补肾散寒通络汤联合艾灸及塞来昔布治疗膝骨关节炎的临床观察

摘要

目的:观察补肾散寒通络汤联合艾灸及塞来昔布治疗膝骨关节炎(KOA)的临床疗效及安全性.方法:选取2014年5月-2015年12月在重庆康华医院就诊的KOA患者70例,按照就诊单双号顺序分为对照组和观察组,各35例.对照组患者给予塞来昔布胶囊0.2 g,qd;观察组患者在对照组基础上加用补肾散寒通络汤(每日1剂,水煎取汁300 mL,分早、中、晚3次服用)及艾灸治疗.两组患者均以4周为1个疗程,连续治疗2个疗程.比较两组患者的临床疗效,治疗前后的中医证候积分、视觉模拟评分法(VAS)评分、西安大略和麦克马斯特大学量表(WOMAC)评分、实验室检查指标、关节情况,以及不良反应发生情况.结果:观察组患者的总有效率(85.71％)显著高于对照组(68.57％),差异有统计学意义(P0.05).治疗后,两组患者的中医证候积分、VAS评分、WOMAC评分、红细胞沉降率、C反应蛋白水平和膝关节肿胀积分均较治疗前显著降低,且观察组各指标水平显著低于对照组,差异均有统计学意义(P0.05).两组患者不良反应发生率比较(5.71％vs.2.86％),差异无统计学意义(P>0.05).结论:补肾散寒通络汤联合艾灸及塞来昔布能改善KOA患者临床症状,缓解关节疼痛,减轻关节炎症和肿胀,且用药较安全.%OBJECTIVE:To observe clinical efficacy and safety of Bushen sanhan tongluo decoction combined with moxi-bustion and celecoxib in the treatment of knee osteoarthritis (KOA). METHODS:A total of 70 KOA patients were selected from Chongqing Kanghua Hospital during May 2014-Dec. 2015,and then divided into observation group and control group ac-cording to odd and even number,with 35 cases in each group. Control group was given Celecoxib capsule 0.2 g,qd;observa-tion group was additionally given Bushen sanhan tongluo decoction(one dose a day,300 mL,decocted with water,taking it 3 times in the morning,noon and night)and moxibustion. A treatment course lasted for 4 weeks,and both received 2 courses of treatment. Clinical efficacies as well as TCM syndrome score,VAS score,WOMAC score,lab indexes,joint condition be-fore and after treatment,the occurrence of ADR were compared between 2 groups. RESULTS:Total response rate of observa-tion group (85.71％) was significantly higher than control group (68.57％),with statistical significance (P0.05). After treatment,TCM syn-drome score,VAS score,WOMAC score,erythrocyte sedimentation rate,CRP level and knee swelling score of 2 groups were decreased significantly,compared to before treatment;those indexes of observation group were significantly lower than those of control group,with statistical significance(P0.05). There was no statistical significance in the incidence of ADR (5.71％ vs. 2.86％) between 2 groups (P>0.05). CONCLUSIONS:Bushen sanhan tongluo decoction combined with moxibustion and celecoxib can improve clinical symptoms,relieve joint pain,joint inflammation and swelling of KOA pa-tients with good safety.