热敏灸联合独活寄生汤治疗膝骨关节炎肝肾亏虚证临床研究

Clinical study on thermal moxibustion combined with Duhuo Jisheng Decoction for the patients with knee osteoarthritis and liver and kidney deficiency syndrome

目的评价热敏灸联合独活寄生汤治疗膝骨关节炎(knee osteoarthritis,KOA)肝肾亏虚证的疗效。方法将符合纳入标准的2020年1月-2021年1月本院124例KOA肝肾亏虚证患者按随机数字表法分为2组,每组62例。对照组服用独活寄生汤,观察组在对照组基础上结合热敏灸治疗。2组均治疗28 d。分别于治疗前后进行症状分级评分,采用西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评价关节功能;采用ELISA法检测血清胰岛素样生长因子-1(insulin-like growth factor-1,IGF-1)、成纤维细胞生长因子-2(fibroblast growth factors-2,FGF-2)、TGF-β1、IL-1β、IL-6、TNF-α水平,评价临床疗效。结果观察组总有效率为91.9%(57/62)、对照组为77.4%(48/62),2组比较差异有统计学意义(χ^(2)=5.04,P=0.025)。观察组治疗后症状分级评分和WOMAC评分低于对照组(t值分别为11.33、12.23,P值均<0.01)。观察组治疗后血清IGF-1[(15.63±2.03)ng/L比(12.78±1.57)ng/L,t=8.75]、FGF-2[(30.26±5.37)ng/L比(26.31±1.94)ng/L,t=5.45]、TGF-β1[(30.39±6.71)μg/L比(24.31±5.12)μg/L,t=5.67]水平高于对照组(P<0.01),IL-1β[(12.50±3.36)ng/L比(16.09±4.90)ng/L,t=4.76]、IL-6[(10.59±3.28)ng/L比(21.75±4.09)ng/L,t=16.76]、TNF-α[(4.04±1.92)ng/L比(6.48±1.43)ng/L,t=8.03]水平低于对照组(P<0.01)。2组治疗期间均未出现明显不良反应。结论热敏灸联合独活寄生汤可有效缓解KOA肝肾亏虚证患者的关节疼痛,改善活动受限,促进关节软骨修复,提高临床疗效。

Objective To explore the clinical efficacy of thermal moxibustion combined with Duhuo Jisheng Decoction in the treatment of liver and kidney deficiency syndrome of knee osteoarthritis(KOA).Methods From January 2020 to January 2021,124 KOA patients with liver and kidney deficiency syndrome,who met the inclusion criteria,were divided into 2 groups according to the random number table method,with 62 in each group.The control group was treated with Duhuo Jisheng Decoction,and the observation group was treated with thermal moxibustion on the basis of the control group.Both groups were treated for 28 days.TCM symptom scores were performed before and after treatment,the Osteoarthritis Index of Western Ontario and McMaster University(WOMAC)was used to evaluate joint function.ELISA was used to detect serum insulin-like growth factor-1(IGF-1),fibroblast growth factor-2(FGF-2),transforming growth factor-β1(TGF-β1),IL-1β,IL-6,TNF-αlevels,and the clinical efficacy was evaluated.Results The total effective rate was 91.9%(57/62)in the observation group and 77.4%(48/62)in the control group,and there was significant difference between two groups(χ^(2)=5.04,P=0.025).After treatment,the TCM symptom score and WOMAC score of the observation group were significantly lower than those of the control group(t values were 11.33 and 12.23,respectively,all Ps<0.01).After treatment,the serum levels of IGF-1[(15.63±2.03)ng/L vs.(12.78±1.57)ng/L,t=8.75],FGF-2[(30.26±5.37)ng/L vs.(26.31±1.94)ng/L,t=5.45]and TGF-β1[(30.39±6.71)μg/L vs.(24.31±5.12)μg/L,t=5.67]in the observation group were significantly higher than those in the control group(P<0.01),while the levels of IL-1β[(12.50±3.36)ng/L vs.(16.09±4.90)ng/L,t=4.76],IL-6[(10.59±3.28)ng/L vs.(21.75±4.09)ng/L,t=16.76]and TNF-α[(4.04±1.92)ng/L vs.(6.48±1.43)ng/L,t=8.03]in the observation group were significantly lower than those in the control group(P<0.01).There was no adverse events from both groups during treatment.Conclusion Thermal moxibustion combined with Duhuo Jisheng Ddecoction can alleviate the joint pain of KOA patients with liver and kidney deficiency syndrome,promote cartilage repair and improve the clinical curative effect.