壮医药线点灸联合针刺治疗寒湿痹阻型膝骨性关节炎的临床观察

Clinical Observation of Zhuang Medicine Medicated Thread Moxibustion Combined with Acupuncture in the Treatment of Knee Osteoarthritis of Cold-damp Obstruction Syndrome Type

【目的】观察壮医药线点灸配合针刺治疗寒湿痹阻型膝骨性关节炎患者的临床疗效,并探讨其可能的作用机制。【方法】将124例寒湿痹阻型膝骨性关节炎患者随机分为观察组和对照组,每组各62例,对照组给予双氯芬酸二乙胺乳胶剂治疗,观察组给予壮医药线点灸配合针刺治疗。疗程为2周。治疗2周后,评价2组患者的临床疗效,观察2组患者治疗前后基质金属蛋白酶抑制剂-1(TIMP-1)、基质金属蛋白酶-3(MMP-13)的变化情况,以及白细胞介素(IL)1β、IL-18的情况。比较2组患者治疗前后西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分与视觉模拟量表(VAS)评分的变化情况。并评价2组不良反应的发生情况。【结果】(1)治疗后,2组患者的TIMP-1、MMP-13水平均明显改善(P<0.05),且观察组在改善TIMP-1、MMP-13水平方面明显优于对照组,差异均有统计学意义(P<0.05)。(2)治疗后,2组患者的IL-18、IL-1β水平均明显改善(P<0.05),且观察组在改善IL-18、IL-1β水平方面明显优于对照组,差异均有统计学意义(P<0.05)。(3)治疗后,2组患者的VAS、WOMAC评分均明显改善(P<0.05),且观察组在改善VAS、WOMAC评分方面明显优于对照组,差异均有统计学意义(P<0.05)。(4)观察组总有效率为96.77%(60/62),对照组为90.32%(56/62)。观察组疗效优于对照组,但差异无统计学意义(P>0.05)。(5)对照组不良反应总发生率为8.06%(5/62),观察组为6.45%(4/62);观察组与对照组的不良反应发生率比较,差异无统计学意义(P>0.05)。【结论】壮医药线点灸配合针刺治疗寒湿痹阻型膝骨性关节炎,能够明显改善患者疼痛症状,减轻炎症反应,改善膝关节功能,疗效显著。

Objective To observe the clinical effect of Zhuang medicine medicated thread moxibustion combined with acupuncture in treating knee osteoarthritis of cold-dampness obstruction syndrome type,and to explore its possible mechanism. Methods A total of 124 cases of knee osteoarthritis of cold-damp obstruction syndrome type were randomly divided into observation group and control group,62 cases in each group. The control group was treated with diclofenac diethylamine latex,and the observation group was treated with Zhuang medicine medicated thread moxibustion combined with acupuncture. The course of treatment was 2 weeks. After 2 weeks of treatment,the clinical efficacy of patients in the two groups was evaluated,and the changes of matrix metalloproteinase-1(TIMP-1),matrix metalloproteinase-3(MMP-13),interleukin 1β(IL-1β)and interleukin 18(IL-18)were observed before and after treatment. The Western Ontario and McMaster University Osteoarthritis Index(WOMAC)and visual analogue scale(VAS)scores were compared between the two groups before and after treatment. The occurrence of adverse reactions in the two groups was evaluated. Results(1)After treatment,the levels of TIMP-1 and MMP-13 in both groups were significantly improved(P < 0.05),and the improvement of TIMP-1 and MMP-13 in the observation group was significantly superior to that in the control group,the difference being statistically significant(P < 0.05).(2)After treatment,the levels of IL-18 and IL-1β in the two groups were significantly improved(P < 0.05), and the improvement of the levels of IL-18 and IL-1β in the observation group was significantly superior to that in the control group,the difference being statistically significant(P < 0.05).(3)After treatment, the VAS and WOMAC scores of the two groups were significantly improved(P < 0.05), and the observation group was significantly superior to the control group in improving the VAS and WOMAC scores,the difference being statistically significant(P < 0.05).(4)The total effective rate was 96.77%(60/62) in the observation group and 90.32%(56/62)in the control group. The effect of the observation group was superior to that of the control group,but the difference was insignificant(P > 0.05).(5)The total incidence of adverse reactions was 8.06%(5/62)in the control group and 6.45%(4/62)in the observation group. There was no significant difference in the incidence of adverse reaction between the observation group and the control group(P > 0.05).Conclusion Zhuang medicine medicated thread moxibustion combined with acupuncture in treating knee osteoarthritis of cold-damp obstruction syndrome type can significantly improve the pain symptom of patients,reduce the inflammatory response,improve the function of the knee joint with significant effect.