热补针法结合黑骨藤追风活络胶囊治疗风寒湿痹型类风湿关节炎临床研究
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R593.22

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Clinical Study on Heat-reinforcing Needling Combined with Heiguteng Zhuifeng HuoluoCapsulesforRheumatoidArthritisofWind-coldandFixed Impediment Type
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    摘要:

    目的:探究热补针法结合黑骨藤追风活络胶囊治疗风寒湿痹型类风湿关节炎的临床疗效。方法:将140例风寒湿痹型类风湿关节炎患者随机分成4组,对照组(37例)予以常规西药治疗,观察组A(33例)在对照组的基础上予以热补针法针刺治疗,观察组B(36例)在对照组的基础上予以黑骨藤追风活络胶囊治疗,观察组C(34例)在对照组的基础上联合热补针法针刺和黑骨藤追风活络胶囊治疗,治疗时间3个月。通过测定比较4组患者总有效率、治疗前后血清红细胞沉降率(ESR)、C-反应蛋白(CRP)和类风湿因子(RF)水平,关节液白细胞介素-17A(IL-17A)、IL-18和IL-27含量,关节压痛数、关节肿胀指数、休息痛和晨僵时间等体征变化以及不良反应情况,分析不同疗法的临床疗效。结果:观察组C临床疗效明显优于其他3组(P<0.05);观察组A和观察组B临床疗效明显优于对照组(P<0.05)。治疗后,4组关节压痛数、关节肿胀数、关节肿胀指数、休息痛评分和晨僵时间较治疗前降低(P<0.05),双手平均握力较治疗前升高(P<0.05)。观察组C关节压痛数、关节肿胀数、关节肿胀指数、休息痛评分和晨僵时间低于其他3组(P<0.05),双手平均握力高于其他3组(P<0.05);观察组A和观察组B关节压痛数、关节肿胀数、关节肿胀指数、休息痛评分和晨僵时间低于对照组(P<0.05);观察组B晨僵时间显著长于观察组A(P<0.05)。治疗后,4组血清CRP、RF和ERS水平较治疗前降低(P<0.05)。观察组C血清CRP、RF和ERS水平低于其他3组(P<0.05);观察组A和观察组B血清RF和ERS水平低于对照组(P<0.05);观察组B血清ERS水平低于观察组A(P<0.05)。治疗后,4组关节液IL-17A、IL-18和IL-27含量较治疗前显著降低(P<0.05)。观察组C关节液IL-17A、IL-18和IL-27含量低于其他3组(P<0.05);观察组A关节液IL-17A和IL-27含量低于对照组(P<0.05);观察组B关节液IL-17A和IL-18含量低于对照组、观察组A(P<0.05),IL-27含量低于对照组(P<0.05)。结论:热补针法联合黑骨藤追风活络胶囊治疗风寒湿痹型类风湿关节炎疗效较好,可以在临床上进一步推广。

    Abstract:

    Objective: To discuss the clinical effect of heat-reinforcing needling combined with Heiguteng Zhuifeng Huoluo capsules for rheumatoid arthritis of wind-cold and fixed impediment type.Methods:A total of 140 cases of patients with rheumatoid arthritis of wind-cold and fixed impediment type were randomly divided into four groups.The control group(37 cases)was treated with routine western medicine.Based on the treatment of the control group,the observation group A(33 cases)was additionally treated with heat-reinforcing needling,the observation group B(36 cases)was additionally treated with Heiguteng Zhuifeng Huoluo capsules,and the observation group C(34 cases)was additionally treated with heatreinforcing needling combined with Heiguteng Zhuifeng Huoluo capsules.All groups were treated for three months.In order to analyze the clinical effect of different treatment before and after treatment in the four groups,the following indexes were measured and compared,including the total effective rates,the levels of erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)and rheumatoid factor(RF)in serum, the content of interleukin-17A(IL-17A), interleukin-18(IL-18)and interleukin-27(IL-27)in synovial fluid, the changes of signs of tender joint count, joint swollen indexes, rest pain and duration of morning stiffness and the adverse responses.Results:The clinical effect in the observation group C was significantly better than that in the other three groups(P < 0.05);the clinical effect in the observation group A and the observation group B was significantly better than that in the control group(P < 0.05).After treatment,the tender joint counts,swollen joint counts,joint swollen indexes,scores of rest pain and duration of morning stiffness in the four groups were decreased when compared with those before treatment(P < 0.05),and the average hand grip strength was increased when compared with that before treatment(P < 0.05).In the observation group C,the tender joint count,swollen joint count,joint swollen indexes,scores of rest pain and duration of morning stiffness were lower than those in the other three groups(P <0.05),and the average hand grip strength was higher than those in the other three groups(P < 0.05).The tender joint counts,swollen joint counts,joint swollen indexes,scores of rest pain and duration of morning stiffness in the observation group A and B were lower than those in the control group(P< 0.05);the duration of morning stiffness in the observation group B was significantly longer than that in the observation group A(P< 0.05).After treatment,the levels of CRP,RF and ERS in serum in the four groups were decreased when compared with those before treatment(P<0.05).The levels of CRP,RF and ERS in serum in the observation group C were lower than those in the other three groups(P < 0.05);the levels of RF and ERS in serum in the observation group A and B were lower than those in the control group(P< 0.05);the level of ERS in serum in the observation group B was lower than that in the observation group A(P< 0.05).After treatment,the content of IL-17A,IL-18and IL-27 in synovial fluid in the four groups were significantly decreased when compared with those before treatment(P<0.05).The content of IL-17A,IL-18 and IL-27 in the observation group A was lower than that in the control group(P < 0.05);the content of IL-17A and IL-18 in the observation group B was lower than that in the control group and the observation group A,and the content of IL-27 was lower than that in the control group(P<0.05).Conclusion:The therapy of heatreinforcing needling combined with Heiguteng Zhuifeng Huoluo capsules has good curative effect in treating rheumatoid arthritis of wind-cold and fixed impediment type,and can be further promoted in clinic.

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王可博,郑秀华,黄培凤.热补针法结合黑骨藤追风活络胶囊治疗风寒湿痹型类风湿关节炎临床研究[J].新中医,2020,52(2):125-129

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  • 在线发布日期: 2020-01-14
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