Objective: To observe the efficacy of the combined treatment with acupuncture and governor vessel moxibustion on ankylosing spondylitis (AS) at early-middle stage and investigate the effect on bone marrow edema of sacroiliac joint.
Methods: Seventy patients of AS at early-middle stage were randomized into an observation group (35 cases) and a control group (35 cases, 1 case dropped off ). In the control group, the recombinant human tumor necrosis factor receptor-antibody of type Ⅱ fusion protein for injection was injected subcutaneously, 25 mg each time, once on every Monday and Friday, consecutively for 3 weeks. In the observation group, on the base of the intervention as the control group, acupuncture combined with governor vessel moxibustion were provided. Acupuncture was applied to Dazhui (GV 14), Changqiang (GV 1), Zhibian (BL 54), Baihui (GV 20), etc.; the thermal needling technique was adopted at Dazhui (GV 4) and Changqiang (GV 1) for promoting the circulation of the governor vessel, and the ginger-isolated moxibustion on the governor vessel was combined. Such intervention measure was provided once daily. One treatment session contained 7 treatments and 3 sessions were required. Before and after treatment, the scores of Spondyloarthritis Research Consortium of Canada (SPARCC), Bath ankylosing spondylitis disease activity index (BASDAI) and Bath ankylosing spondylitis functional index (BASFI) and Bath ankylosing spondylitis patient global score (BAS-G) were observed in the two groups separately. The efficacy and adverse effects were assessed in the two groups after treatment.
Results: The scores of SPARCC, BASDAI, BASFI and BAS-G were all reduced after treatment compared with those before treatment in the two groups (P<0.05), and those in the observation group were lower than the control group (P<0.05). The total effective rate was 97.1% (34/35) in the observation group, higher than 82.4% (28/34) in the control group (P<0.05). There were 4 cases of gastrointestinal reactions and 1 case of skin rashes in the control group; and 3 cases of local skin redness and pruritus after governor vessel moxibustion, no any drug adverse effect was found in the observation group.
Conclusion: Based on the western medicine treatment, the combined therapy of acupuncture and governor vessel moxibustion may relieve bone marrow edema of sacroiliac joint in patients with AS at early-middle stage, control the progression of disease and improve the daily life activity. This therapy is relatively safe and effective.
目的：观察在西药治疗基础上针刺联合督灸治疗早中期强直性脊柱炎（AS）患者的临床疗效及对患者骶髂关节骨髓水肿的影响。方法：将70例早中期AS患者随机分为观察组（35例）和对照组（35例，脱落 1例）。对照组予注射用重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白皮下注射，每次25 mg，每周一、周五各1次， 连续治疗3周。在对照组基础上，观察组予针刺联合督灸治疗，于大椎、长强、秩边、百会等穴针刺，大椎、长强施以通督热针法，并联合督脉隔姜灸，每日1次，7次为一疗程，治疗3个疗程。治疗前后，比较两组加拿大脊柱骨关节炎研究协会（SPARCC）评分、Bath强直性脊柱炎疾病活动指标（BASDAI）评分、Bath强直性脊柱炎功能指标（BASFI）评分、Bath强直性脊柱炎综合指数评分（BAS-G），观察两组临床疗效及不良反应。结果：治疗后，两组患者SPARCC、BASDAI、BASFI、BAS-G评分均较治疗前降低(P<0.05)，且观察组低于对照组（P<0.05)；观察组总有效率为97.1%（34/35），高于对照组的82.4%（28/34，P<0.05)。对照组出现4例胃肠道反应和1例皮疹反应；观察组3例督灸后局部皮肤发红瘙痒，未出现药物不良反应。结论：在西药治疗基础上，针刺联合督灸可改善早中期AS患者骶髂关节骨髓水肿，控制患者疾病活动，改善日常生活能力，且相对安全有效。.
Keywords: acupuncture; ankylosing spondylitis; bone marrow edema of sacroiliac joint; governor vessel moxibustion; randomized controlled trial (RCT).