自拟清热利湿通络方外敷联合局部针刺治疗湿热痹阻型类风湿关节炎的疗效观察

Observation on the Therapeutic Effect of External Application of Self-Formulated Qingre Lishi Tongluo Formula Combined with Local Acupuncture in the Treatment of Damp-Heat Obstruction Pattern Rheumatoid Arthritis

摘要

目的 分析自拟清热利湿通络方外敷联合局部针刺治疗湿热痹阻型类风湿关节炎（rheumatoid arthritis，RA）的临床疗效。方法 选取2022年9月至2024年3月张家口市中医院收治的83例湿热痹阻型RA患者，按随机数字表法分为2组，2组患者均行常规西药治疗，其中针刺组41例行局部针刺治疗，联合组42例在针刺治疗基础上采用自拟清热利湿通络方外敷治疗。比较2组患者治疗12周后的临床疗效、中医证候积分、炎症因子水平、疼痛程度、关节功能及不良反应发生情况。结果 联合组的治疗总有效率较针刺组更高（P<0.05）；治疗12周后，2组患者晨僵、屈伸不利、关节压痛及关节肿胀评分均较治疗前明显降低（P<0.05），且联合组各评分均低于针刺组（P<0.05）；联合组治疗8、12周后的C反应蛋白、红细胞沉降率、类风湿因子及白细胞介素-6水平均低于针刺组（P<0.05）；联合组治疗8、12周后的视觉模拟评分法评分、28关节疾病活动度评分均低于针刺组（P<0.05）；2组不良反应总发生率无统计学差异（P>0.05）。结论 自拟清热利湿通络方外敷联合局部针刺可提高湿热痹阻型RA患者的临床疗效，有效缓解临床症状，降低机体炎症反应，改善关节功能，且安全性良好。

Abstract

Objective To analyze the clinical efficacy of external application of self-formulated Qingre Lishi Tongluo Formula combined with local acupuncture in the treatment of rheumatoid arthritis (RA) with damp-heat obstruction pattern. Methods A total of 83 patients with damp-heat obstruction pattern RA admitted to Zhangjiakou Hospital of Traditional Chinese Medicine from September 2022 to March 2024 were selected. They were divided into two groups according to the random number table method. All enrolled patients received conventional Western medicine treatment; among them, 41 patients in the acupuncture group underwent local acupuncture treatment, while 42 patients in the combined group received external application of self-formulated Qingre Lishi Tongluo Formula in addition to the acupuncture treatment. The clinical efficacy, traditional Chinese medicine syndrome scores, inflammatory factor levels, pain intensity, joint function and incidence of adverse reactions of the two groups were compared after 12 weeks of treatment.Results The total effective rate in the combined group was higher than that in the acupuncture group (P<0.05). At 12 weeks after treatment, the scores of morning stiffness, limitation of flexion and extension, joint tenderness, and joint swelling of patients in both groups were significantly lower than those before treatment (P<0.05), and the scores in the combined group were lower than those in the acupuncture group (P<0.05). At 8 and 12 weeks after treatment, the levels of C-reactive protein, erythrocyte sedimentation rate, rheumatoid factor, and interleukin-6 in the combined group were lower than those in the acupuncture group (P<0.05). The visual analogue scale score and disease activity score using 28 joint counts in the combined group were lower than those in the acupuncture group after 8 and 12 weeks of treatment (P<0.05). There was no statistically significant difference in the total incidence of adverse reactions between the two groups (P>0.05).Conclusion The combination of external application of self-formulated Qingre Lishi Tongluo Formula and local acupuncture can improve clinical efficacy in patients with damp-heat obstruction pattern RA, effectively relieve clinical symptoms, reduce systemic inflammatory response, improve joint function, and demonstrate good safety.

关键词

清热利湿通络方 / 湿热痹阻型 / 局部针刺 / 外敷 / 类风湿关节炎

Key words

Qingre Lishi Tongluo Formula / damp-heat obstruction pattern / local acupuncture / external application / rheumatoid arthritis

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基金资助

张家口市科技计划项目(2221113D)