温针灸配合中药外敷治疗膝关节骨性关节炎对炎症反应及膝关节功能的影响

Effect of Needle Warming Moxibustion Combined with External Application of Chinese Herbal Medicine on Inflammatory Response and Knee Function in Treatment of Knee Osteoarthritis

目的分析温针灸配合中药外敷治疗膝关节骨性关节炎(knee osteoarthritis,KOA)对炎症反应及膝关节功能的影响。方法选取2018年1月—2020年12月64例风寒湿痹型KOA患者,采用随机数字表简单随机分组法分为对照组及观察组,各32例,对照组给予中药外敷治疗,观察组在对照组基础上联合温针灸治疗。记录两组临床疗效,比较两组治疗前及治疗2个疗程后中医证候积分、外周血淋巴细胞DNA损伤诱导转录子4(DDIT4)及雷帕霉素靶蛋白(mTOR)相对表达量、血清白细胞介素1β(IL-1β)及白细胞介素17(IL-17)水平、膝关节功能[西安大略和麦马斯特大学骨关节炎指数可视化量表(WOMAC)、中文版Lequesne指数评分]差异。结果观察组临床疗效明显高于对照组(P<0.05)。治疗2个疗程后,两组中医证候积分、外周血淋巴细胞mTOR mRNA相对表达量、血清IL-1β、IL-17水平及WOMAC、Lequesne评分均较治疗前降低(P<0.05),且观察组治疗后低于对照组(P<0.05);两组外周血淋巴细胞DDIT4 mRNA相对表达量均较治疗前升高(P<0.05),且观察组治疗后高于对照组(P<0.05)。结论温针灸配合中药外敷治疗KOA效果显著,可加速炎症吸收,提高自噬水平,延缓KOA进程。

Objective To analyze the effect of needle warming moxibustion combined with external application of Chinese herbal medicine on inflammatory response and knee function in the treatment of knee osteoarthritis(KOA).Methods A total of 64 patients with KOA of wind-cold-dampness arthralgia type of KOA were selected between January 2018 and December 2020 and were divided into control group and observation group by simple random grouping of the random number table method,with 32 cases in each group.The control group was given external application of Chinese herbal medicine,and the observation group was combined with needle warming moxibustion on the basis of the control group.The clinical efficacy of the two groups was recorded,and the scores of TCM syndromes,relative expression levels of peripheral blood lymphocyte DNA damage-inducing transcript 4(DDIT4)and mammalian target of rapamycin(mTOR),levels of serum interleukin 1β(IL-1β)and interleukin 17(IL-17)and knee function[Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC),Chinese version of Lequesne Index Score]were compared between the two groups before treatment and after 2 courses of treatment.Results The clinical efficacy of the observation group was significantly higher than that of the control group(P<0.05).After 2 courses of treatment,the scores of TCM syndromes,relative expression level of peripheral blood lymphocyte mTOR mRNA,levels of serum IL-1β and IL-17 and scores of WOMAC and Lequesne were decreased in the two groups compared with those before treatment(P<0.05),and the above indicators in the observation group after treatment were lower than those in the control group(P<0.05).The relative expression level of peripheral blood lymphocyte DDIT4 mRNA in the two groups was increased compared to that before treatment(P<0.05),and the expression level of the observation group was higher than that of the control group after treatment(P<0.05).Conclusion Needle warming moxibustion combined with external application of Chinese herbal medicine has a significant effect in the treatment of KOA,and can accelerate the absorption of inflammation,increase the autophagy level and delay the process of KOA.