牛蒡子汤联合石氏推拿治疗痰湿阻络型膝骨关节炎的临床研究

Clinical Study of Niubangzi Decoction Plus Shishi Massage in Treating Phlegm-dampness Blocking Collaterals Type Knee Osteoarthritis

目的:探讨牛蒡子汤联合石氏推拿治疗痰湿阻络型膝关节骨性关节炎(KOA)的临床疗效。方法:选取2017年5月至2018年10月在本院就诊的108例痰湿阻络型KOA患者,采用随机数字表法随机分成观察组54例和对照组54例。观察组采取牛蒡子汤联合石氏推拿治疗,对照组则给予关节腔内注射玻璃酸钠治疗,所有患者均治疗5周。对比两组临床疗效、治疗前后膝关节功能(西安大略和麦克马斯特大学(WOMAC)骨关节炎指数评分)、生活质量(关节炎生活质量测量量表2-短卷(AIMS2-SF)评分)、炎症因子(白介素IL-1,IL-6)、肿瘤坏死因子(TNF-α)水平变化以及副作用发生情况。结果:观察组总有效率为98.15%(53/54),与对照组的83.33%(45/54)相比显著升高,差异有统计学意义(P<0.05)。两组治疗后WOMAC骨关节炎指数中各维度(疼痛程度、僵硬状态、日常生活受限)评分及其总分均较治疗前显著减少,差异有统计学意义(P<0.05),且观察组降低更显著,差异有统计学意义(P<0.05)。两组治疗后AIMS2-SF中各维度(症状、躯体、影响等5个维度)评分及其总分均较治疗前显著增高,差异有统计学意义(P<0.05),而观察组上升更显著,差异有统计学意义(P<0.05)。两组治疗后各项炎症因子(IL-1,IL-6及TNF-α)血清浓度均较治疗前显著下降,差异有统计学意义(P<0.05),但观察组减低更显著,差异有统计学意义(P<0.05)。观察组不良反应率3.70%(2/54)较对照组1.85%(1/54),差异无统计学意义(P>0.05)。结论:牛蒡子汤联合石氏推拿治疗痰湿阻络型KOA能有效促进患者临床症状的缓解,提高膝关节功能,改善生活质量,疗效确切,且安全性较高。

Objective:To explore the clinical efficacy of Niubangzi decoction plus Shishi massage in treating knee osteoarthritis(KOA)of syndrome of phlegm-dampness blocking collaterals.Methods:The subjects of this study,108 KOA patients with syndrome of phlegm-dampness blocking collaterals admitted in our hospital from May 2017 to October 2018,were divided into observation group 54 cases and control group 54 cases on the basis of random number table.The observation group was treated with combination of Niubangzi decoction and Shishi massage,while the control group sodium hyaluronate injection into the articular cavity.All patients were treated for 5 weeks.The clinical efficacy,changes of joint function(the Western Ontario and McMaster Universities(WOMAC)score for osteoarthritis index)and life quality(the Arthritis Measurement Scales 2-Short Form(AIMS2-SF)score)as well as inflammatory factors(interleukin IL-1,IL-6,tumor necrosis factor(TNF-α)levels)before and after treatment,and occurrence of side effect were compared between the two groups.Results:The overall effective rate of the observation group was 98.15%(53/54),much higher than 83.33%(45/54)of the control group(P<0.05).After treatment the scores in each WOMAC dimension(pain degree,stiffness,physical restrictions in daily life)and their total scores of the two groups decreased remarkably as compared with those before the treatment(P<0.05),and the decrease the observation group saw was more obvious(P<0.05).The scores in each AIMS2-SF dimension(5 dimensions including syndromes,body,influence etc)and their total scores of the two groups after treatment were much higher than those before the treatment(P<0.05),and the rise the observation group saw was more obvious(P<0.05).After treatment both groups saw obviously lower inflammatory factor levels(IL-1,IL-6,TNF-α)than they did before the treatment,and the drop the observation group witnessed was more significant(P<0.05).The incidence of side effect of the observation group was 3.70%(2/54),seeing no big difference from 1.85%(1/54)of the control group(P>0.05).Conclusion:In treating KOA patients of syndrome of phlegm-dampness blocking collaterals,the combination of Niubangzi decoction and Shishi massage can significantly relieve clinical symptoms in patients,improve their joint function and better their life quality,proving to be effective and safe.