“双固一通”温针灸治疗膝骨性关节炎疗效观察及对血清炎性因子表达的影响

目的:探讨"双固一通"温针灸治疗膝骨性关节炎(KOA)的临床疗效及作用机制。方法:选取KOA患者90例,随机分为观察组和对照组各45例,对照组口服双氯芬酸钠缓释片治疗,观察组给予"双固一通"温针灸法治疗,观察并比较两组患者治疗前后膝关节功能、血清炎性因子水平,评定临床疗效。结果:治疗后观察组疼痛评分、关节僵硬评分、日常生活评分及总分均低于对照组(P<0.01);血清转化生长因子β(TGF-β)、胰岛素样生长因子-1(IGF-1)、成纤维细胞生长因子-2(FGF-2)水平均高于对照组(P<0.01),治疗愈显率高于对照组(P<0.05)。结论:"双固一通"温针灸法可有效改善KOA患者膝关节功能,抑制炎症反应,疗效显著。

Effects of 650 nm-10.6 μm Combined Laser Acupuncture-Moxibustion on Knee Osteoarthritis: A Randomized,Double-blinded and Placebo-controlled Clinical Trial

Objective： To evaluate the effects of 650 nm-10.6 μm combined laser in patients with knee Osteoarthritis （OA） and to determine whether the combined laser provides greater pain relief and improved function compared with red light. Methods： Forty-eight patients with knee OA were randomly allocated to two groups （24 per group）, receiving 20 min irradiation with 650 nm -10.6 μm combined laser or red light emitting diode respectively on point Dubi （ST 35） 3 times a week for the first course （2 weeks） and twice a week for the second one （4 weeks）. The main outcome measures were WOMAC （Western Ontario and McMaster Universities Osteoarthritis Index） scores. In addition, patients＇ global assessment, adverse effects and validation of patient blinding were analyzed. Results： All the patients completed the in：st course, but 12 were lost during the second one. Due to the high dropout rate by the second course, only the data acquired from the first course could be analyzed. No differences of general data of patients and WOMAC scores were found in between-group comparison before treatment （P〉0.05）. The WOMAC scores of patients in both combined laser group and red light group reduced significantly compared to baseline by the end of the first course （P〈0.01）. There were no significant differences on the reduction rate of WOMAC scores between two groups （P〉0.05）. Neither the patients＇ global assessment nor the dropout rate showed statistical differences between two groups （P〉0.05）. There was no difference between two groups in patients correctly guessing the treatment assignment （P〉0.05）. There was no significant difference in the reduction rate of WOMAC scores and the patients＇ global assessment between patients who guessed their assignment （P〉0.05）. Conclusion： Both combined laser and red light irradiation are beneficial to patients with knee OA. But as the statistical indifferences between two groups, the authors can＇t conclude from this study whether the combined laser is more effective.

Clinical Observation on Treatment of 60 Cases of Osteoarthritis of Knee Joint by Electroacupuncture

Purpose To observe therapeutic effect of electroacupuncture Neixiyan (Ex-LE 4) and Dubi (ST 35) in treating osteoarthritis of knee joint.Method All the 120 cases were randomly divided into electroacupuncture and control groups, 60 cases in each group, and they were given electroacupuncture and Ritalin slowreleased tablet respectively, and pain, mobility and swelling degree of knee joint were observed before and after treatments.Results In treatment group, the average score increased by 18, while in control group, it increased by 12.33 (P<0.05) after treatment.Conclusion Therapeutic effect of electroacupuncture Neixiyan (Ex-LE 4) and Dubi (ST 35) in treating osteoarthritis of knee joint was better than that of administration of Ritalin slow-released tablet. Key Words Electroacupuncture - Point Ex-LE 4 (Neixiyan) - Point ST 35 (Dubi) - Osteoarthritis - Knee Joint Author: DAI Qi-ping (1966-), female, attending physicianTranslator: Wu Xue-fei

热敏灸干预膝骨性关节炎兔模型效应机制的研究

目的:观察热敏灸对膝骨性关节炎(KOA)兔模型一氧化氮(NO)、含Ⅰ型血小板结合蛋白基序的解聚蛋白样金属蛋白酶-4(ADAMTS-4)、Ⅱ型胶原、蛋白多糖(PG)的影响,探讨热敏灸治疗KOA的作用机制。方法:42只雄性日本长耳兔按随机数字表随机分为空白组(6只)、模型组(6只)、艾灸组(24只)、假手术组(6只)。空白组正常饲养,模型组与艾灸组采用木瓜蛋白酶注射膝关节腔建立KOA模型,每日强迫活动30 min,造模15 d。假手术组腔内注射0.9%Na Cl溶液。造模结束后,艾灸组艾灸"犊鼻"穴,每日1次,每次40 min,共14 d,根据兔艾灸过程中温度变化分为热敏灸组和非热敏灸组,两组各随机抽取6只;空白组、模型组、假手术组正常饲养,不予任何刺激。观察各组兔体质量、行为学变化;干预结束后,采用硝酸还原法检测血清NO含量,Real-time PCR法检测软骨ADAMTS-4、Ⅱ型胶原、PG含量。结果:(1)造模后,与空白组相比,模型组、热敏灸组、非热敏灸组、假手术组兔体质量均下降,Lequesne MG评分升高(P<0.05,P<0.01)。干预后,与空白组相比,模型组、假手术组兔体质量仍下降,Lequesne MG评分升高(P<0.05,P<0.01);与模型组相比,热敏灸组、非热敏灸组、假手术组干预后兔体质量升高,Lequesne MG评分降低(P<0.05,P<0.01);与非热敏灸组相比,热敏灸组兔体质量明显升高(P<0.05),但Lequesne MG评分比较差异无统计学意义(P>0.05)。(2)干预后,与空白组相比,模型组、热敏灸组、非热敏灸组、假手术组NO、ADAMTS-4表达均升高,Ⅱ型胶原、PG表达均下降(P<0.05,P<0.01);与模型组相比,热敏灸组、非热敏灸组、假手术组干预后NO、ADAMTS-4表达均明显降低,Ⅱ型胶原、PG均明显升高(P<0.05,P<0.01);与非热敏灸组相比,热敏灸组干预后NO、ADAMTS-4表达明显降低,Ⅱ型胶原、PG表达均明显升高(均P<0.05)。结论:热敏灸可能通过抑制NO和ADAMTS-4表达,减少炎性反应、保护关节软骨从而达到治疗KOA的目的。

随机森林算法在膝骨关节炎穴位敏化研究中的应用初探

目的:采用随机森林算法构建膝骨关节炎(KOA)患者犊鼻穴穴位敏化判别模型,以期为穴位是否敏化的判别及病情评估提供参考。方法:以916例KOA患者和222名健康受试者为研究对象,采集犊鼻穴体表温度、机械痛阈以及压痛阈的数据,运用SPSS 24.0软件进行数据分析,采用Python软件随机森林算法对犊鼻穴穴位敏化数据构建穴位敏化判别模型。结果:与健康受试者比较,KOA患者犊鼻穴温度显著升高、机械痛阈和压痛阈显著降低(P<0.01);穴位敏化判别模型能很好区分KOA患者与健康人(准确率77.85%),其中影像学3级(准确率82.76%)和临床3期(准确率88.37%)KOA患者区分效果最好。结论:穴位敏化判别模型可为穴位是否发生敏化的判别以及病情评估提供参考。

岫玉灸治疗膝骨关节炎临床疗效

目的:比较艾灸与岫玉灸对膝骨关节炎临床疗效的影响。方法:选取2019年7月至2021年1月于上海交通大学附属同仁医院就诊的膝骨关节炎患者,随机分为艾灸组和岫玉灸组各47例,其中艾灸组44例、岫玉灸组45例完成研究。采用视觉模拟评分法(VAS)、西安大略省和麦克马斯特大学关节炎指数(WOMAC)、50英尺(15m)步行时间于治疗2、4周与随访8、12周进行疗效评价。结果:治疗4周后,两组VAS评分、WOMAC指数均较治疗前显著降低(P<0.01),两组15m步行时间较治疗前均显著缩短(P<0.01)。两组组间比较差异无统计学意义。结论:岫玉灸治疗膝骨关节炎能达到与艾灸相似的疗效,且无烟雾异味,安全性高。