observe the effects of Gutong paste combined with warm acupuncture on erythrocyte sedimentation rate（ESR）,serum C-reactive protein（CRP）,interleukin1（IL-1）,IL-10 and joint function in elderly patients with rheumatoid arthritis（RA）.Methods 72 elderly patients with RA were randomly divided into two groups.The two groups were given methopterin tablets,leflunomide tablets and celecoxib capsules for oral.The control group（n = 38） was treated by warm acupuncture.The treatment group（n = 38） was treated by Gutong paste which pasted on the joint pain location on the basis of the control group.A treatment course was 10 d that continuously treatment for 6 courses.The major related symptoms and signs,the changes of ESR,CRP,IL-1 and IL-10 before and after treatment were compared in the two groups.The incidence of adverse reactions and clinical efficacy were evaluated in two groups.Results There were statistical differences on the total effective rate between treatment group（92.11%） and control group（73.68%,P〈0.05）,and the clinical efficacy in treatment group was superior to that in control group.The visual analogue scale（VAS）,morning stiffness time,joint tenderness count,joint tenderness index,swollen joint count,swollen joint count index,20 m walking time,and the levels of ESR,CPR and IL-1 after treatment reduced or decreased in two groups（P〈0.05）,and hands average grip strength,IL-10 increased（P〈0.05）,and with statistical differences between two groups（P〈0.05）.There was no statistical difference on the incidence of adverse reactions between the treatment group（2.63%） and the control group（5.26%,P〈0.05）.Conclusion Gutong paste combined with warm acupuncture has significant clinical efficacy on RA in elderly patients,can down-regulate the levels of ESR,CRP and IL-1,up-regulate the IL-10,improve joint function,suitable for clinical application.