热敏灸配合常规药物治疗膝骨性关节炎阳虚寒凝证的临床疗效观察

摘要

目的 观察热敏灸配合常规药物治疗膝骨性关节炎(KOA)的临床疗效及对血清细胞因子的影响.方法 选择60例双侧KOA患者在接受常规药物治疗的基础上按热敏灸操作步骤区分热敏灸组(治疗组)和常规艾灸组(对照组),每组30例,以双侧犊鼻、阳陵泉、鹤顶6穴为施灸部位,每穴灸疗时间大约15 min,每日1次,连续6 d为1个小疗程,小疗程间隔1 d,总疗程为4个小疗程.采用Lysholm膝关节功能评分表评价总疗程前后的临床疗效,比较2组患者在总治疗前后关节疼痛、膝关节肿胀、膝关节日常活动能力评分及血清细胞因子肿瘤坏死因子-α(TNF-α)、白细胞介素-1(IL-1),以不良反应指标的分级评定方法来评价其配合药物的安全性.结果 2组患者在总疗程后关节疼痛、膝关节肿胀、膝关节日常活动能力评分及血清细胞因子TNF-α、IL-1均较治疗前改善(P<0.05),但治疗组以上各指标较对照组改善更明显(P<0.01).治疗组总有效率为86.7%,对照组为66.7%,治疗组总有效率明显优于对照组(P<0.01),且治疗组的不良反应少(P<0.05).结论 热敏灸配合药物治疗膝骨性关节炎疗效优于常规艾灸疗法,临床疗效确切,无创无毒副作用,且能更好地改善患者的症状和体征.%Objective To explore the effects of heat-sensitized moxibustion combined with conventional medicine on knee osteoarthritis(KOA)including clinical efficacy and cytokine levels.Methods 60 pa-tients with bilateral knee osteoarthritis was divided into two groups(n=30).The treatment group was given heat-sensitized moxibustion combined with conventional drugs,while the control group was adminis-tered with routine acupuncture treatment besides conventional drugs.Bilateral ST35,GB34,and EX-LE2 were selected as treating acupoints for 15 minutes once a day for 6 days as one treatment session.Four treatment sessions were one total treatment course, with 1-day interval between two sessions.The Ly-sholm knee function score was applied to evaluate clinical efficacy before and after treatment.The scores of joint pain,joint swelling,and walking ability and cytokine TNF-α/IL-1 were also compared before and after treatment.Criteria of adverse effect factors was adopted to evaluate the safety.Results The scores of joint pain,joint swelling, walking ability and serum cytokines TNF-α/IL-1of patients in both groups were improved after treatment(P<0.05).Compared with the control group, those above index in the treatment group were improved more markedly(P<0.01).The effective rate of the treatment group and control group was 86.7%,and 66.7%respectively,thus the efficacy of treatment group was significantly superior to that of the control group(P<0.01).Moreover,compared with control group,there were less adverse effects in treatment group(P<0.05).Conclusion To treat knee osteoarthritis,heat-sensitized moxibustion appears to be superior to routine moxibustion therapy in terms of efficacy and safety.The non-invasive heat-sensitized moxibustion may alleviate symptoms,and improve physical signs effectively, which warrants further exploration and development.