凉泻针法辅助治疗活动期湿热痹阻证类风湿关节炎腕关节病变:随机对照试验

Cold reducing acupuncture as adjunctive therapy for wrist joint disorder of active rheumatoid arthritis with dampness-heat obstruction:a randomized controlled trial

目的:比较凉泻针法联合西药与单纯西药治疗活动期湿热痹阻证类风湿关节炎(RA)腕关节病变的临床疗效。方法:将80例活动期湿热痹阻证RA腕关节病变患者随机分为针药组(40例,脱落3例)和西药组(40例,脱落3例)。西药组予甲氨蝶呤片治疗,每次15 mg,每周1次;针药组在西药组基础上行凉泻针法治疗,穴取双侧合谷、后溪、外关等,每日1次,每周5次。两组均治疗8周。比较两组患者治疗前后腕关节疼痛视觉模拟量表(VAS)评分、腕关节肿胀评分、腕关节晨僵评分、Cooney腕关节功能评分、腕关节超声及血清C-反应蛋白(CRP)含量、红细胞沉降率(ESR)。结果:治疗后,两组患者腕关节疼痛VAS评分、肿胀评分、晨僵评分、滑膜炎灰阶超声(GSUS)分级、滑膜炎能量多普勒超声(PDUS)分级及血清CRP含量、ESR均较治疗前降低(P<0.05),Cooney腕关节功能评分较治疗前升高(P<0.05);针药组患者腕关节疼痛VAS评分、肿胀评分、滑膜炎PDUS分级及血清CRP含量、ESR均低于西药组(P<0.05),Cooney腕关节功能评分高于西药组(P<0.05)。结论:凉泻针法联合西药治疗活动期湿热痹阻证RA腕关节病变能减轻患者临床症状、改善关节功能活动、降低炎性反应,疗效优于单纯西药治疗。

Objective To compare the clinical efficacy between cold reducing acupuncture combined with western medication and western medication alone for wrist joint disorder of active rheumatoid arthritis(RA)with dampness-heat obstruction.Methods A total of 80 patients with wrist joint disorder of active RA with dampness-heat obstruction were randomly divided into a combination group(40 cases,3 cases dropped out)and a western medication group(40 cases,3 cases dropped out).The western medication group was treated with methotrexate tablets,15 mg each time,once a week.The combination group was treated with cold reducing acupuncture at bilateral Hegu(LI 4),Houxi(SI 3),Waiguan(TE 5),etc.on the basis of the western medication group,once a day,5 times a week.Both groups were treated for 8 weeks.The pain visual analogue scale(VAS)score,swelling score,morning stiffness score,Cooney wrist joint function score,ultrasound of wrist joint and serum level of C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)before and after treatment were compared in the two groups.Results After treatment,the pain VAS scores,swelling scores,morning stiffness scores,grey scale ultrasound(GSUS)grade of synovitis,power doppler ultrasound(PDUS)grade of synovitis of wrist joint and serum levels of CRP and ESR in the two groups were reduced compared with those before treatment(P<0.05),the Cooney wrist joint function scores were increased compared with those before treatment(P<0.05);the pain VAS score,swelling score,PDUS grade of synovitis of wrist joint and serum level of CRP and ESR in the combination group were lower than those in the western medication group(P<0.05),the Cooney wrist joint function score was higher than that in the western medication group(P<0.05).Conclusion Cold reducing acupuncture combined with western medication could improve clinical symptoms and joint function,reduce inflammatory response in patients with wrist joint disorder of active RA with dampness-heat obstruction,and the efficacy is better than that of western medication alone.