Clinical efficacy of medicinal cake fire dragon moxibustion in the treatment of rheumatoid knee arthritis of the wind-cold-dampness syndrome type
-
摘要:
目的 类风湿性膝关节炎尚缺乏有效治疗手段，本研究旨在探讨药饼火龙灸中医特色疗法的临床疗效。 方法 选取2023年6月—2025年10月金华市中医医院风湿免疫科收治的108例风寒湿痹型类风湿性膝关节炎患者，采用随机数表法分为对照组和试验组，每组各54例。对照组给予塞来昔布胶囊治疗，试验组给予药饼火龙灸治疗，均治疗4周。比较2组中医证候积分、膝关节视觉模拟疼痛（VAS）评分、Lysholm膝关节评分、实验室指标[血沉（ESR）、C-反应蛋白（CRP）、类风湿因子（RF）、肿瘤坏死因子-α（TNF-α）]和肌骨超声情况，评估临床疗效和安全性。 结果 治疗4周后2组中医证候积分、膝关节VAS评分均较治疗前下降，Lysholm评分均高于治疗前（P＜0.05），且试验组中医证候积分、膝关节VAS评分[（1.65±0.43）分vs.（2.70±0.68）分]低于对照组，Lysholm评分[（82.70±6.24）分vs.（78.19±6.07）分]高于对照组（P＜0.05）。治疗4周后2组ESR、CRP、RF、TNF-α均较治疗前下降（P＜0.05），且试验组上述指标均低于对照组（P＜0.05）。治疗4周后2组滑膜厚度、髌上囊积液厚度、滑膜血流信号评分均较治疗前下降（P＜0.05），且试验组上述指标均低于对照组（P＜0.05）。试验组中医证候疗效优于对照组（P＜0.05），2组均无明显不良反应。 结论 药饼火龙灸能明显缓解风寒湿痹型类风湿性膝关节炎患者的临床症状，减轻免疫炎症反应、滑膜炎性损伤和改善膝关节功能，疗效显著且安全性好。 Abstract:Objective There is a lack of specific treatments for rheumatoid arthritis of the knee. This study aimed to evaluate the clinical efficacy of fire dragon moxibustion with medicinal cake, a traditional Chinese medicine therapy, for patients with wind cold damp obstruction type rheumatoid knee arthritis. Methods A total of 108 patients with wind cold damp obstruction type rheumatoid knee arthritis admitted to the Department of Rheumatology and Immunology, Jinhua Hospital of Chinese Medicine, from June 2023 to October 2025 were enrolled. Patients were randomly divided into a control group and a trial group (n=54 each) using a random number table. The control group received celecoxib, and the trial group received fire dragon moxibustion with medicinal cake for 4 weeks. Traditional Chinese medicine (TCM) syndrome scores, visual analogue scale (VAS) pain scores, Lysholm knee scores, laboratory parameters including erythrocyte sedimentation rate (ESR), C reactive protein (CRP), rheumatoid factor (RF), tumor necrosis factor-α (TNF-α), and musculoskeletal ultrasound findings were compared between the two groups. Clinical efficacy and safety were evaluated. Results After 4 weeks of treatment, TCM syndrome scores and VAS scores decreased in both groups compared with baseline, while Lysholm scores increased (P < 0.05). The trial group showed significantly lower VAS scores (1.65±0.43 vs. 2.70±0.68), and higher Lysholm scores (82.70±6.24 vs. 78.19±6.07) than the control group (P < 0.05). Levels of ESR, CRP, RF, and TNF α decreased in both groups after treatment, with significantly lower values in the trial group (P < 0.05). Musculoskeletal ultrasound findings, including synovial thickness, suprapatellar effusion thickness, and synovial blood flow score, improved significantly in both groups, with better outcomes in the trial group (P < 0.05). The TCM syndrome efficacy rate was significantly higher in the trial group (P < 0.05), and no serious adverse events occurred in either group. Conclusion Fire dragon moxibustion with medicinal cake can effectively relieve clinical symptoms, reduce immune inflammatory responses, alleviate synovial inflammation, and improve knee function in patients with wind cold damp obstruction type rheumatoid knee arthritis. It demonstrates significant clinical efficacy and good safety. -
表 1 2组类风湿性膝关节炎患者基线资料比较
Table 1. Comparison of baseline data in two groups of rheumatoid knee arthritis patients
组别 例数 性别(男性/女性，例) 年龄(x±s，岁) 类风湿性膝关节炎病程(x±s，年) 家族史[例(%)] 病情(轻度/中度，例) DAS28评分(x±s，分) 对照组 54 22/32 56.10±10.23 1.86±0.45 6(11.11) 13/41 3.94±1.02 试验组 54 24/30 55.87±10.30 1.83±0.50 8(14.81) 15/39 3.91±1.05 统计量 0.152a 0.116b 0.328b 0.328a 0.193a 0.151b P值 0.697 0.908 0.744 0.567 0.661 0.881 注：a为χ2值，b为t值。 
下载: 导出CSV
表 2 2组类风湿性膝关节炎患者治疗前后中医证候积分比较(x±s，分)
Table 2. Comparison of traditional chinese medicine syndrome scores before and after treatment in two groups of patients with rheumatoid knee arthritis (x±s, points)
组别 例数 中医主症积分 中医次症积分 中医证候积分 治疗前 治疗4周 治疗前 治疗4周 治疗前 治疗4周 对照组 54 15.74±2.54 9.25±2.13b 5.20±1.13 2.91±0.57b 20.94±3.20 12.16±2.24b 试验组 54 15.72±2.62 6.63±1.25b 5.25±1.15 2.18±0.24b 20.97±3.17 8.81±1.67b 统计量 0.040a 15.825c 0.228a 10.349c 0.049a 21.107c P值 0.968 ＜0.001 0.820 ＜0.001 0.961 ＜0.001 注：a为t值，c为F值；与同组治疗前比较，bP＜0.05。
下载: 导出CSV
表 3 2组类风湿性膝关节炎患者中医证候疗效比较[例(%)]
Table 3. Comparison of therapeutic effects of traditional chinese medicine syndromes in two groups of rheumatoid knee arthritis patients [cases (%)]
组别 例数 临床痊愈 显效 有效 无效 对照组 54 3(5.56) 16(29.63) 25(46.30) 10(18.52) 试验组 54 8(14.81) 28(51.85) 15(27.78) 3(5.56) 注：2组疗效比较，Z=6.305，P＜0.001。
下载: 导出CSV
表 4 2组类风湿性膝关节炎患者治疗前后膝关节VAS、Lysholm评分比较(x±s，分)
Table 4. Comparison of knee vas and lysholm scores in two groups of patients with rheumatoid knee arthritis before and after treatment (x±s, points)
组别 例数 膝关节VAS评分 膝关节Lysholm评分 治疗前 治疗4周 治疗前 治疗4周 对照组 54 4.81±1.02 2.70±0.68b 69.85±7.23 78.19±6.07b 试验组 54 4.76±1.05 1.65±0.43b 70.31±7.40 82.70±6.24b 统计量 0.251a 13.081c 0.327a 16.012c P值 0.802 ＜0.001 0.745 ＜0.001 注：a为t值，c为F值；与同组治疗前比较，bP＜0.05。
下载: 导出CSV
表 5 2组类风湿性膝关节炎患者治疗前后实验室相关指标比较(x±s)
Table 5. Comparison of laboratory related indices in two groups of patients with rheumatoid knee arthritis before and after treatment (x±s)
组别 例数 ESR(mm/h) CRP(mg/L) RF(IU/mL) TNF-α(pg/mL) 治疗前 治疗4周 治疗前 治疗4周 治疗前 治疗4周 治疗前 治疗4周 对照组 54 48.73±10.16 30.45±7.32b 42.57±6.20 13.16±2.43b 128.77±24.65 91.20±15.81b 38.76±5.10 27.91±4.23b 试验组 54 47.90±10.24 24.61±5.89b 41.69±6.34 9.12±2.05b 131.03±25.12 83.76±10.37b 39.25±5.17 21.40±3.35b 统计量 0.423a 15.385c 0.729a 31.207c 0.472a 14.278c 0.496a 23.286c P值 0.673 ＜0.001 0.468 0.001 0.638 ＜0.001 0.621 ＜0.001 注：a为t值，c为F值；与同组治疗前比较，bP＜0.05。
下载: 导出CSV
表 6 2组类风湿性膝关节炎患者治疗前后肌骨超声指标比较(x±s)
Table 6. Comparison of musculoskeletal ultrasound indicators in two groups of patients with rheumatoid knee arthritis before and after treatment (x±s)
组别 例数 滑膜厚度(mm) 髌上囊积液厚度(mm) 滑膜血流信号(分) 治疗前 治疗4周 治疗前 治疗4周 治疗前 治疗4周 对照组 54 4.07±1.04 2.98±0.83b 3.97±1.15 2.81±0.65b 3.78±1.02 1.58±0.47b 试验组 54 4.04±1.03 2.37±0.65b 3.94±1.17 2.25±0.49b 3.75±1.05 0.81±0.25b 统计量 0.151a 13.415c 0.134a 11.583c 0.151a 10.521c P值 0.881 ＜0.001 0.893 ＜0.001 0.881 ＜0.001 注：a为t值，c为F值；与同组治疗前比较，bP＜0.05。
下载: 导出CSV
-
[1] ZHANG A R, CHENG Q H, YANG Y Z, et al. Meta-analysis of outcomes after total knee arthroplasty in patients with rheumatoid arthritis and osteoarthritis[J]. Asian J Surg, 2024, 47(1): 43-54. doi: 10.1016/j.asjsur.2023.09.015 [2] 魏爽, 王蕊, 李欣宇, 等. 类风湿关节炎中的免疫与代谢研究及中医药治疗进展[J]. 天津中医药大学学报, 2025, 44(4): 358-365.Wei S, Wang R, Li X Y, et al. Research progress on immunity and metabolism in rheumatoid arthritis and treatment with traditional Chinese medicine[J]. Journal of Tianjin University of Traditional Chinese Medicine, 2025, 44(4): 358-365. [3] 陈君洁, 孙玥, 李明, 等. 正清风痛宁片治疗风寒湿痹型类风湿关节炎的多中心临床疗效[J]. 中国实验方剂学杂志, 2024, 30(16): 132-139.Chen J J, Sun Y, Li M, et al. Multicenter clinical efficacy of Zhengqing Fengtongning Tablets in treating rheumatoid arthritis of wind-cold-dampness obstruction type[J]. Chinese Journal of Experimental Traditional Medical Formulae, 2024, 30(16): 132-139. [4] 董逸飞, 时素华, 杨颖, 等. 从督脉理论探析督脉灸治疗骨质疏松性脊柱骨折[J]. 陕西中医, 2025, 46(6): 791-794.Dong Y F, Shi S H, Yang Y, et al. Analysis on Governor Vessel moxibustion in the treatment of osteoporotic spinal fracture based on Governor Vessel theory[J]. Shaanxi Journal of Traditional Chinese Medicine, 2025, 46(6): 791-794. [5] 中华医学会风湿病学分会. 2018中国类风湿关节炎诊疗指南[J]. 中华内科杂志, 2018, 57(4): 242-251.Chinese Medical Association Rheumatology Branch. 2018 Chinese guidelines for the diagnosis and treatment of rheumatoid arthritis[J]. Chinese Journal of Internal Medicine, 2018, 57(4): 242-251. [6] 姜泉, 王海隆, 巩勋, 等. 类风湿关节炎病证结合诊疗指南[J]. 中国中医骨伤科杂志, 2020, 28(4): 86-88.Jiang Q, Wang H L, Gong X, et al. Guidelines for the diagnosis and treatment of rheumatoid arthritis with integrated traditional Chinese and Western medicine[J]. Chinese Journal of Traditional Chinese Medicine Orthopedics and Traumatology, 2020, 28(4): 86-88. [7] 郑筱萸. 中药新药临床研究指导原则: 试行[M]. 北京: 中国医药科技出版社, 2002: 73-77.Zheng X Y. Guiding Principles for Clinical Research of New Drugs of Traditional Chinese Medicine (Trial)[M]. Beijing: China Medical Science Press, 2002: 73-77. [8] 彭晓松, 曲小雨, 刘培林. 肌肉骨骼超声对膝关节滑膜炎的诊断分析[J]. 影像科学与光化学, 2022, 40(4): 942-946.Peng X S, Qu X Y, Liu P L. Diagnostic analysis of musculoskeletal ultrasound in knee synovitis[J]. Imaging Science and Photochemistry, 2022, 40(4): 942-946. [9] 王小燕, 南雅炫, 马吴丹, 等. 肌骨超声特征评分对老年类风湿关节炎患者疾病活动度的评估价值[J]. 中国老年学杂志, 2025, 45(10): 2368-2371.Wang X Y, Nan Y X, Ma W D, et al. Value of musculoskeletal ultrasound characteristic score in evaluating disease activity in elderly patients with rheumatoid arthritis[J]. Chinese Journal of Gerontology, 2025, 45(10): 2368-2371. [10] 王涛, 李志军. 类风湿关节炎的诊断与治疗[J]. 中华全科医学, 2020, 18(2): 170-171.Wang T, Li Z J. Diagnosis and treatment of rheumatoid arthritis[J]. Chinese Journal of General Practice, 2020, 18(2): 170-171. [11] 张晓东, 王婕. 赵绍琴教授焦树德教授治疗类风湿关节炎用药经验[J]. 光明中医, 2024, 39(8): 1533-1536.Zhang X D, Wang J. Medication experience of Professors Zhao Shaoqin and Jiao Shude in treating rheumatoid arthritis[J]. Guangming Journal of Chinese Medicine, 2024, 39(8): 1533-1536. [12] 杨煜辰, 姜泉, 巩勋, 等. 1 191例寒湿痹阻证类风湿关节炎患者的证候演变特点及相关性分析[J]. 中国中医基础医学杂志, 2024, 30(6): 970-974.Yang Y C, Jiang Q, Gong X, et al. Characteristics of syndrome evolution and correlation analysis in 1 191 patients with rheumatoid arthritis of cold-dampness obstruction syndrome[J]. Chinese Journal of Basic Medicine in Traditional Chinese Medicine, 2024, 30(6): 970-974. [13] 吴东明, 董金莉, 谈平. 谈平教授治疗类风湿关节炎临床经验[J]. 中国医药导报, 2024, 21(7): 139-143.Wu D M, Dong J L, Tan P. Clinical experience of Professor Tan Ping in treating rheumatoid arthritis[J]. China Medical Herald, 2024, 21(7): 139-143. [14] 陈雪猛, 王勇, 吴维. 基于网络药理学分析桂枝治疗类风湿关节炎的作用机制[J]. 中南医学科学杂志, 2023, 51(1): 45-48.Chen X M, Wang Y, Wu W. Analysis on mechanism of Ramulus Cinnamomi in treating rheumatoid arthritis based on network pharmacology[J]. Journal of Xiangnan University(Medical Sciences), 2023, 51(1): 45-48. [15] 白翠慧, 侯国栋, 关永霞, 等. 独活化学成分及药理作用研究进展[J]. 中华中医药学刊, 2025, 43(10): 129-144.Bai C H, Hou G D, Guan Y X, et al. Research progress on chemical constituents and pharmacological effects of Radix Angelicae Pubescentis[J]. Chinese Archives of Traditional Chinese Medicine, 2025, 43(10): 129-144. [16] 张庆, 黄娟, 邵瑜, 等. 基于扶阳通痹理论的火龙灸疗法治疗风寒湿痹型类风湿关节炎疗效观察[J]. 现代中西医结合杂志, 2025, 34(8): 1099-1103.Zhang Q, Huang J, Shao Y, et al. Observation on curative effect of fire dragon moxibustion based on the theory of strengthening yang and unblocking bi-syndrome in treating rheumatoid arthritis of wind-cold-dampness obstruction type[J]. Modern Journal of Integrated Traditional Chinese and Western Medicine, 2025, 34(8): 1099-1103. [17] 梁铭坤, 段晓荣, 刘彩娇, 等. 基于数据挖掘分析针灸治疗类风湿关节炎选穴规律[J]. 中国中医药图书情报杂志, 2025, 49(4): 83-89.Liang M K, Duan X R, Liu C J, et al. Analysis on acupoint selection rules of acupuncture and moxibustion for rheumatoid arthritis based on data mining[J]. Chinese Journal of Traditional Chinese Medicine Library and Information, 2025, 49(4): 83-89. [18] 单玉辉, 李阳, 乔学能, 等. 类风湿性膝关节炎肌骨超声特征与炎症因子的关系及在疗效评估中的作用[J]. 新疆医科大学学报, 2025, 48(7): 957-962, 967.Shan Y H, Li Y, Qiao X N, et al. Relationship between musculoskeletal ultrasound features and inflammatory factors in rheumatoid knee arthritis and its role in curative effect evaluation[J]. Journal of Xinjiang Medical University, 2025, 48(7): 957-962, 967. [19] 许月霞, 郭月蓉, 蔡少桐, 等. 温经散寒方联合中药熏蒸治疗寒湿痹阻型类风湿关节炎的疗效及对炎症细胞因子的影响[J]. 延边大学医学学报, 2025, 48(9): 114-117.Xu Y X, Guo Y R, Cai S T, et al. Curative effect of Wenjing Sanhan Recipe combined with traditional Chinese medicine fumigation on rheumatoid arthritis of cold-dampness obstruction syndrome and its influence on inflammatory cytokines[J]. Journal of Medical Science Yanbian University, 2025, 48(9): 114-117.
点击查看大图
表(6)
计量
- 文章访问数: 7
- HTML全文浏览量: 3
- PDF下载量: 0
- 被引次数: 0
