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罗红梅,莫丽莎,余学龙,周丽莹,吴志红.热敏灸、热敏穴位贴敷联合独活寄生汤三联方案治疗膝骨性关节炎（肝肾亏虚证）的临床研究[J].湖南中医药大学学报英文版,2023,43(12):2278-2283.[Click to copy
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| 热敏灸、热敏穴位贴敷联合独活寄生汤三联方案治疗膝骨性关节炎（肝肾亏虚证）的临床研究 |
| 罗红梅,莫丽莎,余学龙,周丽莹,吴志红 |
| (江西中医药大学附属医院, 江西 南昌 330006) |
| 摘要: |
| 目的 探讨热敏灸、热敏穴位贴敷联合独活寄生汤三联方案治疗膝骨性关节炎（knee osteoarthritis，KOA）肝肾亏虚证患者的临床疗效和安全性。方法 招募2022年5月至2023年6月江西中医药大学附属医院风湿病科、特色治疗部门诊及住院部确诊的KOA肝肾亏虚证患者84例，按随机数字表法分为对照组和观察组，每组42例。对照组采用传统艾灸+常规康复训练治疗，观察组采用热敏灸、热敏穴位贴敷联合独活寄生汤三联方案治疗。比较治疗前后数字评估量表（numerical rating scale，NRS）、西部安大略麦克马斯特大学骨关节炎指数可视化量表（Western Ontario and McMaster university osteoarthritis index visualization scale，WOMAC）、健康调查简表（the MOS item short from health survey，SF-36）的评分，以及基质金属蛋白酶-3 （matrix metalloproteinase-3，MMP-3）和透明质酸（hyaluronic acid，HA）的含量；记录治疗期间的不良反应，比较治疗后的临床疗效。结果 试验期间有3例脱落，实际完成81例（对照组40例、观察组41例）。两组患者治疗后NRS、WOMAC评分均较治疗前明显下降（P<0.05）；观察组治疗后NRS、WOMAC评分较对照组更低（P<0.05）。两组患者治疗后SF-36评分（躯体状况和精神状况）均较治疗前升高（P<0.05）；观察组治疗后在躯体状况改善优于对照组（P<0.05），而精神状况改善程度两组差异无统计学意义（P>0.05）。与治疗前相比，两组患者在治疗后MMP-3含量均下降（P<0.05）、HA含量均升高（P<0.05）；观察组治疗前后的变化情况明显比对照组更高（P<0.05）。观察组总有效率高于对照组（P<0.05），两组患者不良反应发生率差异无统计学意义（P>0.05）。结论 热敏灸、热敏穴位贴敷结合独活寄生汤三联方案对KOA肝肾亏虚证患者治疗效果显著，能有效减轻疼痛程度，改善膝关节功能，调节血清和关节腔内炎症因子水平，有效缓解炎性病理状态，提高生活质量，值得临床推广应用。 |
| 关键词: 膝骨性关节炎 肝肾亏虚证 热敏灸 穴位贴敷 独活寄生汤 膝关节功能 炎症因子 |
| DOI：10.3969/j.issn.1674-070X.2023.12.019 |
| Received:July 28, 2023 |
| 基金项目:江西省中医药管理局科技计划项目（2021A254）。 |
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| Clinical study on the treatment of knee osteoarthritis (liver and kidney deficiency pattern) with the triple therapy of heat-sensitive moxibustion,heat-sensitive acupoint application, and Duhuo Jisheng Decoction |
| LUO Hongmei,MO Lisha,YU Xuelong,ZHOU Liying,WU Zhihong |
| (The Hospital of Jiangxi University of Chinese Medicine, Nanchang, Jiangxi 330006, China) |
| Abstract: |
| Objective To explore the clinical efficacy and safety of the triple therapy of heat-sensitive moxibustion, heatsensitive acupoint application, and Duhuo Jisheng Decoction(DHJSD) in the treatment of knee osteoarthritis(KOA) patients with liver and kidney deficiency pattern.Methods A total of 84 patients with KOA diagnosed by the Rheumatology, Characteristic Treatment, and Inpatient Departments of The Hospital of Jiangxi University of Chinese Medicine from May 2022 to June 2023 were recruited and assigned into control and observation groups by random number table method, with 42 cases in each group. The control group was treated with traditional moxibustion and routine rehabilitation training, while the observation group was treated with the triple therapy of heat-sensitive moxibustion, heat-sensitive acupoint application combined with DHJSD. The scores of the numerical rating scale(NRS), Western Ontario and McMaster University osteoarthritis index visualization scale(WOMAC), and the MOS item short from health survey(SF-36) before and after treatment, as well as the content of matrix metalloproteinase-3(MMP-3)and hyaluronic acid(HA) were compared; adverse reactions during treatment were recorded and clinical efficacy after treatment was compared.Results Three cases fell off during the trial, and 81 cases were actually completed(40 cases in the control group and 41cases in the observation group). After treatment, the NRS and WOMAC scores of both groups were significantly lower than those before treatment(P<0.05); the NRS and WOMAC scores of the observation group were lower than those of the control group(P<0.05).After treatment, the SF-36 scores(physical and mental status) of the two groups were higher than those before treatment(P<0.05);the improvement of physical status in the observation group was better than that in the control group(P<0.05), but there was no statistically significant difference in the improvement of mental status between both groups(P>0.05). Compared with those before treatment, the content of MMP-3 was decreased and the content of HA was increased in both groups after treatment(P<0.05). The changes before and after treatment in the observation group were significantly higher than those in the control group(P<0.05). The total effective rate of the observation group was higher than that of the control group(P<0.05). There was no statistically significant difference in the incidence of adverse reactions between both groups(P>0.05).Conclusion Triple therapy of heat-sensitive moxibustion, heat-sensitive acupoint application, and DHJSD has significant effects on the treatment of KOA patients with liver and kidney deficiency pattern, which can effectively relieve pain, improve knee joint function, regulate levels of serum and inflammatory factors in joint cavity, alleviate inflammatory pathological state, and improve quality of life, and is worthy of clinical application. |
| Key words: knee osteoarthritis liver and kidney deficiency pattern heat-sensitive moxibustion acupoint application Duhuo Jisheng Decoction knee joint function inflammatory factor |
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