针刺膝八针联合独活寄生汤治疗肝肾亏虚型膝骨性关节炎

Discussion on the mechanism of acupuncture at knee eight acupoints combined with Duhuo Jisheng decoction in the treatment of knee osteoarthritis with the liver-kidney deficiency pattern

目的观察针刺膝八针联合独活寄生汤治疗肝肾亏虚型膝骨性关节炎患者临床疗效,探讨两者协同作用。方法选取120例膝骨性关节炎患者,随机分为针刺组、中药组与针药结合组。针刺组予针刺激痛点治疗,中药组予独活寄生汤治疗,针药结合组予针刺激痛点联合独活寄生汤治疗。统计3组治疗前后VAS评分、膝骨性关节炎WOMAC评分,检测3组血清炎性因子白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)含量,比较3组中医证候积分、中医证候疗效。结果治疗后3组VAS评分、WOMAC指数评分均较治疗前明显降低(P<0.05),针药结合组明显优于中药组和针刺组(P<0.05)。治疗后3组IL-6、TNF-α水平均较治疗前明显降低(P<0.05),针药结合组优于中药组和针刺组(P<0.05)。治疗后3组中医证候积分均显著降低(P<0.05),针药结合组中医证候积分优于中药组和针刺组(P<0.05);针药结合组中医证候疗效优于中药组和针刺组(P<0.05)。结论激痛点针刺法联合独活寄生汤治疗肝肾亏虚型膝骨性关节炎疗效优于单独使用独活寄生汤或激痛点针刺疗法,激痛点针刺法联合独活寄生汤治疗可活化Wnt/β-catenin信号通路中信号级联,通过抑制炎症因子IL-6、TNF-α产生,减少炎症反应,缓解关节疼痛、改善关节活动,临床疗效明显。

Objective To observe the clinical effect of acupuncture at knee eight acupoints combined with Duhuo Jisheng decoction in the treatment of patients with knee osteoarthritis of the liver-kidney deficiency syndrome,and to explore their synergistic effect.Methods A total of 120 patients with knee osteoarthritis were randomly divided into an acupuncture group(acupuncture at MTrPs),a traditional Chinese medicine group(Duhuo Jisheng decoction)and an acupuncture and TCM combination group(acupuncture at MTrPs and Duhuo Jisheng decoction).The VAS scores and knee osteoarthritis WOMAC scores were statistically analysed before and after treatment.The levels of serum inflammatory factor interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were measured.The TCM syndrome scores and TCM syndrome curative effect were compared in the three groups.Results After treatment,the VAS scores and WOMAC index scores of the three groups were significantly lower than before treatment,and the acupuncture and TCM combination group was significantly better than the other two groups(P<0.05).After treatment,the levels of IL-6 and TNF-αin the three groups were significantly lower than before treatment,and the acupuncture and TCM combination group was significantly better than the TCM group and the acupuncture group(P<0.05).After treatment,the TCM syndrome scores of the three groups were significantly reduced,and the acupuncture and TCM combination group was significantly better than the TCM group and the acupuncture group(P<0.05).Conclusion The curative effect of acupuncture at MTrPs combined with Duhuo Jisheng decoction is superior to that with Duhuo Jisheng decoction or acupuncture alone.Acupuncture at MTrPs combined with Duhuo Jisheng decoction can activate the signal cascade in the Wnt/β-catenin signaling pathway,reduce inflammation by inhibiting the production of inflammatory factors IL-6 and TNF-α,relieve joint pain,improve joint activity,with significant clinical efficacy.