重骨颗粒结合督脉灸治疗强直性脊柱炎患者的临床效果

Clinical effect of Zhonggu granules combined with governor vessel moxibustion in the treatment of ankylosing spondylitis

目的评估重骨颗粒结合督脉灸治疗强直性脊柱炎患者的临床疗效。方法选取2022年1月至2023年8月陕西中医药大学附属医院收治的128例强直性脊柱炎患者,通过掷硬币法将患者分为试验组和对照组,每组64例。对照组男33例,女31例,年龄(34.89±8.21)岁,病程(8.29±4.63)年。试验组男32例,女32例,年龄(34.56±8.43)岁,病程(8.34±4.57)年。对照组接受常规药物治疗,口服柳氮磺吡啶肠溶片(每次1.0 g,每日2次)+塞来昔布胶囊(每次0.2 g,每日1次)。试验组接受重骨颗粒(每次10 g,每日2次,温水冲服)结合督脉灸(每次持续100 min,1次/周)治疗。两组疗程均为3个月。对比两组的Bath强直性脊柱炎疾病活动指数(BASDAI)及Bath强直性脊柱炎功能指数(BASFI)、中医症状评分、炎症极化指标[M1型巨噬细胞CD86、M2型巨噬细胞CD16表达、基质金属蛋白酶3(MMP-3)、肿瘤坏死因子(TNF)-α]、骨代谢指标[Ⅰ型前胶原氨基端前肽(PINP)、血清β胶原降解产物(β-CTX)、骨特异性碱性磷酸酶(BALP)]、体征指标(指地距、胸廓扩展度、枕墙距)、临床疗效。统计学方法采用t检验、χ^(2)检验。结果治疗3个月后,试验组的BASDAI、BASFI、中医症状评分分别为(2.82±0.40)分、(3.38±0.48)分、(2.91±0.34)分,均低于对照组的(4.05±0.58)分、(4.26±0.61)分、(4.64±0.66)分,差异均有统计学意义(t=13.966、9.070、18.642,均P<0.001);两组M1型巨噬细胞CD86、M2型巨噬细胞CD16、MMP-3、TNF-α、PINP、β-CTX、BALP水平比较,差异均有统计学意义(t=2.761、4.094、4.245、9.505、4.056、3.536、4.356,均P<0.05);试验组的指地距、胸廓扩展度、枕墙距分别为(16.24±3.04)cm、(5.11±0.94)cm、(2.76±1.05)cm,对照组分别为(22.39±3.15)cm、(4.42±1.08)cm、(4.02±1.21)cm,差异均有统计学意义(t=11.239、3.855、6.292,均P<0.001);试验组的临床治疗总有效率高于对照组[93.75%(60/64)比79.68%(51/64)],差异有统计学意义(χ^(2)=5.494,P=0.019)。结论重骨颗粒结合督脉灸治疗强直性脊柱炎,能有效降低BASDAI、BASFI评分,减轻中医症状,调节炎症极化和骨代谢指标,改善体征指标,证明其为一种安全有效的治疗方法。

Objective To evaluate the clinical efficacy of Zhonggu granules combined with governor vessel moxibustion in the treatment of ankylosing spondylitis.Methods A total of 128 patients with ankylosing spondylitis admitted to Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine from January 2022 to August 2023 were selected and were divided into an experimental group and a control group by coin tossing,with 64 cases in each group.In the control group,there were 33 males and 31 females,aged(34.89±8.21)years,and the course of disease was(8.29±4.63)years.In the experimental group,there were 32 males and 32 females,aged(34.56±8.43)years,and the course of disease was(8.34±4.57)years.The control group received conventional drug treatment,oral salazosulfapyridine enteric-coated tablets(1.0 g each time,twice a day)+celecoxib capsules(0.2 g each time,once a day).The experimental group received Zhonggu granules(10 g each time,twice a day,infused with warm water)combined with governor vessel moxibustion(100 min each time,once a week).The treatment course was 3 months.The Bath Ankylosing Spondylitis Disease Activity Index(BASDAI),Bath Ankylosing Spondylitis Function Index(BASFI),traditional Chinese medicine(TCM)symptom score,inflammatory polarization indicators[M1 macrophage CD86 expression,M2 macrophage CD16 expression,matrix metalloproteinase 3(MMP-3),and tumor necrosis factor(TNF)-α],bone metabolism indicators[N-terminal propeptide of type I procollagen(PINP),serumβ-C-terminal telopeptide of type I collagen(β-CTX),and bone-specific alkaline phosphatase(BALP)],physical examination indicators(finger-to-floor distance,chest expansion,and occiput-to-wall distance),and clinical efficacy were compared between the two groups.Statistical methods included t test andχ^(2)test.Results After 3 months of treatment,the BASDAI,BASFI,and TCM symptom score of the experimental group were(2.82±0.40)points,(3.38±0.48)points,and(2.91±0.34)points,which were lower than those of the control group[(4.05±0.58)points,(4.26±0.61)points,and(4.64±0.66)points],with statistically significant differences(t=13.966,9.070,and 18.642,all P<0.001).There were statistically significant differences in the M1 macrophage CD86 expression,M2 macrophage CD16 expression,and levels of MMP-3,TNF-α,PINP,β-CTX,and BALP between the two groups(t=2.761,4.094,4.245,9.505,4.056,3.536,and 4.356,all P<0.05).The finger-to-floor distance,chest expansion,and occiput-to-wall distance of the experimental group were(16.24±3.04)cm,(5.11±0.94)cm,and(2.76±1.05)cm,and those of the control group were(22.39±3.15)cm,(4.42±1.08)cm,and(4.02±1.21)cm,with statistically significant differences(t=11.239,3.855,and 6.292,all P<0.001).The total effective rate of the experimental group was higher than that of the control group[93.75%(60/64)vs.79.68%(51/64)],with a statistically significant difference(χ^(2)=5.494,P=0.019).Conclusion Zhonggu granules combined with governor vessel moxibustion in the treatment of ankylosing spondylitis can effectively reduce the BASDAI and BASFI,alleviate the TCM symptoms,regulate the inflammatory polarization and bone metabolism indexes,and improve the physical examination indexes,proving to be a safe and effective treatment method.