温针灸治疗轻中度膝骨关节炎及可能机制探讨

Study on the Efficacy and Possible Mechanism of Warm Acupuncture in Treating Mild and Moderate Knee Osteoarthritis

目的:探讨温针灸治疗对轻中度膝骨关节炎患者膝关节功能及炎性因子的影响。方法:选取2018年9月至2019年5月30例轻中度膝骨关节炎患者,予温针灸治疗,3次/周,连续5周。比较治疗前后关节疼痛(视觉模拟评分法(VAS))、关节肿胀、关节压痛、骨关节炎指数评分表(WOMAC)、Lysholm膝关节评分、关节活动度、炎性因子(C反应蛋白(CRP)、肿瘤坏死因子(TNF-α)、白介素1β(IL-1β))、骨代谢因子(Ⅰ型胶原C端异物肽(CTX-Ⅰ)、胰岛素样生长因子(IGF)和睾酮)变化。随访8个月,记录所有患者的VAS、关节肿胀评分和关节压痛评分。结果:与治疗前比,患者治疗后的关节疼痛、关节肿胀、关节压痛评分均显著降低(P<0.05),WOMAC评分明显降低(P<0.05),Lysholm及关节活动度显著提高(P<0.05),血清CRP,TNF-α,IL-1β及膝关节局部皮温水平均降低(P<0.05),血清CTX-Ⅰ降低(P<0.05),IGF及睾酮均增高(P<0.05)。治疗期间均未出现明显的不良反应,随访期间无一例失访,随访时间8个月,VAS、关节肿胀评分和关节压痛评分差异无统计学意义(P>0.05)。结论:温针灸治疗能够明显缓解膝骨关节炎患者的临床症状,改善骨内微循环、造血组织状态,从而改善患者的膝关节功能,且无明显的不良反应,远期疗效较好,可能与降低机体炎性水平和调节骨代谢因子有关。

Objective:To study the efficacy and possible mechanism of warm acupuncture in treating mild and moderate knee osteoarthritis(KOA) patients.Methods:30 KOA patients were treated by warm acupuncture for 3 times per week for 5 consecutive weeks from September 2018 to May 2019.The joint pain(visual analogue scale(VAS)), joint swelling, joint tenderness, osteoarthritis index scale(WOMAC), Lysholm knee joint score, joint range of motion, inflammatory factors(C-reactive protein(CRP), tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β)), bone metabolism factor(type Ⅰ collagen C-telopeptide(CTX-Ⅰ), insulin like growth factor(IGF) and testosterone) were compared before and after the treatment.All patients were followed up for 8 months, and the VAS, joint swelling score and joint tenderness score of all patients were documented.Results: Compared with these indexes before treatment, the scores of joint pain, joint swelling, and joint tenderness were significantly reduced(P<0.05), and the WOMAC score was significantly reduced(P<0.05), Lysholm and joint range of motion were significantly increased(P<0.05), serum CRP, TNF-α, IL-1β and local skin temperature of the knee joint were reduced(P<0.05), and serum CTX-Ⅰ was reduced(P<0.05), IGF and testosterone were increased(P<0.05) after treatment.There were no significant adverse reactions during the treatment, and no case was lost during the follow-up period.There was no significant difference in VAS, joint swelling score and joint tenderness score(P>0.05) during the follow-up period of 8 months.Conclusion: Warm acupuncture could improve clinical symptom and knee joint function by adjusting the state of intraosseous microcirculation and hematopoietic tissue, which may involve the regulation of inflammation and bone metabolism factors.The warm acupuncture shows satisfied long-term efficacy without obvious side-effects as well.