耳穴贴压联合电针治疗膝骨性关节炎的作用机制研究

Mechanism of different acupoints combined with acupuncture and moxibustion and auricular point sticking and pressing combined with electroacupuncture in the treatment of knee osteoarthritis

目的:研究耳穴贴压联合电针对治疗膝骨性关节炎(Osteoarthritis, OA)的作用机制。方法:研究将某医院骨科门诊就诊的OA患者进行了随机分组,分别分为耳穴组、试验1组、试验2组,每组各30例。其中耳穴组以耳穴贴压联合电针治疗。试验1组以足三里和阳陵泉进行针灸疗法,试验2组以足三里和阳陵泉进行针灸治疗的同时结合单纯耳穴贴压治疗。针灸治疗每7天1个疗程,共分为3个疗程。每完成1个疗程后即利用电子测痛仪检测患者膝关节的疼痛情况,在完成3个疗程后利用旷场实验和H&E染色实验来检测患者的自发活动能力和病理学改变情况。此外,通过酶联免疫吸附测定(Enzyme-Linked Immunosorbent Assay, ELISA)法对患者的膝关节积液进行检测,并对其血清中的IL-1β和TNF-α表达水平进行分析。结果:耳穴组、试验1组和试验2组的IL-1β表达水平分别为25.37ng/L±4.87ng/L、46.57ng/L±7.09ng/L和36.25ng/L±4.49ng/L(P<0.05),TNF-α的表达水平分别为120.90ng/L±12.44ng/L、260.89ng/L±21.89ng/L和198.55ng/L±20.31ng/L(P<0.05)。结论:耳穴贴压联合电针治疗相较于针灸治疗膝骨性关节炎的疗效更为确切,能有效改善膝关节运动功能以及降低关节滑液炎性指标IL-1β、TNF-α的表达。

Objective Study the mechanism of ear acupoint pressing combined with electroacupuncture in the treatment of knee osteoarthritis(OA).Methods Ninety patients with osteoarthritis were randomly divided into a control group,experimental group 1,and experimental group 2,with 30 cases in each group,from the outpatient departments of Traditional Chinese Medicine and Orthopedics at the 90th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army.The ear acupoint group treated with ear acupoint pressing combined with electroacupuncture.Group 1 was treated with acupuncture and moxibustion at Zusanli and Yanglingquan,and group 2 was treated with acupuncture and moxibustion in combination with Zusanli and Shenshu.Acupuncture and moxibustion treatment is a course of treatment every 7 days,which is divided into 3 courses.After each course of treatment,electronic pain gauges are used to detect the patient's knee joint pain.After completing three courses,open field experiments and H&E staining experiments are used to detect the patient's spontaneous activity ability and pathological changes.In addition,the knee joint effusion of patients was detected by enzyme-linked immunosorbent assay(ELISA)and IL-1 in their serum was measuredβAnd TNF-αAnalyze the expression level.Results The IL-1 in Ear Acupoint Group,Experiment 1 Group,and Experiment 2 GroupβThe expression levels were 25.37ng/L±4.87ng/L,46.57ng/L±7.09ng/L,and 36.25ng/L±4.49ng/L,respectively(P<0.05),indicating TNF-αThe expression levels were 120.90ng/L±12.44ng/L,260.89ng/L±21.89ng/L,and 198.55ng/L±20.31ng/L,respectively(P<0.05).Conclusion Ear point sticking and pressing combined with electroacupuncture is more effective than acupuncture and moxibustion in treating knee osteoarthritis,which can effectively improve the movement function of the knee joint and reduce the expression of inflammatory indicators IL-1βand TNF-αof synovial fluid.