针药并用治疗肝肾阴虚型类风湿关节炎临床研究及对骨细胞因子的影响

Clinical effects of acupuncture medication combined in treating rheumatoid arthritis of liver-kidney yin deficiency type and how to impact on bone cytokines

目的观察针药并用治疗肝肾阴虚型类风湿关节炎(RA)的临床疗效及对骨细胞因子的影响。方法将107例肝肾阴虚型RA患者按照随机数字表法分为2组,对照组53例予甲氨蝶呤片联合美洛昔康片治疗,观察组54例在对照组治疗基础上加针刺联合六味地黄丸加减治疗,2组均治疗2个月。比较2组临床疗效及治疗前后中医证候评分、RA 3项血清学指标[类风湿因子(RF)、抗环瓜氨酸肽抗体(抗CCP抗体)、C反应蛋白(CRP)]水平和骨细胞因子[骨保护素(OPG)、核转录因子-κB受体活性因子配体(RANKL)、巨噬细胞集落刺激因子(M-CSF)]水平。结果观察组总有效率92.59%(50/54),对照组总有效率81.13%(43/53),观察组临床疗效优于对照组(P<0.05)。治疗后2组中医证候各项评分及总分均较本组治疗前降低(P<0.05),且观察组关节肿胀疼痛或痠痛、关节屈伸不利、晨僵、腰膝痠软、头晕目眩评分及总分均低于对照组(P<0.05)。治疗后2组血清RF、抗CCP抗体及CRP水平均较本组治疗前降低(P<0.05),且观察组均低于对照组(P<0.05)。治疗后2组血清OPG水平均较本组治疗前升高(P<0.05),PANKL、M-CSF水平均较本组治疗前降低(P<0.05),且观察组OPG水平高于对照组(P<0.05),PANKL、M-CSF水平低于对照组(P<0.05)。结论针药并用治疗能够改善肝肾阴虚型RA患者临床症状,提高治疗效果,可能与抑制破骨细胞的生成和分化有关。

Objective To observe the effects of acupuncture medication combined in treating rheumatoid arthritis(RA)of liver-kidney yin deficiency type and how to impact on bone cytokines.Methods Totally 107 cases of RA patients(liver-kidney yin deficiency type)were randomly divided into 2 groups:the control group(n=53),the observation group(n=54);in addition to conventional Western medicine(methotrexate tablets and meloxicam tablets),the observation group received acupuncture combined with modified Liuwei Dihuang Pill,a continuation of 2-month treatment was performed,the key observations were before and after treatment the clinical efficacy,TCM syndrome scores,serological indexes(rheumatoid factor[RF],anti-cyclic citrullinated peptide antibody[ACPA],C-reactive protein[CRP]),and bone cytokines levels(osteoprotegerin[OPG],receptor activator of nuclear factor-kappa B ligand[RANKL],macrophage colony-stimulating factor[M-CSF]).Results The overall effective rate in the observation group was better than that in the control group(92.59%[50/54]vs 81.13%[43/53],respectively,[P<0.05]).After treatment,TCM syndromes scores in the two groups were decreased(P<0.05);the scores of joint swelling or soreness,joint flexion and extension disorder,morning stiffness,soreness and weakness of waist and knees,light-headedness and total scores in the observation group were lower than those in the control group(P<0.05).After treatment,the serum levels of RF,ACPA and CRP in groups were lower than those before treatment(P<0.05),and the observation group was common(P<0.05);the serum levels of OPG were higher in groups(P<0.05),the levels of RANKL and M-CSF were lower(P<0.05).In comparison with the control group,the levels of OPG in the observation group were higher(P<0.05),the levels of RANKL and M-CSF were lower(P<0.05).Conclusion Acupuncture and medicine combined can improve the clinical symptoms of RA patients(liver-kidney yin deficiency type)and improve the therapeutic effect by inhibition of osteoclast activity.