刺络拔罐联合骨痹散外敷治疗膝骨关节炎疗效观察及对软骨组织相关信号通路的影响

Observation on the Clinical Efficacy of Pricking Collaterals and Cupping Combined with External Application of Gubi San on Knee Osteoarthritis and Its Influence on Cartilage Tissue Related Signaling Pathways

目的:观察刺络拔罐联合骨痹散外敷治疗膝骨关节炎的疗效及对软骨组织相关信号通路的影响。方法:选取72例膝骨关节炎患者作为研究对象,按随机数字表法分为观察组及对照组各36例。对照组给予骨痹散外敷,观察组给予刺络拔罐联合骨痹散外敷治疗,2组均治疗4周。比较2组临床疗效,比较2组治疗前后疼痛视觉模拟评分法(VAS)评分、“起立-行走”计时测试(TUGT)、中医证候积分、最大主动关节活动度(AROM)、膝关节评分表(KSS)、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)、软骨组织相关信号通路指标值[白细胞介素-1β(IL-1β)、环氧化酶-2(COX-2)]的变化。结果:观察组临床疗效总有效率为97.22%,对照组为83.33%,2组临床疗效比较,差异有统计学意义(P<0.05)。治疗2周、4周后,2组VAS评分、TUGT指标值均较治疗前下降(P<0.05),观察组VAS评分、TUGT指标值均低于对照组(P<0.05)。治疗后,2组关节疼痛、胫软膝酸、活动不利、动作牵强中医证候积分均较治疗前下降(P<0.05),观察组上述4项中医证候积分均低于对照组(P<0.05)。治疗2周、4周后,2组AROM活动度、KSS指标值均较治疗前升高(P<0.05),观察组AROM活动度、KSS指标值均高于对照组(P<0.05)。治疗后,2组疼痛、僵硬、日常生活难度WOMAC评分均较治疗前下降(P<0.05),观察组上述3项WOMAC评分均低于对照组(P<0.05)。治疗后,2组IL-1β、COX-2指标值均较治疗前升高(P<0.05),观察组IL-1β、COX-2指标值均高于对照组(P<0.05)。结论:刺络拔罐联合骨痹散外敷治疗膝骨关节炎疗效较好,能减退关节肿痛程度,改善膝关节活动度,促进患者自主生活能力的恢复,有效缓解关节疼痛、活动不利等症状。

Objective:To observe the effect of the therapy of pricking collaterals and cupping combined with external application of Gubi San on knee osteoarthritis and its influence on cartilage tissue related signaling pathways.Methods:A total of 72 patients with knee osteoarthritis were selected as the study objects,and were divided into the observation group and the control group according to the random number table method,with 36 cases in each group.The control group was given external application of Gubi San,and the observation group was given pricking collaterals and cupping combined with external application of Gubi San,and both groups were treated for four weeks.The clinical effects in the two groups were compared,and the changes of Visual Analogue Scale(VAS),Time Up and Go Test(TUGT),traditional Chinese medicine(TCM)syndrome scores,maximum active range of motion(AROM),Knee Society Score(KSS),Western Ontario and McMaster Universities Arthritis Index(WOMAC),and indexes of cartilage tissue related signaling pathways[interleukin-1β(IL-1β),cyclooxygenase-2(COX-2)]before and after treatment were compared between the two groups.Results:The total effective rate was 97.22%in the observation group,and 83.33%in the control group,the difference being significant(P<0.05).After two weeks and four weeks of treatment,the VAS scores and TUGT levels in the two groups were decreased when compared with those before treatment(P<0.05);the VAS score and TUGT level in the observation group were lower than those in the control group(P<0.05).After treatment,the TCM syndrome scores of joint pain,leg weakness and knee soreness,poor movement and difficulty in operation in the two groups were decreased when compared with those before treatment(P<0.05);the above four TCM syndrome scores in the observation group were lower than those in the control group(P<0.05).After two weeks and four weeks of treatment,the AROM activity and KSS levels in the two groups were increased when compared with those before treatment(P<0.05);the AROM activity and KSS level in the observation group were higher than those in the control group(P<0.05).After treatment,the WOMAC scores of pain,stiffness and difficulty of daily life in the two groups were decreased when compared with those before treatment(P<0.05),and the above three WOMAC scores in the observation group were lower than those in the control group(P<0.05).After treatment,the IL-1βand COX-2 levels in the two groups were increased when compared with those before treatment(P<0.05),and the IL-1βand COX-2 levels in the observation group were higher than those in the control group(P<0.05).Conclusion:The therapy of pricking collaterals and cupping combined with external application of Gubi San has a great curative effect on knee osteoarthritis,which can reduce the degree of joint swelling and pain,improve the knee joint activity,promote the recovery of patients'independent living ability,and effectively relieve joint pain,poor movement and other symptoms.