靳三针治疗痛风性关节炎慢性期的随机对照试验

JIN’s Three-Needle Acupuncture Therapy for Gouty Arthritis at ChronicPhase:A Randomized Controlled Trial

【目的】比较靳三针与西药治疗痛风性关节炎慢性期的临床疗效。【方法】采用随机对照试验,将66例脾肾两虚兼痰瘀痹阻型痛风性关节炎慢性期患者随机分为针刺组和药物组,每组各33例。药物组给予口服非布司他片治疗,针刺组给予靳三针疗法针刺治疗,取肠三针(天枢、上巨虚、关元)、肝俞、脾俞、肾俞、太溪、太白、太冲等穴,隔天针刺1次,每周治疗3次,疗效为8周。观察2组患者治疗前后痛风性关节炎主要症状体征评分及血尿酸水平的变化情况,并评价2组患者的临床疗效和安全性。【结果】(1)研究过程中,有6例患者脱落,最终完成试验60例,其中针刺组和药物组各30例。(2)疗效方面,治疗8周后,针刺组的总有效率为86.7%(26/30),药物组为73.3%(22/30);组间比较(秩和检验),针刺组的疗效明显优于药物组(P<0.05)。(3)症状体征方面,治疗后,2组患者的关节疼痛、肿胀、压痛、活动度评分均较治疗前改善(P<0.05);而2组治疗前后的痛风石评分比较,差异均无统计学意义(P>0.05)。组间比较,针刺组对关节疼痛、肿胀、压痛、活动度评分的改善作用均明显优于药物组(P<0.05),而在改善痛风石评分方面,差异无统计学意义(P>0.05)。(4)血尿酸水平方面,治疗后,2组患者的血尿酸水平均较治疗前下降(P<0.05),且针刺组对血尿酸水平的下降作用明显优于药物组(P<0.05)。(5)安全性方面,试验期间,针刺组1例患者因在饥饿状态下治疗而出现晕针现象,药物组1例患者在服药期间出现皮肤瘙痒症状,给予相应对症处理后好转,均不影响后续治疗。【结论】靳三针疗法治疗脾肾两虚兼痰瘀痹阻型痛风性关节炎慢性期患者疗效确切,其疗效优于西药非布司他。

Objective To compare the clinical efficacy of JIN’s three-needle acupuncture therapy and western medicine for the treatment of gouty arthritis at chronic phase.Methods A randomized controlled trial was carried out in 66 patients with gouty arthritis at chronic phase with the syndrome of spleen and kidney deficiency complicated with phlegm-stasis obstruction.The patients were randomly divided into acupuncture group and medicine group,with 33 patients in each group.The medicine group was treated with oral use of Febuxostat Tablets,while the acupuncture group was treated with JIN’s three-needle acupuncture therapy at triple intestineacupoints[Tianshu(ST25),Shangjuxu(ST37)and Guanyuan(RN4)],Ganshu(BL18),Pishu(BL20),Shenshu(BL23),Taixi(KI3),Taibai(SP3),and Taichong(LR3).Acupuncture therapy was performed once every other day,3 times a week for 8 weeks.The changes in the scores of the primary symptoms and signs of gouty arthritis and the blood uric acid level of the patients in the two groups were observed before and after treatment,and the clinical efficacy and safety of the patients in the two groups were evaluated after treatment.Results(1)During the trial,6 patients fell off,and a total of 60 cases eventually completed the trial,30 cases in the acupuncture group and 30 cases in the medicine group.(2)After 8 weeks of treatment,the overall effective rate in the acupuncture group was 86.7%(26/30)and that in the medicine group was 73.3%(22/30).The intergroup comparison by rank sum test showed that the efficacy of the acupuncture group was significantly superior to that of the medicine group(P<0.05).(3)After treatment,the scores of pain,swelling,tenderness and range of motion of the joints in both groups were improved compared with those before treatment(P<0.05),while there was no significant difference in the tophus scores between the two groups before and after treatment(P>0.05).The intergroup comparison showed that the acupuncture group showed more significant improvement in the scores of pain,swelling,tenderness and range of motion of the joints than the medicine group(P<0.05),while the difference in improving tophus scores was not statistically significant between the two groups(P>0.05).(4)After treatment,the blood uric acid levels in both groups were decreased compared with those before treatment(P<0.05),and the decrease of blood uric acid level in the acupuncture group was significantly superior to that in the medicine group(P<0.05).(5)During the trial,one patient in the acupuncture group fainted during acupuncture under starvation,and one patient in the medicine group had itch of skin during the drug administration.The side effects were all relieved after appropriate symptomatic treatment,and had no influence on the subsequent treatment.Conclusion JIN’s three-needle acupuncture therapy exerts certain effect in treating patients with gouty arthritis at chronic phase with the syndrome of spleen and kidney deficiency complicated with phlegm-stasis obstruction,and its efficacy is superior to that of the western medicine Febuxostat Tablets.