温针灸配合独活寄生汤治疗类风湿性关节炎临床研究

Therapeutic effect of warm acupuncture combined with Duhuo Jisheng decoction on patients with rheumatoid arthritis

目的:探讨温针灸配合独活寄生汤治疗类风湿性关节炎(RA)的疗效及对辅助性T淋巴细胞17(Th_(17))/调节性T淋巴细胞(Tregs)平衡的影响,为其临床诊治提供参考。方法:选择80例类风湿性关节炎患者,随机分为对照组和观察组,每组40例。其中对照组给予常规西药治疗,观察组给予温针灸配合独活寄生汤联合治疗,治疗1个月。比较两组患者治疗前后病情活动指标、血清炎症因子及Th_(17)、Treg细胞、叉头状转录因子P3(Foxp3)及其磷酸化翼状头转录因子P3(p-Foxp3)表达水平差异,分析两组患者治疗后临床症状及体征改善情况,观察两组患者临床疗效。结果:与对照组比较,观察组中医证候评分、RA病情评价量表(DAS28)评分、晨僵时间、关节压痛数及关节肿胀数明显较低,临床疗效明显较高(P<0.05)。与治疗前比较,两组患者治疗后血清转化生长因子β(TGF-β)、白细胞介素10(IL-10)水平及Treg、Foxp3、p-Foxp3表达水平均明显升高,血清白细胞介素-17(IL-17)、C反应蛋白(CRP)、类风湿因子(RF)和红细胞沉降率(ESR)水平及Th_(17)/Treg、Th_(17)表达水平明显降低,且观察组更明显(P<0.05)。结论:温针灸配合独活寄生汤治疗类风湿性关节炎,可以更好地改善其临床体征及症状,通过对Th_(17)细胞和Treg细胞含量进行调节,改善免疫功能,并起到抗炎作用。

Objective:Discuss the curative effect of warming needle moxibustion combined with Duhuo Jisheng decoction in the treatment of rheumatoid arthritis(RA)and its influence on the balance of Th_(17)/Tregs,so as to provide reference for clinical diagnosis and treatment.Methods:Eighty cases of rheumatoid arthritis were selected,and divided into control group(n=40)and observation group(n=40)according to random number method.The control group was treated with conventional western medicine,and the observation group was treated with warm acupuncture and moxibustion combined with Duhuo Jisheng decoction for 1 month.The differences in disease activity indicators,serum inflammatory factors and the expression levels of Th_(17),Treg cells,Foxp3 and p-Foxp3 were compared between the two groups before and after treatment.The improvement of clinical symptoms and signs after treatment was analyzed between the two groups,and clinical efficacy were observed between the two groups.Results:Compared with the control group,the observation group had significantly lower TCM syndrome score,DAS28 score,morning stiffness,joint tenderness,and joint swelling,and the clinical efficacy was significantly higher(P<0.05).Compared with before treatment,the levels of serum TGF-βand IL-10 and the expression levels of Treg,Foxp3 and p-Foxp3 in two groups were significantly increased after treatment.Serum IL-17,CRP,RF,ESR levels and Th_(17)/Treg,Th_(17) expression levels were significantly decreased,and the improvement of the above inflammatory factors levels was more significant in the observation group(P<0.05).Conclusion:Warming acupuncture and moxibustion combined with Duhuo Jisheng decoction in the treatment of rheumatoid arthritis can better improve its clinical signs and symptoms,improve immune function and anti-inflammatory effect by regulating the content of Th 17 cells and Treg cells.