针刺联合督灸治疗强直性脊柱炎的疗效观察

Observation on the efficacy of acupuncture plus moxibustion on Governor Vessel for ankylosing spondylitis

目的 观察针刺联合督灸治疗强直性脊柱炎的临床疗效及对AKT/PI3K/mTOR信号通络的影响。方法将96例强直性脊柱炎患者随机分为两组(观察组和对照组),每组48例。对照组口服美洛昔康治疗,观察组予针刺联合督灸治疗。观察两组治疗前后巴氏强直性脊柱炎病情评测指数(Bath ankylosing spondylitis disease activity index,BASDAI)和巴氏强直性脊柱炎活动能力量表(Bath ankylosing spondylitis functional index,BASFI)评分、血清炎性因子[核因子-κB(nuclear factor-κB,NK-κB)、巨噬细胞移动抑制因子(macrophage migration inhibitory factor,MIF)、CC趋化因子受体6(CC chemokine receptor 6,CCR6)和单核细胞趋化蛋白-4(monocyte chemokine protein-4,MCP-4)]水平、骨化相关蛋白[基质金属蛋白酶组织抑制剂-2(matrix metalloproteinase tissue inhibitor-2,TIMP-2)、高迁移率族蛋白B1(high mobility group protein box 1,HMGB1)、Dickkopf相关蛋白-1(dickkopf-related protein-1,DKK-1)和骨硬化蛋白(sclerostin,SOST)]水平以及AKT/PI3K/mTOR信号通路[蛋白激酶B(protein kinase B,AKT)、磷脂酰肌醇-3-激酶(phosphatidylinositol-3-kinase,PI3K)和雷帕霉素靶蛋白(mammalian target of rapamycin,mTOR)]水平的变化。比较两组临床疗效及不良反应发生情况。结果 观察组总有效率为97.9%,高于对照组的81.8%(P<0.05)。观察组治疗后、随访3个月及6个月BASDAI和BASFI评分均低于对照组(P<0.05)。观察组治疗后血清NK-κB、MIF、CCR6、MCP-4、TIMP-2、HMGB1、AKT、PI3K和mTOR水平均低于对照组(P<0.05),DKK-1和SOST水平高于对照组(P<0.05)。结论 针刺联合督灸可明显缓解强直性脊柱炎患者的临床症状,疗效优于口服美洛昔康治疗,并可调节AKT/PI3K/mTOR信号通络的表达。

Objective To observe the clinical efficacy of acupuncture plus moxibustion on Governor Vessel for ankylosing spondylitis and its effect on the AKT/PI3K/m TOR signaling pathway.Method Ninety-six patients with ankylosing spondylitis were randomized to two groups(an observation group and a control group),with 46 cases in each group.The control group received oral administration of Meloxicam and the experimental group received acupuncture plus moxibustion on Governor Vessel.The Bath ankylosing spondylitis disease activity index(BASDAI)score and the Bath ankylosing spondylitis functional index(BASFI) score were recorded and serum inflammatory factors [nuclear factor-κB(NK-κB),macrophage migration inhibitory factor(MIF),CC chemokine receptor 6(CCR6) and monocyte chemokine protein-4(MCP-4)] levels,ossification associated proteins [(matrix metalloproteinase tissue inhibitor-2(TIMP-2),high mobility group protein box 1(HMGB1),dickkopf-related protein-1(DKK-1) and sclerostin(SOST)] levels and the AKT/PI3K/mTOR signaling pathway [protein kinase B(AKT),phosphatidylinositol-3-kinase(PI3K) and mammalian target of rapamycin(mTOR)] levels were measured in the two groups before and after treatment.The clinical therapeutic effects and the incidences of adverse reactions were compared between the two groups.Result The total efficacy rate was 97.9% in the observation group,which was higher than 81.8% in the control group(P<0.05).After treatment and at 3-and 6-month follow-ups,the BASDAI and BASFI scores were lower in the observation group than those in the control group(P<0.05).After treatment,serum NK-κB,MIF,CCR6,MCP-4,TIMP-2,HMGB1,AKT,PI3K and mTOR levels were lower,and serum DKK-1 and SOST levels were higher in the observation group than those in the control group(P<0.05).Conclusion Acupuncture plus moxibustion on Governor Vessel can markedly relieve the clinical symptoms in patients with ankylosing spondylitis.It is more effective than oral administration of Meloxicam and can regulate the expression of the AKT/PI3K/mTOR signaling pathway.