子午流注蜂针对强直性脊柱炎的疗效及机制研究

目的 观察子午流注蜂针时强直性脊柱炎(ankylosing spondylitis,AS)的疗效、安全性及对患者血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、性激素水平的影响,探讨其产生疗效的机制.方法 将120例AS患者随机分为3组,治疗组40例采用子午流注加辨证取定蜂针治疗,对照1组40例用辨证取穴蜂针治疗,对照2组40例用柳氮磺胺吡啶(sulfasalazine,SSZ)、双氯芬酸钠治疗；3组均以4周为1个疗程,3个疗程后观察疗效,现测患者Bath强直性脊柱炎病情活动性指教(Bath AS disease activity index,BAS-DAI)、Bath强直性脊柱炎功能指数(Bath AS functional index,BASFI)、晨僵时同、全身疼痛和脊柱疼痛Liken 4级积分、患者和医生的总体评价积分,测定血沉(erythrosedi mentation,ESR)、C反应蛋白(C-reactive protein,CRP)、血清IL-6、TNF-α、性激素水平,同时观察药物的不良反应.结果 治疗组和对照1组、对照2组总有效率分别为82.5％和72.5％、70.0％,对照组与治疗组比较差异有统计学意义(P＜0.05);3组治疗前后BAS-Dai、BASFI、晨僵时间、全身疼痛和脊柱疼痛Liken 4级积分、患者和医生的总体评价积分等观察指标有明显改善,ESR、CRP、IL-6、TNF-α、睾酮(T)明显下降,治疗前后差异有统计学意义(P＜0.05)；治疗组的指标下降值与对照组相比,差异有统计学意义(P＜0.05),3组治疗前后雌二醇(E2)、促卵泡激素(FSH)均有上升趋势,3组泌乳素(PRL)、孕酮(P)、促黄体生成素(LH)治疗前后比较有下降趋势,但差异均无统计学意义(P＞0.05).不良反应的发生率治疗组为10％,对照1组为12.5％,对照2组为30％.结论 子午流注蜂针治疗AS疗效显著,且不良反应较少.其疗效可能与其抑制患者血清IL-6、TNF-α、T有关.

Effects and mechanism of bee-venom-acupuncture based on Midnight-Noon Ebb-Flow doctrine on ankylosing spondylitis

Objective To observe the effects and safety of bee-venom-acupuncture based on Midnight-Noon Ebb-Flow doctrine on ankylosing spondylitis(AS),and its impacts on IL-6,TNF-α and sex hormone levels,and to explore its mechanisms.Methods 120 AS patients were randomly divided into 3 groups: 40 patients in treatment group were treated with bee-venom-acupuncture based on Midnight-Noon Ebb-Flow doctrine and syndrome differentiation;40 patients in control group A were treated with bee-acupuncture based on syndrome differentiation;and 40 patients in the control group B were treated with sulfasalazine(SSZ) and diclofenac sodium.A treatment course was 4 weeks.Before and after 3 courses,indexes were observed and recorded,such as Bath AS disease activity index(BAS-DAI),Bath AS functional index(BASFI),duration of morning stiffness,Likert’ 4-grade score of whole body pain and spinal pain,evaluation by doctors and patients,the erythrosedi mentation(ESR),C-reactive protein(CRP),and the levels of IL-6,TNF-α and sex hormones.Adverse effects of medicines were also observed.Results The total effective rate was 82.5%,72.5% and 70.0% in treatment group,control group A and control group B respectively;the statistic differences were significant(P<0.05).In 3 groups,indexes of BASDAI,BASFI,duration of morning stiffness,Likert’ 4-grade score of whole body pain and spinal pain,evaluation by doctors and patients were improved obviously after treatments;ESR,CRP,IL-6,TNF-α and Testosterone were significantly decreased after treatments;the differences had statistic significance(P<0.05).Compared with the date of controls,the treatment group also showed better results after treatments;the differences between treatment group and control groups had significance(P<0.05).In 3 groups,Estradiol and Follicle-stimulating hormones were increased after treatments;Prolactin,Progesterone and Luteinizing hormones were decreased after treatments;but before and after treatments there was no significant difference(P>0.05).The incidence rate of adverse effects in treatment group was 10%,while that in the control group A and B was 12% and 30% respectively.Conclusion Bee-venom-acupuncture based on Midnight-Noon Ebb-Flow doctrine presents significant efficacy on AS with less adverse effects.The mechanism may be related to inhibition of IL-6,TNF-α and Testosterone production.