针药并用对强直性脊柱炎伴骨量减少或骨质疏松症患者OPG/RANKL调节的研究

Study on OPG/RANKL Regulation in Patients with Ankylosing Spondylitis with Osteopenia or Osteoporosis

目的:观察"双固一通"针法联合西药对强直性脊柱炎伴骨量减少和(或)骨质疏松症患者的疗效及对骨保护素(OPG)/核转录因子-κB受体活化因子配体(RANKL)的调节作用,初步探讨其作用机制。方法:将52例强直性脊柱炎伴骨质疏松症患者随机分为治疗组和对照组,每组26例。2组均口服碳酸钙D3片、骨化三醇胶丸、利塞膦酸钠片、双氯芬酸钠肠溶胶囊,治疗组加用"双固一通"针法,其主要穴位包括双侧大杼、膈俞、肾俞、委中、夹脊穴、足三里,以及关元穴。2组均以12周为1个疗程。观察2组临床疗效,以及治疗前后中医证候积分、红细胞沉降率(ESR)、骨密度、OPG及RANKL变化。结果:治疗组脱落1例,完成25例,对照组完成26例。治疗组显效6例,有效16例,无效3例,总有效率为88.46%;对照组显效4例,有效12例,无效10例,总有效率为61.54%。2组比较,差异有统计学意义(P<0.05)。治疗后,2组中医证候积分、ESR、骨密度、OPG、RANKL、OPG/RANKL较治疗前均有明显改善(P<0.01),且治疗组优于对照组(P<0.01或P<0.05)。结论:"双固一通"针法联合西药治疗强直性脊柱炎伴骨质疏松症患者疗效确切,能减轻临床症状和炎症反应,提高骨密度,改善生活质量,提高OPG,降低RANKL,调节OPG/RANKL。

Objective:To observe the effect of"Shuanggu Yitong"acupuncture combined with western medicine on patients of ankylosing spondylitis with osteopenia and/or osteoporosis and the regulatory effect of OPG/RANKL.Methods:Fifty-two patients with ankylosing spondylitis and osteoporosis were randomly divided into a treatment group and a control group,26 cases in each group.The two groups were treated with calcium carbonate D3 tablets,calcitriol capsules,risedronate sodium tablets and diclofenac sodium enteric coated capsules.The treatment group was treated with"Shuanggu Yitong"acupuncture based on above treatment,which mainly includes such acupoints as bilateral Dazhu(BL 11),Geshu(SI 10),Shenshu(BL 23),Weizhong(BL 40),Jiaji(EX-B2),Zusanli(ST 36)and Guanyuan(BL 26).Both groups were treated for 12 weeks as a course.The clinical efficacy,TCM syndrome score,erythrocyte sedimentation rate(ESR),bone mineral density,OPG and RANKL were observed before and after treatment.Results:One case fell off the treatment group,25 cases completed,and 26 cases completed in the control group.In the treatment group,6 cases were markedly effective,16 cases were effective and 3 cases were ineffective.The total effective rate was 88.46%;In the control group,4 cases were markedly effective,12 cases were effective and 10 cases were ineffective.The total effective rate was 61.54%.There was significant difference between the two groups(P<0.05).After treatment,the TCM syndrome score,ESR,bone mineral density,OPG,RANKL and OPG/RANKL in the two groups were significantly improved compared with those before treatment(P<0.01),and the treatment group was better than the control group(P<0.01 or P<0.05).Conclusion:"Shuanggu Yitong"acupuncture combined with western medicine is effective in the treatment of ankylosing spondylitis with osteoporosis.It can reduce clinical symptoms and inflammatory response,improve bone mineral density,quality of life and OPG,reduce RANKL and regulate OPG/RANKL.