不同针灸方法治疗类风湿关节炎寒湿痹阻证的临床研究OACSTPCD

Objective:To observe the therapeutic effects of different warm acupuncture and moxibustion methods(needle-warming moxibustion,fire needling,thunder-fire moxibustion)in treatment of rheumatoid arthritis(RA).Methods:126 RA patients were randomly divided into the needle-warming moxibustion group,the fire needling group and the thunder-fire moxibustion group.All the three groups received routine treatment.The needle-warming moxibustion group was treated with needle-warming moxibustion,the fire needling group was treated with fire needling,and the thunder-fire moxibustion group was treated with thunder-fire moxibustion.All three groups were treated for 6 weeks.The three groups of patients were evaluated for pain and disease activity by using Visual Analog Scale(VAS)and Disease Activity Scale(DAS28)before the treatment,after 2 weeks,4 weeks and 6 weeks of treatment,respectively.The levels of C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),rheumatoid factor(RF),Nod like receptor protein 3(NLRP3),and angiopoietin like protein 2(ANGPTL2)were measured before and after the treatment in the three groups.Simultaneously,both hands X-ray examination,routine ultrasound examination,and ultrasound palpation tissue imaging quantification(VTIQ)examination were performed to obtain Sharp score,synovial hyperplasia thickness and SWVmean value.Results:The scores of VAS and DAS28 were lower after 2 weeks,4 weeks and 6 weeks of treatment than those before the treatment in the three groups(P＜0.05).The VAS scores of the needle-warming moxibustion group were lower than those of the other two groups after 4 weeks and 6 weeks of treatment,and the DAS28 score of the needle-warming moxibustion group was lower than that of the other two groups after 6 weeks of treatment(P＜0.05).The levels of NLRP3 and ANGPTL2 were lower in the needle-warming moxibustion group than those in the other two groups(P＜0.05);the levels of CRP and ESR were lower in the needle-warming moxibustion group than those in the fire needling group(P＜0.05),and there were no statistical differences in the levels of CRP and ESR between the needle-warming moxibustion group and the thunder-fire moxibustion group(P＞0.05);there were no statistical difference in RF level among the three groups(P＞0.05).The synovial thickness and SWVmean level were lower in the needle-warming moxibustion group than those in the other two groups(P＜0.05);the X-ray Sharp score was lower in the needle-warming moxibustion group than that in the fire needling group(P＜0.05),and there was no statistical difference in the X-ray Sharp score between the needle-warming moxibustion group and the thunder-fire moxibustion group(P＞0.05).Conclusion:Needle-warming moxibustion,fire needling and thunder-fire moxibustion can alleviate the pain of patients with rheumatoid arthritis,inhibit disease activity,reduce the thickness of synovium and inflammatory reaction,and improve bone destruction.Among them,needle-warming moxibustion shows best effect.