针灸推拿结合柳氮磺吡啶肠溶片治疗强直性脊柱炎临床研究

Clinical study of acupuncture and massage combined with sulfasalazine enteric-coated tablets in the treatment of ankylosing spondylitis

目的评价针灸推拿结合柳氮磺吡啶肠溶片治疗强直性脊柱炎(ankylosing spondylitis,AS)的疗效.方法将符合入选标准的88例AS患者采用随机数字表法分为2组,每组44例.对照组口服柳氮磺吡啶肠溶片治疗,观察组在对照组基础上结合针灸推拿治疗.2组均治疗6个月,随访6个月.分别于治疗前后进行中医证候评分,采用双抗体夹心ELISA法检测骨钙素(bone glaprotein,BGP)、红细胞比容(hematocrit,Hct)、ALP、MMP-3、CRP、TNF-α,采用双能X射线DPX-NT型骨密度检测仪检测第1~4腰椎、大转子及全身骨密度,计算骨矿物质含量.选择简明健康调查问卷(Medical Outcomes Study Short-Form 36,SF-36)中生理职能、躯体疼痛、社会功能及精神健康4项进行生活质量评估,评价临床疗效,记录复发率.结果治疗后,观察组BGP[(8.22±0.67)ng/ml比(9.78±0.85)ng/ml,t=9.561]、ALP[(86.57±3.21)U/L比(92.33±3.55)U/L,t=7.983]低于对照组(P<0.01),Hct[(48.22±4.25)ng/ml比(41.47±3.58)ng/ml,t=8.057]高于对照组(P<0.01);第1~4腰椎[(1.26±0.17)g/m2比(1.18±0.15)g/m2,t=2.341]、股骨大转子[(0.92±0.12)g/m2比(0.81±0.11)g/m2,t=4.482]及全身[(1.21±0.09)g/m2比(1.12±0.11)g/m2,t=4.200]骨密度值均高于对照组(P<0.05或P<0.01);血清MMP-3[(81.67±6.77)pg/ml比(96.55±7.68)pg/ml,t=9.641]、CRP[(12.67±4.42)mg/L比(19.86±5.15)mg/L,t=7.027]及TNF-α[(334.24±41.07)μg/ml比(367.13±47.16)μg/ml,t=3.488]水平均低于对照组(P<0.01).观察组治疗后生理职能、社会功能及精神健康评分均高于对照组(t值分别为8.469、9.210、8.608,P<0.01),躯体疼痛评分低于对照组(t=4.146,P<0.01).观察组总有效率为95.5%(42/44)、对照组为77.3%(34/44),2组比较差异有统计学意义(χ^2=4.728,P=0.029).随访6个月,观察组复发率为4.8%(2/42)、对照组为11.8%(4/34),2组复发率比较差异无统计学意义(χ^2=0.435,P=0.509).结论针灸推拿结合柳氮磺吡啶肠溶片可明显改善AS患者骨代谢水平,提高骨密度值,降低MMP-3、CRP及TNF-α水平,提高患者生活质量.

Objective To explore the effect of acupuncture and massage combined with sulfasalazine enteric-coated tablets on ankylosing spondylitis (AS) and its influence on bone mineral density and serum MMP-3. Methods A total of 88 AS patients who met the criteria were divided into two groups by the random number table method, 44 cases in each group. The control group was treated with sulfasalazine enteric-coated tablets, while the observation group was treated with acupuncture and massage on the basis of the control group. Both groups were treated for 6 months and followed up for 6 months. TCM syndromes were scored before and after treatment. The Bone Glaprotein (BGP), hematocrit (Hct), alkaline phosphatase (ALP), matrix metalloproteinase-3 (MMP-3), CRP and TNF-α were detected by double antibody sandwich enzyme-linked immunosorbent assay. The bone mineral content of lumbar spine, trochanter and whole body were measured by DPX-NT X-ray bone mineral density analyzer. The quality of life (QOL) was assessed by four items in the Medical Outcomes Study Short-Form 36 (SF-36), including physiological function, physical pain, social function and mental health. The clinical efficacy was evaluated and the recurrence rate was recorded. Results After treatment, the BGP, ALP, MMP-3, CRP, TNF-α and somatic pain scores in the observation group were significantly lower than those in the control group (t value were 9.561, 7.983, 9.641, 7.027, 3.488, 4.146, all Ps<0.01), while the Hct, BMD (lumbar spine 1-4, large rotor, whole body), physiological function, social function and mental health scores in the observation group were significantly higher than those in the control group (t value were 8.057, 2.341, 4.482, 4.200, 8.469, 9.210, 8.608, P<0.05). The total effective rate of the observation group was 95.5% (42/44) higher than 77.3% (34/44) of the control group (χ^2=4.728, P=0.029);There was no significant difference in recent recurrence rate between the two groups (4.8% in the observation group and 11.8% in the control group, χ^2=0.435, P=0.509). Conclusions TCM massage combined with acupuncture can significantly improve the level of bone metabolism, increase bone mineral density, reduce the levels of MMP-3, CRP and TNF-α, and improve the quality of life.