温针灸治疗轻中度膝骨关节炎疗效观察及其对TLR4/NF-κB信号通路的影响

Therapeutic Observation of Needle Warming Moxibustion for Mild-to-moderate Knee Osteoarthritis and Its Effect on TLR4/NF-κB Signaling Pathway

目的观察温针灸治疗膝骨关节炎(KOA)的临床疗效及其对TLR4/NF-κB信号通路的影响。方法纳入91例KOA患者随机分为观察组(46例)和对照组(45例)。对照组予氟比洛芬凝胶贴膏治疗,观察组在对照组治疗基础上予温针灸治疗。比较两组患者治疗前后膝骨关节炎自评量表(WOMAC)评分、疼痛模拟量表评分(VAS)、健康评价调查表(HAQ)评分和生活质量评价简表(SF-36)评分的变化,观察两组临床疗效和不良反应发生率,比较两组患者治疗前后关节液白介素-1β(IL-1β)、IL-6、肿瘤坏死因子-α(TNF-α)的水平和Toll样受体4(TLR4)、髓样分化初级反应基因(MyD88)、核因子κB(NF-κB)mRNA的表达。结果与对照组比较,观察组治疗后WOMAC、VAS和HAQ评分更低、SF-36评分更高、总有效率更高、不良反应发生率更低,差异均具有统计学意义(P<0.05)。与对照组比较,观察组治疗后患者关节液中IL-1β、IL-6、TNF-α水平以及TLR4、MyD88、NF-κB mRNA表达均更低,差异具有统计学意义(P<0.05)。结论在药物贴膏治疗基础上采用温针灸治疗膝骨关节炎有助于缓解临床症状,改善患者生活质量,且安全性较好;其机制可能与抑制TLR4/NF-κB信号通路介导的炎性反应有关。

Objective To observe the clinical efficacy of needle warming moxibustion in treating knee osteoarthritis(KOA)and its effect on TLR4/NF-κB signaling pathway.Method Ninety-one KOA patients were recruited and randomized into an observation group(46 cases)and a control group(45 cases).The control group was treated with Flurbiprofen gel plasters and the observation group was given additional needle warming moxibustion treatment.The scores of the Western Ontario and McMaster Universities osteoarthritis index(WOMAC),visual analogue scale(VAS),health assessment questionnaire(HAQ),and 36-item short-form health survey(SF-36)were compared before and after treatment.The clinical efficacy and adverse reactions in the two groups were observed.The levels of interleukin(IL)-1β,IL-6,and tumor necrosis factor(TNF)-αin joint fluid and the expression levels of toll-like receptor 4(TLR4),myeloid differentiation factor 88(MyD88),and nuclear factor kappa-B(NF-κB)mRNAs were also compared before and after treatment.Result Compared with the control group after treatment,the scores of WOMAC,VAS,and HAQ were lower,the SF-36 score and total effective rate were higher,and the adverse reaction rate was lower in the observation group,and the differences were statistically significant(P<0.05).After treatment,the levels of IL-1β,IL-6,and TNF-αin joint fluid and the expression levels of TLR4,MyD88,and NF-κB mRNAs were lower in the observation group than in the control group,and the differences were statistically significant(P<0.05).Conclusion Based on medicinal plasters,needle warming moxibustion can help ease the clinical symptoms,improve the quality of life of the patients,and is safe in treating KOA;its mechanism may be related to the inhibition of inflammatory reactions mediated by TLR4/NF-κB signaling pathway.