摘要
目的:观察中西药物配合针刺治疗湿热痹阻型类风湿关节炎的临床疗效和安全性。方法:将70例湿热痹阻型RA患者随机分为对照组和针药组,每组35例。对照组口服甲氨蝶呤、依托考昔及宣痹汤加减治疗,针药组在对照组的基础上加用三部针刺法治疗。2组均以4周为1个疗程,共治疗3个疗程。观察2组治疗前及治疗4,8,12周的炎症指标、休息痛、关节肿胀数、压痛数等症状、体征的变化和临床疗效。结果:治疗过程中,针药组脱落2例,对照组脱落3例。(1)治疗4,8,12周后,2组红细胞沉降率、C-反应蛋白、中医证候评分较治疗前均有改善(P<0.05),且针药组优于对照组(P<0.05)。(2)治疗4,8,12周后,2组关节肿胀数、关节压痛数、晨僵时间、视觉模拟评分法(VAS)评分、DAS28评分较治疗前均有改善(P<0.05);治疗4周后,针药组关节肿胀数、VAS评分较对照组改善更明显(P<0.05);治疗8,12周后,针药组关节肿胀数、关节压痛数、晨僵时间、VAS评分、DAS28评分均较对照组改善更明显(P<0.05或P<0.01)。(3)治疗4周后,针药组ACR20患者多于对照组(P<0.01);治疗8,12周后,针药组ACR20、ACR50患者均多于对照组(P<0.05或P<0.01)。(4)中医证候疗效比较,针药组总有效率为81.81%,对照组总有效率为71.88%,2组比较,差异有统计学意义(P<0.05)。结论:针药并用治疗类风湿关节炎临床疗效确切,比单纯口服药物治疗更优。
Objective：To observe the clinical effcacy and safety of Chinese and Western medicine combined with acupuncture in the treatment of damp-heat-bi-type rheumatoid arthritis.Methods：Seventy casesof damp-heat-bi-type rheumatoid arthritis were randomly divided into a control group and a medicine and acupuncture group（a MA group）,with 35 cases in each.The control group was treated with methotrexate,etoricoxib and modifed Xuanbi Tang（宣痹汤）.Based on the treatment for the control group,the MA group was treated with Three-part Acupuncture.The two groups were treated 4 weeks as a course and there were totally 3 courses.The infammation indexes,rest pain,the count of joint swelling and the count of pressure pain of the two groups were observed respectively before treatment and 4,8,12 weeks after treatment,and the curative effects were evaluated.Results：During the course of treatment,2 cases in the MA group were dropped,while 3 cases in the control group. ① After 4,8,12 weeks of treatment,ESR,CRP and the scores of TCM syndromeswere improved in the two groups（P 〈 0.05）,and the MA group was better than the control group（P 〈 0.05）.② After 4,8,12 weeks of treatment,the counts of swollen joints and morning stiffness,VAS scores,and DAS28 scores were improved compared with those before treatment（P 〈 0.05）.After 4 weeks of treatment,the count of joint swelling and VAS score of the MA group were improved significantly compared with those of the control group（P 〈 0.05）.8,12 weeks after treatment,the joint swelling count,joint pressing pain count,morning stiffness time,VAS score and DAS28 score were obviously improved compared with those in the control group（P 〈 0.05 or P 〈 0.01）. ③ After 4 weeks of treatment,patients with ACR20 in the MA group were more than those in the control group（P 〈 0.01）.After 8,12 weeks,patients with ACR20 and ACR50 in the MA group were more than those in the control group（P 〈 0.05 or P 〈 0.01）. ④ As for TCM syndromes,the total effective rate of the MA group was 81.81%,and the total effective rate of the control group was 71.88%.There was a signifcant difference between the two groups（P 〈 0.05）.Conclusion：The clinical effcacy of acupuncture and medicine in the treatment of rheumatoid arthritis is better than that of oral medicine alone.
出处
《风湿病与关节炎》
2017年第12期14-18,共5页
Rheumatism and Arthritis
基金
河南省高等学校重点科研项目计划(15A360040)
关键词
关节炎
类风湿
宣痹汤
三部针刺法
湿热痹阻证
arthritis,rheumatoid
Xuanbi Tang（宣痹汤）
three-part acupuncture
damp-heat-bi syndrome
