四逆汤饼灸治疗膝骨性关节炎的临床观察及对其血清相关细胞因子影响的研究

发布时间：2017-12-31 20:32

本文关键词：四逆汤饼灸治疗膝骨性关节炎的临床观察及对其血清相关细胞因子影响的研究　出处：《宁夏医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的1.观察四逆汤饼灸治疗膝骨性关节炎(Knee osteoarthritis,KOA)的临床疗效。2.观察血清中白介素-1(Interleukin-1,IL-1),白介素-6(Interle ukin-6,IL-6)和肿瘤坏死因子-α(Tumor necrosis factor-alpha,TNF-α)表达水平的变化,探讨四逆汤饼灸治疗KOA的部分作用机理。方法将2015年9月至2016年9月于宁夏医科大学总医院中医骨伤科、宁夏医科大学总医院集团阳光医院中医骨伤科、宁夏彭阳县中医医院院针灸康复科门诊和住院收集的170例符合标准的患者通过随机数字编码的方法分为两组,分别给予四逆汤饼灸(85例)和安慰剂饼灸(85例)治疗,采用双盲法进行临床研究,由参与本次试验的三个科室经过培训的护士以及其他人员进行操作。四逆汤饼灸组和安慰剂饼灸组受试者均选取双膝关节的犊鼻穴、内膝眼、鹤顶穴、足三里四个穴位进行治疗。10天(d)为一个疗程,疗程间隔2d,连续治疗2个疗程。治疗前后运用“膝关节骨性关节炎自评量表”(Western Ontario and Memaster university Osteoarthritis index,WOMAC)结合视觉疼痛模拟法(Visual A nalogue Scale/score VAS)进行临床疗效评价。采用双抗体夹心酶联免疫吸附法(Enzyme-linked Immunosorbent assay,ELISA)检测患者血清中IL-1、IL-6和TNF-α的水平。采用SPSS19.0统计分析软件分析数据,数据结果均采用均数±标准差(?X±s)表示,计数资料采用卡方检验,符合正态分布的计量资料采用t检验,不符合正态分布的计量资料采用秩和检验,P0.05为差异有统计学意义。结果1.治疗前,四逆汤饼灸组和安慰剂饼灸组受试患者的膝关节WOMAC总分比较,差异均无统计学意义(P0.05);治疗后,四逆汤饼灸组和安慰剂饼灸组受试者膝关节WOMAC评分均有明显降低,差异有统计学意义(P0.05),治疗过程中所有受试患者未出现不良事件;与安慰剂饼灸组相比较,四逆汤饼灸组的WOMAC评分下降更明显,差异有统计学意义(P0.05)。2.与治疗前比较,四逆汤饼灸组和安慰剂饼灸组受试患者血清中IL-1、IL-6和TNF-α的表达水平均明显降低,差异有统计学意义(P0.05);与安慰剂饼灸相比,四逆汤饼灸组血清IL-1、IL-6和TNF-α的水平下降更明显,差异有统计学意义(P0.05)。3.治疗后四逆汤饼灸组的总有效率(96.25%)优于安慰剂饼灸组(77.22%),差异有统计学意义(P0.05)。结论1.四逆汤饼灸治疗KOA的临床疗效显著且安全性高,能够很好地改善KOA患者膝关节的临床症状以及提高膝关节功能;2.四逆汤饼灸可能是通过有效地抑制KOA患者血清中IL-1、IL-6和TNF-α的表达水平,延缓KOA的发病进程,达到治疗KOA的目的。
[Abstract]:Objective 1. To observe the effect of Sini decoction moxibustion on knee osteoarthritis (osteoarthritis). The clinical efficacy of KOA.2.To observe the serum interleukin-1 Interleukin-1 ukin-6 and Interleukin-1 Interleukin-1 ukin-6. IL-6) and Tumor necrosis factor-alpha TNF- 伪. To explore the mechanism of treating KOA by Sinii decoction moxibustion. Methods from September 2015 to September 2016, the orthopedics and injury department of traditional Chinese medicine in Ningxia Medical University General Hospital were selected. Department of Orthopaedics and Trauma of traditional Chinese Medicine, Sunshine Hospital, General Hospital of Ningxia Medical University. 170 patients who met the standard were divided into two groups by random number coding method. The clinical study was carried out by using double blind method to treat 85 cases of Si-ni decoction and 85 cases of placebo moxibustion. Trained nurses and other personnel from the three departments involved in the experiment were operated. The subjects of the Si-Ni soup cake moxibustion group and the placebo cake moxibustion group all selected the calf nose point, the inner knee eye and the craning point of the knee joint. Four acupoints of Zusanli were treated for 10 days) as a course of treatment, with a course of treatment interval of 2 days. Two consecutive courses of treatment. Self-Rating knee Osteoarthritis scale before and after treatment (. Western Ontario and Memaster university Osteoarthritis index. WOMAC (Visual A nalogue Scale/score vas) combined with visual pain simulation. The clinical efficacy was evaluated. Enzyme-linked Immunosorbent assay was detected by double antibody sandwich enzyme-linked immunosorbent assay (Elisa). The levels of IL-6 and TNF- 伪 in serum of patients were detected by Elisa. The data were analyzed by SPSS19.0 statistical analysis software, and the data were analyzed with mean 卤standard deviation. X 卤s) indicated that the counting data was chi-square test, the normal distribution data was t test, and the non-normal distribution data was rank sum test. Before treatment, the total score of WOMAC of knee joint of the patients in the SINI decoction moxibustion group and the placebo cake moxibustion group were compared. 2. The difference was not statistically significant (P 0.05). After treatment, the WOMAC score of knee joint of the subjects in the Sinii decoction moxibustion group and the placebo cake moxibustion group were significantly decreased (P 0.05). There were no adverse events in all the patients during the treatment. Compared with placebo cake moxibustion group, the WOMAC score of Sini decoction cake moxibustion group decreased more obviously, and the difference was statistically significant (P 0.05) .2.Compared with that before treatment. The expression levels of IL-6 and TNF- 伪 in serum of patients with Sini decoction moxibustion group and placebo cake moxibustion group were significantly decreased, and the difference was statistically significant (P 0.05). Compared with placebo cake moxibustion, the serum levels of IL-1- 6 and TNF- 伪 decreased more significantly in Sini decoction moxibustion group. After treatment, the total effective rate of Sini decoction moxibustion group (96.25) was better than that of placebo cake moxibustion group (77.22). The difference was statistically significant (P 0.05). Conclusion 1. The clinical efficacy of SINI decoction moxibustion in treating KOA is significant and the safety is high. 2. It can improve the clinical symptoms of knee joint and improve the function of knee joint in patients with KOA. 2.Simi decoction moxibustion may be an effective way to inhibit the expression of IL-6 and TNF- 伪 in serum of patients with KOA, delay the pathogenesis of KOA and achieve the purpose of treating KOA.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.9

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