四妙散加味联合针灸对膝关节滑膜炎患者炎症因子、疼痛介质及关节功能的影响

Effect of Modified Simiaosan Combined with Acupuncture on Inflammatory Factor,Pain Medium and Joint Function in Patients with Knee Synovitis

目的:观察四妙散加味联合针灸治疗膝关节滑膜炎患者的临床疗效。方法:158例膝关节滑膜炎患者按照随机数字表法随机平均分为观察组与对照组。对照组给予患膝关节腔内注射玻璃酸钠+曲安奈德+口服塞来昔布+针灸治疗,观察组给予四妙散加味+针灸治疗。所有患者均治疗4周。比较两组患者临床疗效,治疗前后患膝关节液内肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-1β(interleukin 1 beta,IL-1β)、IL-6水平,血清中前列腺素(prostaglandin E2,PGE2)、NO、5-羟色胺(5-hydroxytryptamine,5-HT)水平,Lysholm膝关节评分系统(Lysholm knee score,LKSS)评分,膝关节麦克马斯特大学骨关节炎指数(the Western Ontario and McMaster university,WOMAC)各项评分及不良反应发生情况。结果:观察组有效率为93.7%(74/79),明显高于对照组[82.3%(65/79),P<0.05]。治疗后两组患膝关节液内各项炎性因子(TNF-α、IL-1β、IL-6)水平和血清中各项疼痛介质(PGE2、NO、5-HT)水平均显著低于治疗前(P<0.05),LKSS评分显著升高(P<0.05);且观察组改善显著优于对照组(P<0.05)。与对照组比较,治疗2周、4周和治疗结束后4周,观察组膝关节WOMAC各项评分均低于对照组,差异有统计学意义(P<0.05)。观察组不良反应率[3.8%(3/79)]与对照组[1.3%(1/79)]比较,差异无统计学意义(P>0.05)。结论:四妙散加味联合针灸治疗膝关节滑膜炎疗效显著,可明显缓解患者症状,下调患膝关节液内炎症因子水平,降低外周血中疼痛介质水平,促进膝关节功能恢复,且无明显不良反应。

Objective:To observe the clinical effect of Modified Simiaosan combined with acupuncture in the treatment of knee synovitis.Methods:158 patients with knee synovitis were randomly divided into observation group and control group according to the random number table method.The control group was given intra-articular injection of sodium hyaluronate+triamcinolone acetonide+oral celecoxib+acupuncture treatment,while the observation group was given modified Simiaosan+acupuncture treatment.All patients were treated for 4 weeks.The clinical efficacy of the two groups was compared.The levels of tumor necrosis factorα(TNFα),interleukin-1β(IL-1β),IL-6 in knee joint fluid and serum prostate,protaglandin E2(PGE2),NO,5-hydroxytryptamine(5 HT),Lysholm knee score system(LKSS),the western Osteoarthritis and McMaster university(WOMAC)and the incidence of adverse reactions were measured before and after treatment.Results:The effective rate of the observation group was 93.7%(74/79),which was significantly higher than that of the control group[82.3%(65/79),P<0.05].After treatment,the levels of inflammatory factors(TNF-α,IL-1β,IL-6)in knee joint fluid and pain mediators(PGE2,NO,5 HT)in serum of the two groups were significantly lower than those before treatment(P<0.05),and the LKSS score was significantly higher(P<0.05),and the observation group was improved significantly better than the control group(P<0.05).Compared with the control group,the WOMAC scores of the knee joint in the observation group were lower than those in the control group after 2,4 and 4 weeks of treatment(P<0.05).There was no significant difference in the rate of adverse reactions between the observation group[3.8%(3/79)]and the control group[1.3%(1/79)](P>0.05).Conclusion:Modified Simiaosan combined with acupuncture has a remarkable effect on knee synovitis.It can relieve the symptoms of patients,reduce the level of inflammatory factors in knee joint fluid,reduce the level of pain mediators in peripheral blood,and promote the recovery of knee joint function without obvious adverse reactions.