Objective: To observe the effect of acupuncture combined with moxibustion on serum bone metabolism indexes in patients with knee osteoarthritis (KOA), so as to evaluate its clinical efficacy on KOA.
Methods: Ninety-six patients with KOA were randomly divided into control and observation groups, with 48 cases in each group. The patients in the control group were treated with acupuncture at Zusanli(ST36), Neixiyan(EX-LE4), Heding(EX-LE2) and Xuanzhong(GB39) etc. on the affected side for 30 min once daily. Patients in the observation group were given moxibustion on the above-mentioned acupoints on the basis of treatment in the control group. The course of treatment for both groups was 4 weeks. The Western Ontario and MacMaster University Osteoarthritis Index (WOMAC) scores were compared before and after treatment and the clinical efficacy of the two groups were calculated according to the WOMAC scores after treatment. Ultrasound examination of the knee joint was used to analyze the thickness of joint effusion and synovial membrane thickness of the patients. Enzyme-linked immunoassay was used to detect the serum type Ⅰ collagen C-terminal foreign body peptide (CTX-Ⅰ), insulin-like growth factor (IGF), bone gla protein (BGP), matrix metalloproteinase-9 (MMP-9), matrix metalloproteinase inhibitor-1 (TIMP-1) levels.
Results: Compared with those before treatment, WOMAC score, knee joint synovial thickness and joint effusion thickness, serum CTX-Ⅰ, MMP-9, TIMP-1 levels, and MMP-9/TIMP-1 ratio were all down-regulated (P<0.05), while the levels of serum IGF and BGP up-regulated (P<0.05) in the two groups after treatment. The improvements of the above indexes in the observation group were superior to those in the control group (P<0.05). The total effective rate in the observation group was 95.83% (46/48), which was higher than 81.25% (39/48) in the control group(P<0.05).
Conclusion: Acupuncture combined with moxibustion can regulate bone metabolism and effectively improve the symptoms of KOA patients, which may be related to its effect in regulating the dynamic balance of MMP-9 and TIMP-1 in serum.
目的：观察针刺联合艾灸治疗对膝骨关节炎（KOA）患者血清基质金属蛋白酶（MMP）及其抑制物的影响, 探讨其治疗KOA疗效的部分作用机制。方法：96例KOA患者按照随机数字表法分为对照组及观察组, 每组48例。对照组予以针刺患侧足三里、内膝眼、鹤顶、悬钟、阴陵泉等穴, 每次30 min；观察组在对照组治疗基础上予以膝部艾灸箱施灸治疗, 每次30 min。两组均每日治疗1次, 每周治疗6次, 治疗4周。比较两组治疗前后西安大略和马克马斯特大学骨关节炎指数（WOMAC）评分, 彩色多普勒超声诊断仪测定膝关节积液厚度和滑膜厚度, 酶联免疫吸附法检测血清中Ⅰ型胶原C端异物肽（CTX-Ⅰ）、胰岛素样生长因子（IGF）、骨钙素（BGP）、基质金属蛋白酶-9（MMP-9）、基质金属蛋白酶抑制剂-1（TIMP-1）含量, 计算MMP-9/TIMP-1比值, 观察两组临床疗效。结果：与本组治疗前相比, 两组患者治疗后WOMAC各维度功能评分、膝关节滑膜厚度和积液厚度、血清CTX-Ⅰ、MMP-9、TIMP-1含量及MMP-9/TIMP-1比值均较本组治疗前降低（P<0.05）, 且观察组均低于对照组（P<0.05）；两组患者血清IGF和BGP水平较本组治疗前升高（P<0.05）, 且观察组均高于对照组（P<0.05）。观察组总有效率为95.83%（46/48）, 对照组总有效率为81.25%（39/48）, 观察组临床疗效优于对照组（P<0.05）。结论：针刺联合艾灸治疗可有效改善KOA患者临床症状, 可调节骨代谢, 同时减轻滑膜水肿、减少关节腔积液, 其机制可能与调节MMP-9、TIMP-1动态平衡有关。.
Keywords: Acupuncture combined with moxibustion; Knee osteoarthritis; Matrix metalloproteinase inhibitor-1; Matrix metalloproteinase-9.