苁蓉独活散联合温针灸治疗肾阳亏虚型强直性脊柱炎的临床观察

Clinical Efficacy of Needle Warming Moxibustion Combined with Congrong Duhuosan in Treating Ankylosing Spondylitis with Deficiency of Kidney-Yang Type

目的:观察苁蓉独活散联合温针灸对肾阳亏虚型强直性脊柱炎(ankylosing spondylitis,AS)的疗效及安全性。方法:将186例肾阳亏虚型AS患者随机分为观察组和对照组,每组93例。对照组患者给予美洛昔康分散片联合柳氮磺吡啶肠溶片治疗,观察组患者给予苁蓉独活散联合温针灸治疗,两组患者疗程均为63 d。观察两组患者治疗前后综合指数评分(bath ankylosing spondylitis patient global score,BAS-G),脊柱疼痛视觉模拟评分(visual analog scale,VAS),巴氏强直性脊柱炎活动指数(bath ankylosing spondylitis disease activity index,BASDAI),疾病功能指数(bath ankylosing spondylitis functional index,BASFI),患者整体评分(physicians global assessment,PGA)和中医辨证肾阳亏虚证评分;检测治疗前后白细胞介素-17(interleukin-17,IL-17),白细胞介素-23(interleukin-23,IL-23)mRNA表达水平及辅助性T细胞17(T helper cell 17,Th17),调节性T细胞(regulatory cells,Treg)水平及Th17/Treg的变化;比较两组肾阳亏虚型强直性脊柱炎患者的治疗效果以及不良反应发生率。结果:治疗过程中对照组脱落7例,观察组脱落1例。治疗后观察组总有效率为85.87%(79/92),显著优于对照组的60.47%(52/86)(χ2=6.08,P<0.01);观察组BAS-G,VAS,BASDAI,BASFI,PGA评分以及中医肾阳亏虚证评分较对照组改善更为明显(P<0.05,P<0.01);观察组患者的IL-17,IL-23 mRNA表达水平及Th17,Treg水平及Th17/Treg较对照组患者的改善情况均更为显著(P<0.01);观察组的不良反应发生率显著低于对照组(P<0.01)。结论:温针灸联合苁蓉独活散能有效缓解肾阳亏虚型AS患者的疼痛及炎症反应等临床症状,恢复患者的活动功能,不良反应小,是一种安全有效的临床治疗方法。

Objective:To observe the efficacy and safety of warm acupuncture combined with Congrong Duhuosan in treating ankylosing spondylitis(AS)with deficiency of kidney-Yang.Method:Totally 186 patients with AS of deficiency of kidney Yang type were randomly divided into observation group and control group,with 93 patients in each group.The control group was treated with meloxicam dispersive tablets combined with Sulfasalazine enteric-coated tablets,while the observation group was treated with warm acupuncture combined with Congrong Duhuosan,with a course of treatment of 63 d.Bath ankylosing spondylitis patient global score(BAS-G),visual analogue score(VAS),bath ankylosing spondylitis disease activity index(BASDAI),bath ankylosing spondylitis functional index(BASFI),physicians global assessment(PGA)and syndrome differentiation of kidney-Yang deficiency syndrome in traditional Chinese medicine(TCM)were observed before and after treatment.Interleukin-17(IL-17),interleukin-23(IL-23)mRNA expression levels,T helper cell 17(Th17)and regulatory cells(Treg)levels and Th17/Treg ratio were detected before and after treatment.Efficacy and incidence of adverse reactions were compared between two groups.Result:There were 7 cases falling off in control group and 1 case in observation group.After treatment,the total effective rate of observation group was 85.87%(79/92),which was better than 60.47%(52/86)of control group(χ2=6.08,P<0.01).The scores of BAS-G,VAS,BASDAI,BASFI,PGA and TCM kidney-Yang deficiency syndrome in observation group were significantly improved than those in control group(P<0.05,P<0.01).IL-17 and IL-23 mRNA expression levels,Th17 and Treg levels and Th17/Treg ratio in observation group were significantly improved compared with control group(P<0.01).The incidence of adverse reactions in observation group was significantly lower than that in control group(P<0.01).Conclusion:Warm acupuncture combined with Congrong Duhuosan can effectively relieve pain,inflammatory reaction and other clinical symptoms of patients with kidney-Yang deficiency AS,and restore the activity function of patients with small adverse reactions.Therefore,it is a safe and effective clinical therapy.