摘要
目的 观察烧山火针刺法联合甲氨蝶呤治疗类风湿关节炎(RA)活动期的效果,并探讨其抗炎和调节免疫作用机制。方法 选取2020年2月至2022年10月郑州市第一人民医院收治的60例RA活动期患者纳入研究,按照随机数表法分为常规组和联合组各30例。常规组患者给予甲氨蝶呤治疗,联合组患者给予烧山火针刺法联合甲氨蝶呤治疗,均治疗两周。于治疗两周后比较两组患者的治疗效果,以及治疗前后的中医证候评分、28个关节疾病活动(DAS28)评分、疼痛(VAS)评分、炎性指标[血沉(ESR)、C反应蛋白(CRP)、肿瘤坏死因子-α (TNF-α)、类风湿因子(RF)、抗环瓜氨酸肽(CCP)抗体]、免疫指标(Treg细胞、Th17细胞、Treg/Th17细胞),同时比较两组患者治疗期间的不良反应发生情况。结果 联合组患者的治疗总有效率为93.33%,明显高于常规组的73.33%,差异有统计学意义(P<0.05);联合组患者治疗两周后的中医证候关节肿胀、冷痛、压痛、晨僵、屈伸不利评分分别为(0.72±0.18)分、(0.70±0.20)分、(0.81±0.22)分、(0.68±0.15)分、(0.77±0.19)分,明显低于常规组的(1.03±0.24)分、(0.96±0.23)分、(1.14±0.26)分、(0.91±0.21)分、(1.09±0.23)分,差异均有统计学意义(P<0.05);联合组患者治疗两周后的DAS28、VAS评分分别为(2.18±0.33)分、(2.46±0.22)分,明显低于常规组的(3.26±0.47)分、(2.89±0.27)分,差异均有统计学意义(P<0.05);联合组患者治疗两周后的ESR、抗CCP抗体、RF、CRP、TNF-α水平分别为(16.23±2.29) mm/h、(172.30±30.14) IU/mL、(130.85±15.42) IU/mL、(10.20±1.68) mg/L、(18.95±4.38) pg/mL,明显低于常规组的(21.84±3.41) mm/h、(205.68±36.77) IU/mL、(157.62±24.10) IU/mL、(13.65±2.06) mg/L、(24.51±6.02) pg/mL,差异均有统计学意义(P<0.05);联合组患者治疗两周的外周血Treg细胞百分比、Treg/Th17比值分别为(2.61±0.35)%、2.44±0.37,明显高于常规组的(2.17±0.28)%、1.68±0.32,Th17细胞百分比为(1.07±0.18)%,明显低于常规组的(1.29±0.22)%,差异均有统计学意义(P<0.05);两组患者治疗期间的不良反应发生率差异无统计学意义(P>0.05)。结论 烧山火针刺法联合甲氨蝶呤治疗RA活动期能明显减轻患者的临床症状,降低炎症反应,调节免疫功能,临床应用疗效显著,且安全性良好。
Objective To investigate the effect of mountain-burning fire acupuncture combined with metho-trexate in the treatment of rheumatoid arthritis(RA),and to analyze its anti-inflammatory and immune-regulating mecha-nism.Methods Sixty patients with active RA admitted to Zhengzhou First People's Hospital from February 2020 to Oc-tober 2022 were selected and divided into the conventional group and the combined group according to the random num-ber table method,with 30 cases in each group.The patients in the conventional group were treated with methotrexate,and the patients in the combined group were treated with mountain-burning fire acupuncture combined with methotrex-ate,for 2 weeks.After treatment,the therapeutic effects of the two groups were compared,as well as the TCM syndrome score,28 joint disease activity(DAS28)score,pain(Visual Analogue Scale,VAS)score,inflammatory indicators[eryth-rocyte sedimentation rate(ESR)and C-reactive protein(CRP),tumor necrosis factorα(TNF-α),rheumatoid factor(RF),anti-cyclic citrullinated peptide(CCP)antibody],immune indexes(Treg cells,Th17 cells,Treg/Th17 cells)be-fore and after treatment.The incidences of adverse reactions during treatment were also compared between the two groups.Results The total effective rate of the combined group was 93.33%,which was significantly higher than 73.33%of the conventional group(P<0.05).After 2 weeks of treatment,the scores of joint swelling,cold pain,tenderness,morn-ing stiffness,and poor flexion and extension in the combined group were(0.72±0.18)points,(0.70±0.20)points,(0.81±0.22)points,(0.68±0.15)points,and(0.77±0.19)points,respectively,significantly lower than(1.03±0.24)points,(0.96±0.23)points,(1.14±0.26)points,(0.91±0.21)points,and(1.09±0.23)points in the conventional group(P<0.05).After 2 weeks of treatment,the DAS28 and VAS scores of the combined group were(2.18±0.33)points and(2.46±0.22)points,respectively,which were significantly lower than(3.26±0.47)points and(2.89±0.27)points of the conven-tional group(P<0.05).After 2 weeks of treatment,the levels of ESR,anti-CCP antibodies,RF,CRP,and TNF-αin the combined group were(16.23±2.29)mm/h,(172.30±30.14)IU/mL,(130.85±15.42)IU/mL,(10.20±1.68)mg/L,and(18.95±4.38)pg/mL,respectively,significantly lower than(21.84±3.41)mm/h,(205.68±36.77)IU/mL,(157.62±24.10)IU/mL,(13.65±2.06)mg/L,and(24.51±6.02)pg/mL in the conventional group(P<0.05).After 2 weeks of treat-ment,the percentage of peripheral blood Treg cells and Treg/Th17 ratio in the combined group after 2 weeks of treat-ment were(2.61±0.35)%and 2.44±0.37,respectively,significantly higher than(2.17±0.28)%and 1.68±0.32 in the con-ventional group(P<0.05),while the percentage of Th17 cells was(1.07±0.18)%,significantly lower than(1.29±0.22)%in the conventional group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Mountain-burning fire acupuncture combined with methotrexate in the treatment of active RA has significant curative effect,which can significantly alleviate clinical symptoms,reduce inflammatory re-action,regulate immune function,and has good safety.
作者
陈建飞
武慧群
李凌鑫
罗伟贤
任连军
CHEN Jian-fei;WU Hui-qun;LI Ling-xin;LUO Wei-xian;REN Lian-jun(Department of Traditional Chinese Medicine,Zhengzhou First People's Hospital,Zhengzhou 450000,Henan,CHINA;Department of Rehabilitation Medicine,the First Affiliated Hospital of Baotou Medical College,Inner Mongolia University of Science and Technology,Baotou 014010,Inner Mongolia,CHINA;Department of Rehabilitation Medicine,West China Hospital,Sichuan University,Chengdu 610044,Sichuan,CHINA)
出处
《海南医学》
2024年第2期200-205,共6页
Hainan Medical Journal
基金
四川省成都市科技局技术创新研发项目(编号:2019-YF05-00061-SN)。
关键词
类风湿关节炎活动期
烧山火针刺法
甲氨蝶呤
治疗效果
炎症因子
免疫功能
Rheumatoid arthritis in active stage
Mountain-burning fire acupuncture
Methotrexate
Therapeu-tic effect
Inflammatory factors
Immunological function
