痹痛膏灸治疗寒湿痹阻型类风湿膝关节炎的疗效及对免疫炎症失衡和血液流变学的影响

Therapeutic effect of moxibustion with Bitonggao on phlegm and moxibustion moxibustion on knee rheumatoid arthritis of syndrome cold-dampness stagnation and its influence on immune inflammatory imbalance and hemorheology

目的观察痹痛膏灸治疗寒湿痹阻型类风湿膝关节炎的疗效及对免疫炎症失衡和血液流变学的影响。方法将120例寒湿痹阻型类风湿膝关节炎患者随机分为观察组和对照组,每组60例。对照组给予常规西医治疗,观察组在对照组治疗的基础上加用痹痛膏灸治疗,2组疗程均为8周。统计2组临床疗效,并记录2组中医症状积分、西医症状体征和实验室检查指标、膝关节功能、Th17/treg细胞因子和血液流变学指标的变化。结果观察组临床疗效显著优于对照组(P<0.05);2组治疗后中医症状(关节冷痛、关节肿胀、关节屈伸不利、关节晨僵、关节酸软乏力、头晕耳鸣、恶风寒)单项积分和总积分均显著降低(P均<0.05),观察组治疗后以上积分均显著低于对照组(P均<0.05);2组治疗后疼痛VAS评分、晨僵时间、膝关节周径、血清类风湿因子(RF)、血清抗环状瓜氨酸抗体(CCP)和红细胞沉降率(ESR)均显著降低(P均<0.05),观察组治疗后以上指标均显著低于对照组(P均<0.05);2组治疗后Lysholm膝关节评分分级情况、评分均显著改善(P均<0.05),观察组改善情况显著优于对照组(P均<0.05);2组治疗后血清干扰素-γ(IFN-γ)、白细胞介素-17(IL-17)和IL-6水平均显著降低(P均<0.05),转化生长因子-β(TGF-β)、IL-4和IL-10水平显著升高(P均<0.05),观察组治疗后以上指标改善情况均显著优于对照组(P均<0.05);2组治疗后全血黏度高切、中切、低切,血浆黏度,红细胞聚集指数和D-二聚体均显著降低(P均<0.05),观察组治疗后以上指标显著低于对照组(P均<0.05)。2组不良反应发生率比较差异无统计学意义(P>0.05)。结论痹痛膏灸治疗寒湿痹阻型类风湿膝关节炎的疗效确切,可显著缓解患者膝关节疼痛,促进膝关节炎症水肿消散,改善膝关节功能,且安全性好,其机制可能与促进机体免疫炎症细胞因子平衡,降低血液黏稠度和高凝状态有关。

Objective It is to observe the curative effect of moxibustion with Bitonggao on phlegm and moxibustion moxibustion on knee rheumatoid arthritis of syndrome cold-dampness stagnation and its influence on immune inflammatory imbalance and hemorheology. Methods 120 patients with knee rheumatoid arthritis of syndrome cold-dampness stagnation were randomly divided into observation group and control group, 60 cases in each group. The control group was treated with conventional western medicine, and the observation group was treated with moxibustion with Bitonggao on the basis of the control group. Both groups were treated for 8 weeks. The clinical efficacy of the two groups was assessed, and the changes of TCM symptom scores, western medicine symptoms and signs, laboratory tests, knee function, Th17/treg cytokines and hemorheology indexes were observed before and after treatment. Results The clinical efficacy of the observation group was significantly better than that of the control group(P<0.05). The symptoms of TCM after treatment(cold joint pain, joint swelling, joint inhibited flexion and extension, joint stiffness, joint fatigue, dizziness, tinnitus, intolerance of cold and wind) and total scores were significantly decreased after treatment in both groups, and the scores above in the observation group were more lower(P<0.05). The pain VAS score, morning stiffness time, knee circumference, serum rheumatoid factor(RF), anti-cyclic citrulline antibody(CCP) and erythrocyte sedimentation rate(ESR) were significantly decreased in the two groups, the above indicators were lower in the observation group than those in the control group(P<0.05);Lysholm knee score and the average score were significantly improved after treatment in the two groups, the improvements of the observation group were better than that of the control group(P<0.05). The levels of serum interferon-γ(IFN-γ), interleukin-17(IL-17) and IL-6 after treatment were significantly decreased, and the levels of transforming growth factor-β(TGF-β), IL-4 and IL-10 were significantly increased in the two groups, the improvements in the observation group were better than the control group(P<0.05);the blood viscosity of high cut, low cut, plasma viscosity, erythrocyte aggregation index and D-dimer were significantly decreased in the two groups, the above indicators were more lower in the observation group(P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion The clinical efficacy of moxibustion with Bitonggao is obvious in the treatment of knee rheumatoid arthritis,it can significantly alleviate knee pain, promote inflammation and edema of knee joint, improve knee function, and have good safety. The mechanism may be related to promoting the balance of immune inflammatory cytokines and reducing blood viscosity and hypercoagulability.