膝骨性关节炎患者穴位压痛敏化现象的多中心动态临床观察

Multicenter dynamic clinical observation of acupoint sensitization phenomenon for knee osteoarthritis patients

目的:探讨膝骨性关节炎(KOA)患者穴位压痛敏化现象的时空动态分布规律。方法:招募256例KOA患者,同时招募232名健康受试者。使用瓦格纳压痛仪检测KOA相关穴位的压痛阈值,每例患者每周固定时间检测1次,共4次,健康受试者检测1次,比较KOA患者与健康受试者相关穴位压痛阈值、压痛敏化率的差异,观察患者相关穴位4次检测压痛阈值及压痛敏化率的变化,比较不同时间点不同部位、经脉、分区的压痛阈值、压痛敏化率的差异。结果:KOA患者鹤顶、梁丘、曲泉、阴谷、内膝眼、犊鼻、委阳、阴陵泉、膝关、足三里、阳陵泉、大杼、肾俞、命门、腰阳关、血海、委中、悬钟压痛阈值低于健康受试者(P<0.01);KOA患者上述穴位压痛敏化率高于健康受试者(P<0.01);鹤顶、梁丘、曲泉、内膝眼、犊鼻、阴陵泉、足三里、大杼L、肾俞L、命门、腰阳关、委阳的4次压痛敏化率有升高的趋势;足少阳胆经的4次压痛敏化率均较高,最高达87.5%;Ⅴ区、Ⅸf区的4次压痛敏化率均较高,最高达88.6%。结论:KOA患者穴位压痛敏化率均较高,穴位压痛敏化现象具有普遍性;穴位压痛敏化现象具有规律性,可能与经络、分区相关。

Objective: To explore the temporal and spatial dynamic distribution of acupoint sensitization phenomenon in patients with knee osteoarthritis(KOA). Methods: A total of 256 patients with KOA were recruited, and 232 healthy subjects were also recruited. Wagner tenderness instrument was used to detect the tenderness threshold of KOA related acupoints, each patient was tested 1 time a week for a total of 4 times, healthy subjects were tested once. The differences of tenderness threshold and tenderness sensitization rate between KOA patients and healthy subjects were compared. By observing the changes of tenderness threshold and tenderness sensitization rate at relevant acupoints for 4 times, the differences of tenderness threshold and tenderness sensitization rate in different parts, meridians and zones at different time points were compared. Results: The tenderness thresholds of Heding(EX-LE 2), Liangqiu(ST 34), Ququan(LR 8), Yingu(KI 10), Neixiyan(EX-LE 4), Dubi(ST 35), Weiyang(BL 39),Yinlingquan(SP 9), Xiguan(LR 7), Zusanli(ST 36), Yanglingquan(GB 34), Dazhu(BL 11), Shenshu(BL 23), Mingmen(GV 4), Yaoyangguan(GV 3), Xuehai(SP 10), Weizhong(BL 40) and Xuanzhong(GB 39) in KOA patients were lower than those in healthy subjects(P<0.01). The tenderness sensitization rate of the above acupoints in KOA patients was higher than that in healthy subjects(P<0.01). The four times’ tenderness sensitization rates of Heding(EX-LE 2), Liangqiu(ST 34), Ququan(LR 8),Neixiyan(EX-LE 4), Dubi(ST 35), Yinlingquan(SP 9), Zusanli(ST 36), Dazhu L(BL 11), Shenshu L(BL 23), Mingmen(GV 4), Yaoyangguan(GV 3) and Weiyang(BL 39) tended to increase. The 4 times of tenderness of the foot shaoyang gallbladder channel had higher sensitization rate, up to 87.5%. The sensitization rates of tenderness in Ⅴ zone and Ⅸf zone were higher, up to 88.6%. Conclusion: The sensitization rate of acupoint tenderness in patients with KOA is high, and the phenomenon of acupoint tenderness sensitization is universal. Acupoint tenderness sensitization has regularity, which may be related to meridians and zoning.