补肾通络针法联合热敏灸治疗膝骨关节炎的临床观察及对TRACP、CTX-Ⅰ的影响

Clinical observation of kidney-tonifying and collateral-tonifying acupuncture combined with thermosensitive moxibustion in the treatment of knee osteoarthritis and its effect on TRACP and CTX-Ⅰ

目的:观察补肾通络针法联合热敏灸治疗膝骨关节炎的临床疗效及对抗酒石酸酸性磷酸酶(TRACP)、Ⅰ型胶原蛋白C末端异物肽(CTX-Ⅰ)的影响。方法:90例诊断为膝骨关节炎患者分为针灸组、热敏灸组、常规组,每组30例。常规组给予关节腔注射玻璃酸钠,配合口服双氯芬酸钠缓释片;热敏灸组在常规治疗的基础上,给予热敏灸;针灸组在热敏灸组治疗上,给予补肾通络针法。观察治疗前后、随访2周视觉模拟评分量表(VAS评分)、膝骨关节炎功能评估量表(JKOM评分)、膝关节运动伤病评分表(Ly-sholm膝关节评分);治疗前后血清TRACP、CTX-Ⅰ含量。结果:各组治疗前,VAS评分、JKOM评分、Ly-sholm膝关节评分比较,差异无统计学意义(P>0.05);治疗后,VAS评分、JKOM评分均下降,针灸组下降程度最大,差异具有统计学意义(P<0.05);Ly-sholm膝关节评分上升,针灸组变化程度最大,差异具有统计学意义(P<0.05)。各组治疗前血清TRACP、CTX-Ⅰ含量比较,差异无统计学意义(P>0.05);治疗后血清TRACP、CTX-Ⅰ含量均降低,针灸组下降程度最大,差异有统计学意义(P<0.05);各组总有效率比较,差异均具有统计学意义(P<0.05)。结论:补肾通络针法联合热敏灸能显著缓解膝骨关节炎患者膝关节疼痛等症状,值得临床推广使用。

Objective:To observe the clinical effect of kidney-tonifying and colllateral-tonifying acupuncture combined with thermosensitive moxibustion in the treatment of knee osteoarthritis and cold congealing syndrome and the effect on Tartrate-resistant Acid Phosphatase(TRACP)andⅠcollagen C-terminal foreign body peptide(CTX-Ⅰ).Methods:Totally 90 patients with knee osteoarthritis were divided into three groups:acupuncture group,thermosensitive moxibustion group and routine group with 30 cases in each group.In the conventional group,sodium hyaluronate was injected into the joint cavity and diclofenac sustained release tablets were taken orally.Thermosensitive moxibustion group was given thermosensitive moxibustion on the basis of conventional treatment.Acupuncture and moxibustion group in the heat sensitive moxibustion group treatment was given kidney tonifying acupuncture.VAS score,JKOM score and Ly-Sholm knee score were observed before and after treatment and followed up for 2 weeks.The levels of TRACP and CTX-Ⅰin serum before and after treatment.Results:Before treatment,there were statistically significant differences in VAS score,JKOM score and Ly-Sholm knee score among all groups(P>0.05).After treatment,the VAS score and JKOM score decreased,and the decrease degree was the greatest in the acupuncture group(P<0.05).Ly-Sholm knee score increased,and the change degree was the greatest in acupuncture group(P<0.05).Before treatment,the levels of TRACP and CTX-Ⅰin serum of all groups were significantly different(P>0.05).After treatment,serum TRACP and CTX-Ⅰlevels were decreased,and the decrease degree was the greatest in acupuncture group(P<0.05).The total effective rates of the acupuncture group,the thermal sensitive moxibustion group and the conventional group were 96.7%,80%and 66.7%,respectively,and the difference between each group was statistically significant(P<0.05).Conclusion:Kidney-tonifying and collature-tonifying acupuncture combined with thermosensitive moxibustion can significantly relieve knee pain and other symptoms of knee osteoarthritis in patients and cold congealing syndrome,which is worthy of clinical promotion.