CAJ | 학술논문

目的：观察威灵仙浸膏外敷联合电针配穴齐刺手法治疗膝关节骨性关节炎的疗效及对患者HA、IL－1β及MMP－1水平的影响。方法将286例膝关节骨性关节炎住院患者随机分为治疗组和联合组，每组143例。治疗组给予电针配穴齐刺手法及超短波理疗＋口服盐酸氨基葡萄糖胶囊治疗，联合组在此基础上外敷自制威灵仙浸膏，2组疗程均为21 d。检测2组治疗前后关节液透明质酸（ HA）、白细胞介素－1β（ IL－1β）含量，病理检查软骨MMP－1细胞阳性表达率，对2组患者进行疼痛VAS评分，计算WOMAC骨关节炎指数，观察2组临床疗效及不良反应发生情况，随访6个月复发情况。结果治疗后2组HA含量均明显高于治疗前（P均＜0．05），且联合组明显高于治疗组（P＜0．05）；2组IL－1β含量均较治疗前明显降低（P均＜0．05），且联合组明显低于治疗组（P＜0．05）。治疗组治疗前后MMP－1阳性表达率比较差异无统计学意义，联合组治疗后MMP－1阳性表达率明显低于治疗前及治疗组（P均＜0．05）。2组治疗后WOMAC、VAS评分均较治疗前明显降低（P均＜0．05），且联合组明显低于治疗组（P＜0．05）。联合组总有效率明显高于治疗组（P＜0．05），复发率明显低于治疗组（P＜0．05）。结论自制威灵仙浸膏外敷联合电针配穴齐刺法治疗膝关节骨性关节炎疗效好，可明显降低复发率，是一种安全、可靠、有效的联合治疗方案。
목적：관찰위령선침고외부연합전침배혈제자수법치료슬관절골성관절염적료효급대환자HA、IL－1β급MMP－1수평적영향。방법장286례슬관절골성관절염주원환자수궤분위치료조화연합조，매조143례。치료조급여전침배혈제자수법급초단파리료＋구복염산안기포도당효낭치료，연합조재차기출상외부자제위령선침고，2조료정균위21 d。검측2조치료전후관절액투명질산（ HA）、백세포개소－1β（ IL－1β）함량，병리검사연골MMP－1세포양성표체솔，대2조환자진행동통VAS평분，계산WOMAC골관절염지수，관찰2조림상료효급불량반응발생정황，수방6개월복발정황。결과치료후2조HA함량균명현고우치료전（P균＜0．05），차연합조명현고우치료조（P＜0．05）；2조IL－1β함량균교치료전명현강저（P균＜0．05），차연합조명현저우치료조（P＜0．05）。치료조치료전후MMP－1양성표체솔비교차이무통계학의의，연합조치료후MMP－1양성표체솔명현저우치료전급치료조（P균＜0．05）。2조치료후WOMAC、VAS평분균교치료전명현강저（P균＜0．05），차연합조명현저우치료조（P＜0．05）。연합조총유효솔명현고우치료조（P＜0．05），복발솔명현저우치료조（P＜0．05）。결론자제위령선침고외부연합전침배혈제자법치료슬관절골성관절염료효호，가명현강저복발솔，시일충안전、가고、유효적연합치료방안。
Objective It is to observe the curative effect of self-made clematis chinensis extract ( CCE) external application combined with electro acupuncture and triple needling in treating knee osteoarthritis, and its influence on the levels of hyalu-ronic acid (HA), interleukin-1beta (IL-1β) and MMP-1.Methods 286 patients with knee osteoarthritis were randomly divided into treatment group and combine group, 143 cases in each group.The patients were treated with electro acupuncture and triple needling, ultrashort wave therapy, glucosamine hydrochloride capsule oral combined with routine treatment in treat-ment group;on this basis, the patient were treated with external application of self-made CCE in the combine group, the course of treatment was 21 days in the two groups.The levels of interleukin-1 beta ( IL-1β) and hyaluronic acid ( HA) in joint fluid were detected, and the cell positive expression rate of cartilage MMP-1 was examined, the pain was estimated by VAS score, and the WOMAC osteoarthritis index were calculated, the clinical efficacy and adverse reactions of the two groups were observed, and the recurrence was followed up for 6 months.Results After treatment, the content of HA were significantly higher than those before treatment in the two groups (all P<0.05), and that of the combine group was significantly higher than that of the treatment group (P<0.05);the levels of IL-1βwere significantly lower than those before treatment in the two groups (all P<0.05), and that of the combine group was significantly lower than that of the treatment group (P<0.05);the MMP-1 positive expression rate in combine group was significantly lower than that before treatment and of the treatment group ( all P<0.05);the VAS score and WOMAC index were decreased significantly than those before treatment ( all P<0.05), and that of the combine group were significantly lower than that of the treatment group (all P<0.05).The total effec-tive rate of the combine group was markedly higher than that of the treatment group and the recurrence rate was markedly lower than that of the treatment group (all P<0.05).Conclusion Self-made CCE external application combined with electroacu-puncture and triple needling in the treatment of knee osteoarthritis can achieve good results, and significantly reduce the recur-rence rate;it is a safe, reliable and effective combination therapy.