【作者】 吉玲玲；

【导师】 欧阳八四；

【作者基本信息】 南京中医药大学 ， 针灸学， 2012， 硕士

【摘要】 目的：本课题通过电针和温针治疗KOA,观察治疗前后患者WOMAC症状积分等临床症状与体征的变化以及患者血清相应细胞因子等的变化,确定电针与温针对KOA患者的疗效,比较电针与温针作用的优劣,探讨电针与温针治疗KOA的作用机理。方法：本研究采用完全随机对照设计,60例符合标准的患者由研究人员根据随机数字表生成随机分配结果随机分为电针治疗组及温针治疗组,两组治疗均以强筋通络,舒气止痛为治疗原则,腧穴选取均以局部选穴与辨证选穴相结合的方法,局部腧穴为：梁丘、血海、内膝眼、外膝眼、阿是穴；辨证选穴为阳虚寒凝型取阴陵泉、足三里；瘀血阻络型取阳陵泉、悬钟。电针治疗组选取关节附近腧穴通电,采用连续波,频率为3～5HZ,中等量刺激,以患者舒适度为宜。温针治疗组在关节附近的主穴上以艾绒灸之,每次2壮；两组均治疗30分钟后取针。两组治疗均为隔日1次,10次为1个疗程,共治疗3个疗程。治疗前后对患者WOMAC骨关节炎指数、患者对疼痛的评估、患者对病情的总体评价、医生对病情的综合评估、中医证候评分、患者生活质量评价、患者血清中IL-1、TNF-α和TGF-β、BMP的含量等方面进行评定及测定,并进行统计分析。结果：1. WOMAC骨关节炎指数：电针与温针均能有效改善患者WOMAC积分(P<0.01),且两者作用相当(P>0.05)；在疼痛权重方面,电针作用优于温针(P<0.05)；在僵硬权重方面,温针作用优于电针(P<0.05)；在关节功能障碍权重方面,两者作用相当(P>0.05)。2.患者对疼痛的评价：电针与温针均能有效改善患者对疼痛的评价(P<0.01),且电针作用优于温针(P<0.05)。3.患者对疾病情况的总体评价：电针与温针均能显著的改善KOA患者对病情活动的总体评价(P<0.01),且电针作用优于温针(P<0.05)。4.医生对疾病情况的综合评价：电针与温针均能显著的改善医生对疾病情况的综合评价(P<0.01),且两者作用相当(P>0.05)。5.中医证候评分：电针与温针均能显著的改善KOA患者中医证候评分(P<0.01),且两者作用相当(P>0.05)。6.患者生活质量评价(HAQ评分)：电针与温针均能显著的改善KOA患者HAQ评分(P<0.01),且两者作用相当(P>0.05)。7.患者血清IL-1含量：电针与温针均能有效降低患者血清IL-1含量(P<0.05),且电针对改善患者血清中IL-1含量作用优于温针(P<0.05)。8.患者血清TNF-α含量：电针与温针均能有效降低患者血清TNF-α含量(P<0.05),且两者作用相当(P>0.05)。9.患者血清TGF-β含量：电针和温针对增加KOA患者血清中TGF-β含量均有显著性作用(P<0.05),且两者作用相当(P>0.05)。10.患者血清BMP含量：电针和温针对改变KOA患者血清中BMP含量无明显作用(P>0.05)。11.总体疗效方面：电针组总有效率为70%,温针组总有效率为76.7%,两组对KOA患者总体临床疗效相当(P>0.05)。12.中医证候疗效方面：电针组总有效率为76.7%,温针组总有效率为73.3%,两组中医证候疗效作用相当(P>0.05)；电针组阳虚寒凝型患者总有效率为57.1%,瘀血阻滞型患者总有效率为93.8%,温针组阳虚寒凝型患者总有效率为88.2%,瘀血阻滞型患者总有效率为88.2%,电针对瘀血阻滞型患者中医证候疗效优于温针(P<0.05),温针对阳虚寒凝型患者中医证候疗效优于电针(P<0.05)。13.60例患者治疗前WOMAC积分与血清IL-1、TNF-α含量及TGF-β含量有相关性(P<0.05),治疗前患者WOMAC评分越高患者血清IL-1、TNF-α含量越高,TGF-β含量越低。结论：1.电针与温针均能有效缓解KOA患者临床症状,改善患者生活质量，电针侧重于止痛作用,而温针侧重于散寒作用。2.电针与温针均能起到有效治疗KOA患者的作用,且电针对于瘀血滞型患者的治疗作用优于温针,而温针对于阳虚寒凝型患者的作用优于电针。3.电针与温针均能有效降低KOA患者血清中分解性细胞因子IL-1、TNF-α的含量,能提高患者血清中合成性细胞因子TGF-β的含量。4.电针与温针均能有效缓解患者症状,达到治疗KOA目的的作用机制之一有可能是通过降低血清中IL-1、TNF-α以及提高TGF-β的含量。更多还原

【Abstract】 Objective: To observe changes of clinical symptoms and signs as WOMAC and relevant serum cytokine of knee osteoarthritis (KOA)patients before and after treatment with electro-acupuncture and warm-acupuncture, to confirm the curative effects of electro-acupuncture and warm-acupuncture, to compare the disadvantage and advantage of the two treatments, to discuss the probable action mechanism of electro-acupuncture and warm-acupuncture for treating KOA.Methods:Completely random compare design was adopted,60patients up to standard were divided into electro-acupuncture treatment group and warm-acupuncture treatment group according the random assortment results with random number table. The treatment principles of the both groups were strengthening channels and dredging collaterals, smoothing qi to stop painful, acupoints selection took the method combine local choose with dialectical choose, local points as Liangqiu(ST34), Xuehai(SP10), Neixiyan(EX-LE4), Waixiyan(EX-LE5), Ashi; dialectical points as yang deficiency and blood stagnation type with Yinlingquan(SP9), Zusanli(ST36) and blood-stasis obstruction type with Yanglingquan(GB34), Xuanzhong(GB39). Powered on joint near acupoints in electro-acupuncture group and took continuous wave with frequency as3~5HZ, secondary stimulation and appropriate with patients’comfortable felling. With moxa moxibusion the main acupoints nearby the joints in the warm-acupuncture group, each time for two zhuang; and both groups treated for30minutes. Both treatment for one time every other day and ten times as a course and totally for three courses. Evaluated WOMAC index, assessment of painful with patients, total appraisement of disease condition with patients, comprehensive appraisement of disease condition with doctors, TCM syndrome grade, life quality evaluation of patients and assayed the content of IL-1、TNF-α、TGF-βand BMP in patient’s serum before and after treatment and performed statistical analysis.Results:1. WOMAC index:both electro-acupuncture and warm-acupuncture can effectively improve the WOMAC faction of patients (P<0.01), and have a quite effect (P>0.05); weight in pain, effect of electro-acupuncture is better than warm-acupuncture (P<0.05), weight in rigid, effect of warm-acupuncture is superior to electro-acupuncture (P<0.05), weight in joint dysfunction, both roles fairy (P>0.05).2. Patients’ assessment of painful:electro-acupuncture and warm-acupuncture can effectively improve patients’ assessment of painful (P<0.01), and electro-acupuncture is better than warm-acupuncture (P<0.05).3. Patients’ total appraisement of disease condition: electro-acupuncture and warm-acupuncture can both effectively improve patients’ total appraisement of disease condition (P<0.01), and electro-acupuncture is much better than warm-acupuncture (P<0.05).4. Doctors’ comprehensive appraisement of disease condition:electro-acupuncture and warm-acupuncture can both effectively improve doctors’comprehensive appraisement of disease condition (P<0.01) and have a quite effect (P>0.05).5. TCM syndrome grade:electro-acupuncture and warm-acupuncture can both effectively improve TCM syndrome grade (P<0.01) and have a quite effect (P>0.05).6. Life quality evaluation of patients: electro-acupuncture and warm-acupuncture can both effectively increase life quality evaluation of patients (P<0.01) and have a quite effect (P>0.05).7. IL-1content in patients serum:electro-acupuncture and warm-acupuncture can both decline the content of IL-1in serum (P<0.05) and electro-acupuncture is better than warm-acupuncture (P<0.05).8. TNF-a content in patients serum:electro-acupuncture and warm-acupuncture can both decline the content of TNF-a in serum (P<0.05) and have a quite effect (P>0.05).9. TGF-p content in patients serum:electro-acupuncture and warm-acupuncture can both increase the content of TGF-β in serum (P<0.05) and have a quite effect (P>0.05).10. BMP content in patients serum:electro-acupuncture and warm-acupuncture have no significance effect to change the content of BMP in patients serum (P>0.05).11. Total curative effect:total effective rate of electro-acupuncture group is70%and warm-acupuncture is76.7%, both groups have a quiet effect (P>0.05).12. Curative effect of TCM syndrome:total effective rate of electro-acupuncture group is76.7%and warm-acupuncture is73.3%and have a quite effect (P>0.05), effective rate of yang deficiency and blood stagnation type in electro-acupuncture is57.1%and blood-stasis obstruction type is93.8%, effective rate of yang deficiency and blood stagnation type in warm-acupuncture group is88.2%and blood-stasis obstruction type is88.2%. Electro-acupuncture has a better effect on blood stagnation obstruction type (P<0.05) and warm-acupuncture has a better effect on yang deficiency and blood stagnation type (P<0.05).13. WOMAC grade of60patients before treatment have a dependence with content of IL-1、TNF-α and TGF-β(P<0.05), WOMAC grade much higher more content of IL-1、TNF-α and less of TGF-p.Conclusions:1. Both electro-acupuncture and warm-acupuncture can effectively release patients’clinical symptoms and improve life equality, electro-acupuncture particular emphasis on stopping pain and warm-acupuncture emphasis on dispersing cold.2. Electro-acupuncture and warm-acupuncture can play a role in effective treatment of patients with KOA, and therapeutic effect of electro-acupuncture on patients with blood-stasis obstruction type is better than warm-acupuncture, and warm-acupuncture is much better for the patients with yang deficiency and blood stagnation.3. Both electro-acupuncture and warm-acupuncture can effectively decline the content of decomposable cytokine as IL-1、TNF-α in patients serum and increase the content of compoundable cytokine as TGF-β.4. The proper mechanism of electro-acupuncture and warm-acupuncture effectively releasing patients’symptoms and reaching the aim for treating is from the declining the content of IL-1、TNF-α and increasing the content of TGF-β.更多还原