针刺配合西药治疗类风湿关节炎及对患者血瘀状态的影响

Acupuncture combined with western medicine on rheumatoid arthritis and effects on blood stasis

目的:观察针刺配合西药治疗类风湿关节炎(rheumatoid arthritis,RA)患者的临床疗效以及对血瘀状态的影响,探讨治疗本病提高临床疗效的方法。方法:将56例RA患者随机分为观察组和对照组,每组28例。对照组予以:(1)布洛芬缓释片每天2次,每次0.3 g;(2)甲氨蝶呤片(MTX)每周服用1次,每次10 mg;(3)叶酸片每周服用1次,每次5 mg,30 d为一疗程,共服用3个疗程。观察组在对照组药物治疗基础上采用针刺疗法,取肝俞、脾俞、肾俞、合谷、曲池、足三里穴为主穴加局部阿是穴,每日治疗1次,每周连续治疗6 d,休息1 d,30 d为一疗程,共治疗3个疗程。评定两组患者治疗前后血清学指标类风湿因子(RF)、超敏C反应蛋白(hs-CRP)、血沉(ESR)、血小板(PLT)、纤维蛋白原(FBG)、D-二聚体(D-D)的变化,及疾病活动评分(DAS-28)、症状分级量化评分、血瘀证症状(关节刺痛、舌质、唇色、脉象、皮下瘀斑、肌肤甲错)评分的变化。结果:(1)与治疗前比较,两组患者治疗后RF、hs-CRP、ESR、PLT、D-D、FBG、DAS-28及症状分级量化评分明显改善(均P<0.05);观察组hs-CRP、ESR、DAS-28及症状分级量化评分较对照组改善更为明显(均P<0.05)。(2)两组患者治疗后关节刺痛、唇色、舌质、脉象、皮下瘀斑、肌肤甲错及血瘀证总积分均降低(均P<0.05),观察组在关节刺痛、舌质、唇色及皮下瘀斑方面较对照组改善明显(均P<0.05)。(3)观察组总有效率为85.7%(24/28),优于对照组的75.0%(21/28,P<0.05)。结论:针刺配合西药治疗不仅能够提高RA患者临床疗效而且能够改善RA患者的血瘀状态。

Objective To observe the clinical efficacy of acupuncture combined with western medicine in the treatment of rheumatoid arthritis（RA） and its effect on blood stasis, and to explore ways to improve the clinical curative effect. Methods A total of 56 patients of RA were randomly divided into an observation group and a control group, 28 cases in each one.（1） ibuprofen sustained-release tablets, 2 times a day, each time 0.3 g;（2） methotrexate tablets（MTX）, once a week, each time 10 mg（3） folic acid tablets, once a week, each time 5 mg were given in the control group, 30 days as one course, a total of 3 courses were required. In the observation group, acupuncture was adopted on the basis of the treatment as the control group. The main acupoints were Ganshu（BL 18）, Pishu（BL 20）, Shenshu（BL 23）, Hegu（LI 4）, Quchi（LI 11）, Zusanli（ST 36）combined with local ashi points. The treatment was given once every day for continuous 6 days a week, the treatment for 30 days as one course, a total of 3 courses were required. The serological indexs were evaluated before and after treatment, including the rheumatoid factor（RF）, hypersensitive C-reactive protein（hs-CRP）, erythrocyte sedirnentation rate（ESR）, platelet（PLT）, fibrinogen（FBG） and D-dimer（D-D）, the changes of disease activity score（DAS-28）, symptom grade quantitative score, blood stasis syndrome symptom（the joint tingling, lip color, tongue, pulse, subcutaneous ecchymosis, squamous and dry skin） score were observed. Results（1） The scores of RF, hs-CRP, ESR, PLT, D-D, FBG, DAS-28 and symptom grade quantitative were significantly improved in the two groups compared with those before treatment（all P〈0.05）, and the scores of hs-CRP, ESR, DAS-28 and symptom grading in the observation group were more better than those in the control group（all P〈0.05）.（2） The total score of joint tingling, lip color, tongue, pulse, subcutaneous ecchymosis, squamous and dry skin and blood stasis syndrome in both groups were decreased after treatment（all P〈0.05）, the joint tingling, tongue, lip color and subcutaneous ecchymosis were improved obviously in the observation group than those in the control group（all P〈0.05）.（3） The total effective rate in the observation group was 85.7%（24/28）, which was better than 75.0%（21/28） in the control group（P〈0.05）. Conclusion Acupuncture combined with western medicine can not only improve the clinical efficacy of RA patients but also improve the blood stasis.