针刺治疗中轴型脊柱关节病的研究进展

Research progress of acupuncture treating axial spondyloarthritis

中医认为中轴型脊柱关节病基本病机为本虚标实、内外合邪,临床医家治疗时常选用腰背部经络如督脉、足太阳膀胱经上的腧穴及华佗夹脊穴等进行针刺,并依据患者邪正盛衰随证加减,以宣通督肾阳气、祛除邪气。此外,研究表明,选用合适的针刺手法如“盘龙针法”“齐刺”“扬刺”“督脉排针法”等有助于调和患者之气机,从而增强针刺疗效。探索针刺治疗本病的作用机制,发现其可能是通过调节肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-1(interleukin-1,IL-1)、白细胞介素-17(interleukin-17,IL-17)等致炎因子与白细胞介素-2(interleukin-2,IL-2)、白细胞介素-4(interleukin-4,IL-4)、白细胞介素-10(interleukin-10,IL-10)等抗炎因子间平衡,维持CD4+与CD8+T淋巴细胞间数目的稳态,以减轻患者炎性反应;通过调控中枢及外周疼痛相关的神经—内分泌网络,增加镇痛物质并降低致痛物质以发挥即时和长效镇痛作用;通过调节OPG-RANKL-RANK及Wnt/β-catenin等骨稳态相关的信号通路及降低基质金属蛋白酶-3(matrix metalloproteinase 3,MMP-3)等组织水解酶含量,以减少患者骨质融合和破坏的发生,从而延缓病情进展。

Traditional Chinese medicine believes that the basic pathogenesis of axial spondyloarthritis is deficient root and excessive superficial,and evil inside combined with evil outside.In clinic,medical experts often choose the hua jiaji points and acupoints on lumbar and back meridians,such as governor meridian and bladder meridian,to needle.And according to the patient evil is ups and downs along with the syndrome of addition and subtraction,to diffuse and dredging Yang Qi of governor meridian and kidney meridian,and dispelling evil.In addition,the study showed that the selection of appropriate acupuncture techniques,such as‘panlong acupuncture’,‘triple puncture’,‘quintuple puncture’,‘row acupuncture on governor meridian’and others,is helpful to harmonize the patient’s Qi movement,and thus enhancing the efficacy of acupuncture.This article explores the mechanism of acupuncture in the treatment of axial spondyloarthritis.It is found that it could alleviate the patients’inflammatory response,by regulating the balance between proin-flammatory(like tumor necrosis factor-α,interleukin-1 and interleukin-17)and anti-inflammatory factors(like interleukin-4 and interleukin-10),and maintaining homeostasis in the number of CD4+and CD8+T lymphocytes.By regulating central and peripheral pain-related neuroendocrine networks,increasing analgesic substances and decreasing pain-causing substances to exert immediate and long-term analgesic effects.By regulating the signaling pathways related to bone homeostasis such as OPG-RANKL-RANK and Wnt/β-catenin and reducing the content of tissue hydrolase such as matrix metalloproteinase 3(MMP-3)to reducing the incidence of bone fusion,so as to delay the progression of the disease.