中药外敷与艾灸联合加味阳和汤治疗风寒湿痹型膝关节炎的临床效果

Clinical effect of external application of traditional Chinese medicine and moxibustion combined with modified Yanghe decoction in the treatment of wind-cold-damp retention type of knee arthritis

目的 观察中药外敷与艾灸联合加味阳和汤治疗风寒湿痹型膝关节炎的临床效果。方法 选取2018年5月—2021年5月宁德市中医院收治的风寒湿痹型膝关节炎患者100例。采用随机数字表法分为观察组和对照组,各50例。对照组予加味阳和汤治疗,观察组在对照组基础上配合中药外敷与艾灸治疗。1周为1个疗程,2组均治疗3个疗程。比较2组治疗前后疼痛视觉模拟评分(VAS)、骨关节炎指数(WOMAC)评分、Lysholm膝关节评分,血液流变学指标及血清和关节液中炎性因子水平。随访6个月比较复发率。结果 治疗3个疗程后,2组VAS评分、WOMAC评分均较治疗前降低,Lysholm膝关节评分上升,且观察组降低或上升的程度大于对照组(P<0.05或P<0.01);观察组血浆黏度、低切全血黏度、高切全血黏度均较治疗前降低(P均<0.01),且血浆黏度、低切全血黏度低于对照组(P<0.05或P<0.01),2组纤维蛋白原组内、组间比较差异无统计学意义(P>0.05);2组血清IL-1β、IL-6、IL-8水平均较治疗前降低,且观察组血清IL-6、IL-8水平低于对照组,其中2组血清IL-1β水平比较差异有统计学意义(P<0.05);2组关节液中IL-1β、IL-6、IL-8水平均较治疗前降低,且观察组低于对照组(P均<0.01);随访6个月,观察组复发率低于对照组(6.00%vs. 22.00%,χ^(2)=5.316,P=0.021)。结论 中药外敷与艾灸联合加味阳和汤治疗风寒湿痹型膝关节炎的临床效果值得肯定,可多途径、多靶点改善血液循环和抑制炎性因子释放,疗效显著且持久。

Objective To observe the clinical effect of external application of traditional Chinese medicine and moxibustion combined with modified Yanghe decoction in the treatment of wind-cold-damp retention type of knee arthritis.Methods A total of 100 patients with wind-cold-damp retention type knee arthritis treated in Ningde Hospital of Traditional Chinese Medicine from May 2018 to may 2021 were selected.The patients were randomly divided into observation group and control group,with 50 cases in each group.The control group was treated with modified Yanghe Decoction,while the observation group was treated with external application of traditional Chinese medicine and moxibustion on the basis of the control group.Both groups were treated with 1 week as a course of treatment,and both groups were treated with 3 courses of treatment.The VAS score,WOMAC score,Lysholm knee score,hemorheological indexes,and the levels of inflammatory factors in serum and joint fluid were compared between the two groups before and after treatment.The recurrence rate was compared after 6 months of follow-up.Results After 3 courses of treatment,the VAS score and WOMAC score in both groups decreased,while the Lysholm knee score increased,and the degree of decrease or increase in the observation group was greater than that in the control group(P<0.05 or P<0.01).In the observation group,plasma viscosity,low shear whole blood viscosity,and high shear whole blood viscosity decreased compared to before treatment(all P<0.01).Moreover,plasma viscosity and low shear whole blood viscosity were lower than those in the control group(P<0.05 or P<0.01).The between-group and within-group differences were not statistically significant for fibrinogen levels(P>0.05).The serum levels of IL-1β,IL-6 and IL-8 in the two groups were lower than those before treatment,and the levels in the observation group were lower than those in the control group,and the difference of serum IL-1βbetween the two groups was statistically significant(P<0.05).The levels of IL-1β,IL-6 and IL-8 in the synovial fluid of the two groups were lower than those before treatment,and the levels in the observation group were lower than those in the control group(all P<0.01).After a 6-month follow-up,the observation group had a lower recurrence rate compared to the control group(6.00%vs.22.00%,χ^(2)=5.316,P=0.021).Conclusion The clinical effect of external application of traditional Chinese medicine and moxibustion combined with modified Yanghe Decoction in the treatment of wind cold damp retention type of knee arthritis is positive.It can improve patients′blood circulation and inhibit the release of inflammatory factors in multiple ways and targets,and the curative effect is significant and lasting.