针药并用治疗类风湿结节临床观察

Clinical Observations on Combined Use of Acupuncture and Medicine for Rheumatoid Nodules

目的评价针刺基础穴及阿是穴配合药物治疗类风湿结节的临床疗效及安全性。方法将66例类风湿结节患者随机分为对照组和观察组,每组33例。对照组给予甲氨蝶呤每周口服1次,每次7.5 mg;来氟米特每日口服1次,每次10 mg;美洛昔康每日口服1次,每次7.5 mg。针刺基础穴(大椎、风池、曲池、足三里、血海、阴陵泉、三阴交)。观察组在对照组基础上加针刺局部结节处阿是穴。观察两组类风湿因子(RF)、抗环瓜氨酸肽抗体(CCP)、超敏C反应蛋白(CRP)指标变化,结节变化(大小、软硬)和不良反应,评价两组临床疗效。结果最终51例患者完成临床试验,对照组26例,观察组25例。两组治疗后RF、CCP、CRP指标均较治疗前降低,差异有统计学意义(P<0.05)。观察组治疗后RF、CRP低于对照组,差异有统计学意义(P<0.05),CCP指标差异无统计学意义(P>0.05)。两组治疗后结节大小比较差异有统计学意义(P<0.05)。两组治疗后结节软硬度与治疗前比较差异有统计学意义(P<0.05),两组治疗后结节软硬度比较差异无统计学意义(P>0.05)。对照组总有效率为76.9%,观察组总有效率为96.0%。两组疗效经秩和检验,差异无统计学意义(P>0.05)。结论针刺基础穴及阿是穴配合药物治疗类风湿结节具有一定临床疗效,不良反应较少。

Objective To assess the clinical efficacy and safety of acupuncture at basic points and ashi points plus medication for rheumatoid nodules.Method Sixty-six patients with rheumatoid nodules were randomized to control and observation groups,33 cases each.The control group received oral administration of methotrexate 7.5 mg once a week,leflunomide 10 mg once daily and andandmeloxicam 7.5 mg once daily,and acupuncture at basic points[Dazhui(GV14),Fengchi(GB20),Quchi(LI11),Zusanli(ST36),Xuehai(SP10),Yinlingquan(SP9)and Sanyinjiao(SP6)].The observation group received acupuncture at ashi points in local nodules in addition to those given to the control group.Rheumatoid factor(RF),anti-cyclic citrullinated peptide(CCP)antibody and high sensitive C-reactive protein(CRP)were measured,the therapeutic effects on the symptoms and adverse reactions were observed and the clinical therapeutic effects were evaluated in the two groups.Result Finally,51 patients(26 in the control group and 25 in the observation group)completed the clinical trial.RF,anti-CCP antibody and CRP decreased in the two groups after treatment compared with before with statistically significant differences(P<0.05).After treatment,RF and anti-CCP antibody decreased more in the observation group than in the control group with statistically significant differences(P<0.05)and there was no statistically significant difference in CRP(P>0.05).There was a statistically significant difference in nodule size between the two groups(P<0.05).There was a statistically significant pre-/post-treatment difference in nodule hardness in the two groups(P<0.05).After treatment,there was no statistically significant difference in nodule hardness between the two groups(P>0.05).The total efficacy rate was 76.9%in the control group and 96.0%in the observation group(P<0.05).A rank sum test showed no statistically significant difference in the therapeutic effect between the two groups(P>0.05).Conclusion Acupuncture at basic points and ashi points plus medication has clinically a certain effect on rheumatoid nodules with fewer adverse reactions.