摘要
目的:评价壮医热敏探穴针刺疗法配合抗风湿病联盟西药治疗类风湿关节炎的临床疗效及安全性。方法:将符合纳入标准的168例类风湿关节炎患者,随机分为观察组和对照组,各84例。对照组参照欧洲抗风湿病联盟2013年更新的用药指南制定用药方案:甲氨蝶呤片7.5 mg口服,每周1次;柳氮磺吡啶肠溶片100 mg口服,每天2次;硫酸羟氯喹片20 mg口服,每天2次;美洛昔康片15 mg口服,每天1次。观察组在对照组治疗基础上加用壮医热敏探穴针刺法治疗,使用点燃的壮医药艾在病变关节附近施行温和灸,探寻热敏点,然后进行壮医针刺,留针30 min,每日1次。均2周为一疗程,连续2个疗程。观察两组治疗前后双手握力、晨僵时间、28个关节肿胀关节个数(SJC 28)、28个关节压痛关节个数(TJC 28)、28个关节疾病活动度评分(DAS28)、患者对自身病情活动度的VAS评分(PtGA)、医生对患者病情活动度的VAS评分(PhGA),及类风湿因子(RF)、C-反应蛋白(CRP)、血沉(ESR)、抗环瓜氨酸肽抗体(A-CCP)水平,并评价两组临床疗效。结果:经4周治疗后,最终163例患者完成临床试验,观察组81例,对照组82例。两组治疗4周后双手握力、晨僵时间、SJC 28、TJC 28、PtGA、PhGA、DAS 28及RF、A-CCP、CRP、ESR水平均较治疗前改善(均P<0.05);观察组晨僵时间、双手握力、SJC 28、TJC 28、PtGA、PhGA、DAS 28评分及CRP、ESR水平均优于对照组(均P<0.05),RF、ACCP评分两组间比较差异无统计学意义(均P>0.05)。观察组总有效率为85.19%(69/81),高于对照组的70.73%(58/82,P<0.05)。结论:壮医热敏探穴针刺疗法治疗类风湿关节炎临床疗效满意,不良反应小。
Objective To evaluate the clinical therapeutic effects and safety on rheumatoid arthritis（RA） treated with acupuncture at the points detected with thermosensitive moxibustion in Zhuang medicine combined with western medication.Methods A total of 168 RA patients in compliance with the inclusive criteria were collected and randomized into an observation group and a control group, 84 cases in each one. In the control group, in reference to the updated guideline of new drugs by the European League Against Rheumatism（EULAR） in 2013, the medication scheme was formulated for oral administration, methotrexate tablet 7.5 mg, once a week; salazosulfapyridine enteric-coated tablets, 100 mg, twice a day; hydroxychloroquine sulfate tablets, 20 mg, twice a day; and meloxicam tablets, 15 mg, once a day. In the observation group,besides the treatment as the control group, the acupuncture therapy at the points detected with thermosensitive moxibustion in Zhuang medicine was given. The mild moxibustion was applied near to the affected joint with the moxa material of Zhuang herbal medicine to detect the sensitization points. Afterwards, the acupuncture technique of Zhuang medicine was given on those points, without any manipulation applied. The needles were retained for 30 min, once daily. The treatment for 2 weeks was as one course, continuously for 2 courses. The indexes were observed before and after treatment in the two groups including gripping power, the time of morning stiffness, the swollen joint count 28（SJC 28）, the tender joint count 28（TJC 28）, the disease activity score 28（DAS 28）, the score of patient global assessment of disease activity（PtGA） and the score of provider global assessment of disease activity（PhGA）, as well as rheumatoid factors（RF）, C-reactive protein（CRP）,erythrocyte sedimentation rate（ESR） and anti-cyclic peptide containing citrulline（A-CCP）. The clinical therapeutic effects were evaluated in the two groups. Results After 4-week treatment, a total of 163 patients accomplished the clinical trial, 81 cases in the observation group and 82 cases in the control group. The results of gripping power, the time of morning stiffness, SJC 28, TJC 28, PtGA, PhGA, DAS 28, RF, CRP, ESR and A-CCP were all improved as compared with those before treatment（all P〈0.05）. In 4 weeks of treatment, the results of gripping power, the time of morning stiffness, SJC 28, TJC 28, PtGA, PhGA, DAS 28, as well as CRP and ESR in the observation group were better than those in the control group（all P〈0.05）. The results of RF and A-CCP were not different significantly between the two groups（both P〈0.05）. The total effective rate was 85.19%（69/81） in the observation group, higher than 70.73%（58/82） in the control group（P〈0.05）. Conclusion The acupuncture therapy at the points detected with thermosensitive moxibustion in Zhuang medicine achieves the satisfactory clinical effects with few adverse effects.
出处
《中国针灸》
CAS
CSCD
北大核心
2018年第3期245-250,共6页
Chinese Acupuncture & Moxibustion
基金
2014年广西科学研究与技术开发计划项目：桂科攻14124003-10-1
关键词
类风湿关节炎
针灸
壮医
热敏灸
甲氨蝶呤
美洛昔康
类风湿因子
C-反应蛋白
随机对照试验
rheumatoid arthritis
acupuneture
Zhuang medicine
thermosensitive moxibustion
methotrexate
meloxicam
rheumatoid factors （RF）
C-reactive protein （CRP）
randomized controlled trial （RCT）
