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Article(id=1322922837467607606, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322922680609014711, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.02.044, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793338983169, onlineDateStr=2026-10-30, pubDate=1739116800000, pubDateStr=2025-02-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793338983169, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793338983169, creator=13701087609, updateTime=1793338983169, updator=13701087609, issue=Issue{id=1322922680609014711, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='2', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1739116800000', pubDateStr='2025-02-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793338945772, creator='13701087609', updateTime=1793340618065, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322929694785536732, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322922680609014711, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322929694785536733, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322922680609014711, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=216, endPage=219, ext={EN=ArticleExt(id=1322922837924786743, articleId=1322922837467607606, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Effect of Acupuncture Combined with Traditional Chinese Medicine Decoction in Treatment of Knee Osteoarthritis and Its Effect on Serum Inflammatory Pain Mediators, columnId=1256183365644968140, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Platform of Provincial Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To study the effect of acupuncture combined with traditional Chinese medicine decoction on knee osteoarthritis and its effect on serum inflammatory pain mediators.

Methods

From August 2020 to January 2022，80 patients with knee osteoarthritis in the Affiliated Hospital of Chengde Medical College were divided into two groups according to the random number table method，40 cases in the control group and 40 cases in the observation group. The control group was treated with fire acupuncture alone，and the treatment group was treated with acupuncture combined with traditional Chinese medicine decoction. After 8 weeks of treatment，the efficacy，the levels of inflammatory factors interleukin-1（IL-1），interleukin-6（IL-6）and tumor necrosis factor-α（TNF-α），knee joint pain and activity，osteoarthritis index and adverse reactions were compared between the two groups.

Results

The total effective rate of the treatment group was 97.50%（39/40），which was significantly higher than that of the control group（80.00%，32/40），and the difference was statistically significant（P<0.05）. After treatment，the levels of inflammatory factors（IL-1，IL-6，TNF-α）in the two groups were significantly decreased（P<0.001），and the levels in the treatment group were significantly lower than those in the control group（P<0.001）. Before treatment，there was no significant difference in visual analogue scale（VAS），active activity and passive activity between the two groups（P>0.05）. After treatment，the VASscores of the two groups were significantly decreased，and the active activity and passive activity were significantly increased（P<0.001）. The VASscores，active activity and passive activity of the treatment group were significantly better than those of the control group（P<0.05）. There was no significant difference in Western Ontario and McMaster Universities Osteoarthritis Index（WOMAC）scores between the two groups before treatment（P>0.05）. After treatment，the WOMAC scores of the two groups decreased significantly（P<0.001），and the WOMAC score of the treatment group was significantly lower than that of the control group（P<0.05）. The incidence of adverse reactions in the treatment group and the control group was 7.50%（3/40）and 10.00%（4/40），and the difference was not statistically significant（P>0.05）.

Conclusion

The curative effect of acupuncture combined with traditional Chinese medicine decoction in the treatment of knee osteoarthritis is significant. It can reduce the levels of inflammatory factors and better relieve the pain of knee joint of knee joint，so as to improve the condition of knee joint.

, authors=Yanwei LIU, Jian SHEN, Ruijie YU, Aixia MENG, authorsList=Yanwei LIU, Jian SHEN, Ruijie YU, Aixia MENG, authorCompany=null, correspAuthors=Aixia MENG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322922840957268544, articleId=1322922837467607606, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=针药结合治疗膝骨关节炎的疗效及对血清炎症疼痛介质的影响, columnId=1256183369033965799, journalTitle=中华中医药学刊, columnName=省级项目平台, runingTitle=null, highlight=null, articleAbstract=
目的

研究针灸联合中药汤剂治疗膝骨关节炎的疗效及对血清炎症疼痛介质的影响。

方法

将2020年8月—2022年1月承德医学院附属医院膝骨关节炎80例患者作为研究对象，根据随机数字表法均分为两组，对照组40例、治疗组40例。对照组单纯应用火针治疗，治疗组应用火针联合中药汤剂治疗。治疗8周后，比较两组患者疗效，炎症因子白介素-1（Interleukin-1，IL-1）、白介素-6（Interleukin-6，IL-6）、肿瘤坏死因子-α（Tumor necrosis factor-α，TNF-α）水平，膝关节疼痛及活动度，骨关节炎指数，不良反应情况。

结果

治疗组总有效率为97.50%（39/40）显著高于对照组（80.00%，32/40），差异有统计学意义（P<0.05）。治疗前，两组患者炎症因子IL-1、IL-6、TNF-α水平差异无统计学意义（P>0.05），治疗后，两组患者炎症因子IL-1、IL-6、TNF-α水平均显著下降（P<0.001），并且治疗组炎症因子IL-1、IL-6、TNF-α水平显著低于对照组（P<0.001）。治疗前两组膝关节疼痛视觉模拟评分（visual analogue scale，VAS）、主动活动及被动活动度差异均无统计学意义（P>0.05），治疗后，两组患者VAS评分显著降低、主动活动及被动活动度显著增加（P<0.001），并且治疗组VAS评分、主动活动及被动活动度显著优于对照组（P<0.05）。治疗前两组西安大略和麦克马斯特大学骨关节炎指数（Western Ontario and McMaster Universities Osteoarthritis Index，WOMAC）评分差异无统计学意义（P>0.05），治疗后，两组患者WOMAC评分显著下降（P<0.001），并且治疗组WOMAC评分显著低于对照组（P<0.05）。治疗组、对照组不良反应发生率分别为7.50%（3/40）、10.00%（4/40），差异无统计学意义（P>0.05）。

结论

针灸联合中药汤剂治疗膝骨关节炎的疗效显著，能够降低炎症因子水平，更好地缓解患者膝关节疼痛、增加膝关节活动度，从而改善膝关节状况，具有良好的应用价值。

, authors=刘艳伟, 沈健, 于瑞杰, 孟爱霞, authorsList=刘艳伟, 沈健, 于瑞杰, 孟爱霞, authorCompany=null, correspAuthors=孟爱霞, authorNote=

刘艳伟（1980-），男（满族），河北围场人，副主任医师，硕士，研究方向：中西医结合治疗颈肩背腰腿痛。

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孟爱霞（1981-），女，河北衡水人，副主任医师，硕士，研究方向：全科医疗。E-mail：。
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刘艳伟（1980-），男（满族），河北围场人，副主任医师，硕士，研究方向：中西医结合治疗颈肩背腰腿痛。

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刘艳伟（1980-），男（满族），河北围场人，副主任医师，硕士，研究方向：中西医结合治疗颈肩背腰腿痛。

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组别例数临床治愈显效有效无效总有效
治疗组4012（30.00）20（50.00）7（17.50）1（2.50）39（97.50）
对照组409（22.50）14（35.00）9（22.50）8（20.00）32（80.00）
χ2值4.507
P值0.034
), ArticleFig(id=1322922843503211111, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922837467607606, language=CN, label=表1, caption=

两组膝骨关节炎患者疗效比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数临床治愈显效有效无效总有效
治疗组4012（30.00）20（50.00）7（17.50）1（2.50）39（97.50）
对照组409（22.50）14（35.00）9（22.50）8（20.00）32（80.00）
χ2值4.507
P值0.034
), ArticleFig(id=1322922845143183977, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922837467607606, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间IL-1IL-6TNF-α
治疗组40治疗前39.21±3.7027.90±2.6856.40±4.51
治疗后21.43±2.5612.20±1.7924.37±2.64
t1值18.90415.82624.109
P1值<0.001<0.001<0.001
对照组40治疗前38.82±3.9428.11±2.5355.83±5.22
治疗后25.61±2.3614.95±1.8327.09±2.18
t2值13.44510.92019.872
P2值<0.001<0.001<0.001
两组治疗前比较t3值0.4560.3600.653
P3值0.6490.7200.516
两组治疗后比较t4值7.5936.7945.025
P4值<0.001<0.001<0.001
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两组膝骨关节炎患者炎症因子IL-1、IL-6、TNF-α水平比较（±s）

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组别例数时间IL-1IL-6TNF-α
治疗组40治疗前39.21±3.7027.90±2.6856.40±4.51
治疗后21.43±2.5612.20±1.7924.37±2.64
t1值18.90415.82624.109
P1值<0.001<0.001<0.001
对照组40治疗前38.82±3.9428.11±2.5355.83±5.22
治疗后25.61±2.3614.95±1.8327.09±2.18
t2值13.44510.92019.872
P2值<0.001<0.001<0.001
两组治疗前比较t3值0.4560.3600.653
P3值0.6490.7200.516
两组治疗后比较t4值7.5936.7945.025
P4值<0.001<0.001<0.001
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组别例数时间VAS评分/（分）主动活动度/（°）被动活动度/（°）
治疗组40治疗前6.17±1.1282.34±6.3090.63±8.52
治疗后2.03±0.71109.84±11.54117.29±10.70
t1值29.13413.57414.093
P1值<0.001<0.001<0.001
对照组40治疗前6.21±1.2382.45±6.0489.74±8.89
治疗后2.95±0.80102.15±10.76109.47±11.03
t2值22.17010.2199.952
P2值<0.001<0.001<0.001
两组治疗前比较t3值0.1520.0800.457
P3值0.8800.9370.649
两组治疗后比较t4值5.4403.0833.218
P4值<0.0010.0030.002
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两组膝骨关节炎患者膝关节疼痛VAS评分、主动活动及被动活动度比较（±s）

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组别例数时间VAS评分/（分）主动活动度/（°）被动活动度/（°）
治疗组40治疗前6.17±1.1282.34±6.3090.63±8.52
治疗后2.03±0.71109.84±11.54117.29±10.70
t1值29.13413.57414.093
P1值<0.001<0.001<0.001
对照组40治疗前6.21±1.2382.45±6.0489.74±8.89
治疗后2.95±0.80102.15±10.76109.47±11.03
t2值22.17010.2199.952
P2值<0.001<0.001<0.001
两组治疗前比较t3值0.1520.0800.457
P3值0.8800.9370.649
两组治疗后比较t4值5.4403.0833.218
P4值<0.0010.0030.002
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组别例数治疗前治疗后t值P值
治疗组4041.85±5.8017.25±3.1223.724<0.001
对照组4042.56±6.1720.14±3.9819.312<0.001
t值0.5303.614
P值0.5970.001
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两组膝骨关节炎患者WOMAC评分比较（±s）

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组别例数治疗前治疗后t值P值
治疗组4041.85±5.8017.25±3.1223.724<0.001
对照组4042.56±6.1720.14±3.9819.312<0.001
t值0.5303.614
P值0.5970.001
), ArticleFig(id=1322922845663277679, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922837467607606, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数感染皮疹出血恶心呕吐合计
治疗组401（2.50）1（2.50）0（0.00）1（2.50）3（7.50）
对照组402（5.00）1（2.50）1（2.50）0（0.00）4（10.00）
χ2值0.000
P值1.000
), ArticleFig(id=1322922845742969456, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922837467607606, language=CN, label=表5, caption=

两组不良反应发生情况比较

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组别例数感染皮疹出血恶心呕吐合计
治疗组401（2.50）1（2.50）0（0.00）1（2.50）3（7.50）
对照组402（5.00）1（2.50）1（2.50）0（0.00）4（10.00）
χ2值0.000
P值1.000
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针药结合治疗膝骨关节炎的疗效及对血清炎症疼痛介质的影响
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刘艳伟 , 沈健 , 于瑞杰 , 孟爱霞
中华中医药学刊 | 省级项目平台 2025,43(2): 216-219
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中华中医药学刊 |省级项目平台 2025 , 43 (2) : 216 -219
针药结合治疗膝骨关节炎的疗效及对血清炎症疼痛介质的影响
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刘艳伟（1980-），男（满族），河北围场人，副主任医师，硕士，研究方向：中西医结合治疗颈肩背腰腿痛。

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刘艳伟（1980-），男（满族），河北围场人，副主任医师，硕士，研究方向：中西医结合治疗颈肩背腰腿痛。

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刘艳伟, 沈健, 于瑞杰, 孟爱霞
作者信息
  • 承德医学院附属医院，河北 承德 067000
通讯作者:
孟爱霞（1981-），女，河北衡水人，副主任医师，硕士，研究方向：全科医疗。E-mail：。
作者简介:

刘艳伟（1980-），男（满族），河北围场人，副主任医师，硕士，研究方向：中西医结合治疗颈肩背腰腿痛。

Effect of Acupuncture Combined with Traditional Chinese Medicine Decoction in Treatment of Knee Osteoarthritis and Its Effect on Serum Inflammatory Pain Mediators
Yanwei LIU, Jian SHEN, Ruijie YU, Aixia MENG
Affiliations
  • Affiliated Hospital of Chengde Medical College，Chengde 067000，Hebei，China
出版时间: 2025-02-10 doi: 10.13193/j.issn.1673-7717.2025.02.044
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摘要
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目的

研究针灸联合中药汤剂治疗膝骨关节炎的疗效及对血清炎症疼痛介质的影响。

方法

将2020年8月—2022年1月承德医学院附属医院膝骨关节炎80例患者作为研究对象，根据随机数字表法均分为两组，对照组40例、治疗组40例。对照组单纯应用火针治疗，治疗组应用火针联合中药汤剂治疗。治疗8周后，比较两组患者疗效，炎症因子白介素-1（Interleukin-1，IL-1）、白介素-6（Interleukin-6，IL-6）、肿瘤坏死因子-α（Tumor necrosis factor-α，TNF-α）水平，膝关节疼痛及活动度，骨关节炎指数，不良反应情况。

结果

治疗组总有效率为97.50%（39/40）显著高于对照组（80.00%，32/40），差异有统计学意义（P<0.05）。治疗前，两组患者炎症因子IL-1、IL-6、TNF-α水平差异无统计学意义（P>0.05），治疗后，两组患者炎症因子IL-1、IL-6、TNF-α水平均显著下降（P<0.001），并且治疗组炎症因子IL-1、IL-6、TNF-α水平显著低于对照组（P<0.001）。治疗前两组膝关节疼痛视觉模拟评分（visual analogue scale，VAS）、主动活动及被动活动度差异均无统计学意义（P>0.05），治疗后，两组患者VAS评分显著降低、主动活动及被动活动度显著增加（P<0.001），并且治疗组VAS评分、主动活动及被动活动度显著优于对照组（P<0.05）。治疗前两组西安大略和麦克马斯特大学骨关节炎指数（Western Ontario and McMaster Universities Osteoarthritis Index，WOMAC）评分差异无统计学意义（P>0.05），治疗后，两组患者WOMAC评分显著下降（P<0.001），并且治疗组WOMAC评分显著低于对照组（P<0.05）。治疗组、对照组不良反应发生率分别为7.50%（3/40）、10.00%（4/40），差异无统计学意义（P>0.05）。

结论

针灸联合中药汤剂治疗膝骨关节炎的疗效显著，能够降低炎症因子水平，更好地缓解患者膝关节疼痛、增加膝关节活动度，从而改善膝关节状况，具有良好的应用价值。

膝骨关节炎  /  针灸  /  中药  /  汤剂  /  炎症因子  /  疗效  /  不良反应
Objective

To study the effect of acupuncture combined with traditional Chinese medicine decoction on knee osteoarthritis and its effect on serum inflammatory pain mediators.

Methods

From August 2020 to January 2022，80 patients with knee osteoarthritis in the Affiliated Hospital of Chengde Medical College were divided into two groups according to the random number table method，40 cases in the control group and 40 cases in the observation group. The control group was treated with fire acupuncture alone，and the treatment group was treated with acupuncture combined with traditional Chinese medicine decoction. After 8 weeks of treatment，the efficacy，the levels of inflammatory factors interleukin-1（IL-1），interleukin-6（IL-6）and tumor necrosis factor-α（TNF-α），knee joint pain and activity，osteoarthritis index and adverse reactions were compared between the two groups.

Results

The total effective rate of the treatment group was 97.50%（39/40），which was significantly higher than that of the control group（80.00%，32/40），and the difference was statistically significant（P<0.05）. After treatment，the levels of inflammatory factors（IL-1，IL-6，TNF-α）in the two groups were significantly decreased（P<0.001），and the levels in the treatment group were significantly lower than those in the control group（P<0.001）. Before treatment，there was no significant difference in visual analogue scale（VAS），active activity and passive activity between the two groups（P>0.05）. After treatment，the VASscores of the two groups were significantly decreased，and the active activity and passive activity were significantly increased（P<0.001）. The VASscores，active activity and passive activity of the treatment group were significantly better than those of the control group（P<0.05）. There was no significant difference in Western Ontario and McMaster Universities Osteoarthritis Index（WOMAC）scores between the two groups before treatment（P>0.05）. After treatment，the WOMAC scores of the two groups decreased significantly（P<0.001），and the WOMAC score of the treatment group was significantly lower than that of the control group（P<0.05）. The incidence of adverse reactions in the treatment group and the control group was 7.50%（3/40）and 10.00%（4/40），and the difference was not statistically significant（P>0.05）.

Conclusion

The curative effect of acupuncture combined with traditional Chinese medicine decoction in the treatment of knee osteoarthritis is significant. It can reduce the levels of inflammatory factors and better relieve the pain of knee joint of knee joint，so as to improve the condition of knee joint.

knee osteoarthritis  /  acupuncture  /  Chinese medicine  /  decoction  /  inflammatory factors  /  curative effect  /  adverse reactions
刘艳伟, 沈健, 于瑞杰, 孟爱霞. 针药结合治疗膝骨关节炎的疗效及对血清炎症疼痛介质的影响. 中华中医药学刊, 2025 , 43 (2) : 216 -219 . DOI: 10.13193/j.issn.1673-7717.2025.02.044
Yanwei LIU, Jian SHEN, Ruijie YU, Aixia MENG. Effect of Acupuncture Combined with Traditional Chinese Medicine Decoction in Treatment of Knee Osteoarthritis and Its Effect on Serum Inflammatory Pain Mediators[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (2) : 216 -219 . DOI: 10.13193/j.issn.1673-7717.2025.02.044
正文
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膝骨关节炎是中老年人易患的一种临床常见病、多发病，以反复发作的关节疼痛、晨僵、关节肿胀及关节活动障碍为特点，尤其下蹲、上下楼时明显，严重者膝关节畸形，影响正常的工作与生活，明显降低了生活质量[1-2]。流行病学数据显示，我国55岁以上人群中60%有膝骨关节炎的影像学改变，65岁以上老年人膝骨关节炎的发病率达85%[3]。膝骨关节炎在中医学属于“痹证”“膝痹”等范畴，有研究表明针刺、艾灸、针刀、拔罐、刺络拔罐等中医非药物疗法具有简、便、效、廉的特点，被广泛用于膝骨关节炎的治疗，但中医非药物疗法也存在准入门槛较低、治疗者技术水平参差不齐等问题，最终影响了治疗效果[4-5]。近年来中成药因其自身药性稳定、应用方便、疗效确切，逐渐成为膝骨关节炎治疗的重要选择，但其应用还在不断地探索和完善、规范中[6-7]。本研究分析针灸联合中药汤剂治疗膝骨关节炎的疗效及对血清炎症疼痛介质的影响，现总结分析相关资料并报道如下。
1　资料与方法
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1.1　一般资料
选取2020年8月—2022年1月承德医学院附属医院膝骨关节炎80例患者作为研究对象，纳入标准：①均符合《中医骨伤科临床诊疗指南·膝痹病（膝骨关节炎）》中疾病诊断标准[8]；②成年患者，性别不限；③生命体征平稳，具有正常认知及交流能力；④均知情同意研究内容并积极配合完成研究项目。排除标准：①膝关节局部皮肤伴有感染或过敏性疾病患者；②痛风、糖尿病等累及膝关节功能的疾病患者；③创伤、先天性疾病等引起的继发性膝骨关节炎患者；④严重心肝肾功能不全患者；⑤孕期或哺乳期女性患者。将所有研究对象根据随机数字表法均分为两组，对照组40例、治疗组40例。对照组中男23例，女17例；年龄49～74岁，平均（65.9±7.6）岁；病程1～14年，平均（4.2±1.9）年。治疗组中男21例，女19例；年龄47～75岁，平均（66.2±7.1）岁；病程1～16年，平均（4.6±1.7）年。两组患者性别、年龄、病程等资料进行比较，差异均无统计学意义（P>0.05），具有可比性。研究内容经医院医学伦理委员会审核批准进行。
1.2　方法
对照组单纯应用火针治疗，患者取仰卧位、屈膝，常规消毒局部皮肤，取血海、梁丘、内膝眼、阳陵泉、犊鼻以及阿是穴，以0.8 mm×50 mm中粗火针，以酒精灯烧红针身前中段，疾进疾出以上穴位，进针10 mm，每个穴位密刺3针，范围不超过穴位半径2 mm，出针后消毒并按压针孔片刻。嘱患者当日保持治疗部位皮肤干燥，隔日治疗1次。
治疗组应用针灸联合中药汤剂治疗，火针治疗同对照组，中药汤剂组分：黄芪30 g，细辛10 g，蜈蚣1条、当归10 g，干地黄10 g，防风10 g，牛膝10 g，人参10 g，秦艽10 g，赤芍10 g，桂枝10 g，杜仲10 g，川芎10 g，桑寄生15 g，独活20 g，甘草6 g，每日1剂以水煎服，分早晚2次服用。
两组均治疗8周。
1.3　观察项目及判定标准
比较两组患者疗效，炎症因子水平，膝关节疼痛及活动度，骨关节炎指数，不良反应情况。①疗效：根据国家中医药管理局办公室印发的膝痹病（膝关节骨关节病）中医诊疗方案[9]判定，膝痛、肿胀完全消失，行走及上下楼梯无不适感为临床治愈；静息无膝痛、无肿胀，偶有活动时疼痛，行走时无疼痛，不影响工作及生活为显效；膝痛时发时止，行走时仍有轻度疼痛，上下楼梯稍感不便，关节活动稍受限为有效；膝痛、肿胀及活动时疼痛无明显改善为无效；总有效率＝（临床治愈+显效+有效）例数/总例数×100%。②炎症因子水平：于治疗前、后采用酶联免疫吸附法测定炎症因子白介素-1（Interleukin-1，IL-1）、白介素-6（Interleukin-6，IL-6）、肿瘤坏死因子-α（Tumor necrosis factor-α，TNF-α）水平。③膝关节疼痛及活动度：膝关节疼痛采用模拟评分（visual analogue scale，VAS）法，0分为无痛，10分为剧烈疼痛，总分范围0～10分，分值越高则表明疼痛越严重[10]；通过关节量角器测量患者膝关节主动活动度和被动活动度。④骨关节炎指数：采用西安大略和麦克马斯特大学骨关节炎指数（Western Ontario and McMaster Universities Osteoarthritis Index，WOMAC）[11]评分，包括关节疼痛、僵硬程度和日常活动三大方面的24个条目，每个条目0～4分，总分0～96分，评分越高表示膝关节功能越差。⑤不良反应：包括感染、皮疹、出血、恶心呕吐等，不良反应发生率＝不良反应患者例数/总例数×100%。
1.4　统计学方法
数据资料均采用SPSS 21.0统计软件包进行处理，计数资料以例（%）表示、采用χ2检验，计量资料呈正态分布，以均数±标准差（）表示、进行t检验，P<0.05表示差异有统计学意义。
2　结果
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2.1　疗效比较
治疗组总有效率为97.50%，显著高于对照组（80.00%），差异有统计学意义（P<0.05）。见表1。
2.2　炎症因子IL-1、IL-6、TNF-α水平比较
治疗前，两组患者炎症因子IL-1、IL-6、TNF-α水平差异无统计学意义（P>0.05），治疗后，两组患者炎症因子IL-1、IL-6、TNF-α水平均显著下降（P<0.001），并且治疗组炎症因子IL-1、IL-6、TNF-α水平显著低于对照组（P<0.001）。见表2。
2.3　膝关节疼痛及活动度比较
治疗前两组膝关节疼痛VAS评分、主动活动及被动活动度差异均无统计学意义（P>0.05），治疗后，两组患者VAS评分显著降低、主动活动及被动活动度显著增加（P<0.001），并且治疗组VAS评分、主动活动及被动活动度显著优于对照组（P<0.05）。见表3。
2.4　骨关节炎指数WOMAC评分比较
治疗前，两组WOMAC评分差异无统计学意义（P>0.05），治疗后，两组患者WOMAC评分显著下降（P<0.001），并且治疗组WOMAC评分显著低于对照组（P<0.05）。见表4。
2.5　不良反应情况比较
治疗组、对照组不良反应发生率分别为7.50%、10.00%，差异无统计学意义（P>0.05）。见表5。
3　讨论
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膝骨关节炎在中医属于痹证，痹在病机上以经络阻滞、气血失禁、气血瘀、痰瘀、气虚为内病状态，营卫失和，气血亏虚、肝肾不足，脾胃不足，都可能导致正虚邪恋，由风、寒冷、潮湿的邪气，入侵人体或应变，创伤和其他因素痹阻膝盖经络及气血运行，不通则痛，患者出现疼痛、肿痛、重着、屈伸不利、肿大、僵硬等症状[12-13]。
火针疗法是一种中医针灸疗法，通过将针在火上烧红后快速刺入穴位，可以发挥疏通经络、温经散寒等作用。早在《灵枢·官针》中载：有“淬刺者，刺燔针则取痹也。”《千金翼方》有“处疖痈疽，针惟令极热”的论述。火针疗法可以结合患者自身情况辨证取穴，通过膝关节周围的穴位刺激，来促进膝关节部位血液循环，以促进膝关节内部炎性水肿的吸收和消退，还能够促进膝关节部位的血运，有利于膝关节内部变性退化的软骨修复，能够很好地缓解膝关节疼痛的症状，还能够延缓膝关节骨性关节炎的发展[14-16]。
本研究中治疗组在火针疗法基础上增加了中药汤剂治疗，结果在治疗总有效率、改善炎症因子及膝关节症状、功能等方面均体现出显著优势。中医学认为膝骨关节炎的病位在骨，其本在肝肾，肝肾亏虚是病变的根本，风寒湿痰、瘀痹阻络为标[17]。肝藏血，主筋；肾藏精，主骨；老年肝肾不足或劳损、外伤损伤气血，复受风寒湿（热）邪，邪滞膝部，气滞血瘀，经络闭阻，筋骨失荣为本病的基本病机[18]。故中药治疗当以补益肝肾、强筋壮骨为主，活血祛瘀、祛风通络为辅[19]。本研究治疗组所用中药汤剂中，黄芪补气升阳，利水消肿，生津养血，行滞通痹；细辛解表散寒，祛风止痛；蜈蚣息风镇痉，通络止痛，攻毒散结；当归补血活血，温通经络；干地黄清热凉血，温补肾阳；防风祛风解表，除湿止痛，疏肝解痉；牛膝活血祛瘀，补肝肾，强筋骨；人参大补元气，复脉固脱；秦艽祛风湿，清湿热，止痹痛；赤芍行瘀、止痛、凉血、消肿；桂枝发汗解肌、温经通脉；杜仲补益肝肾、强筋壮骨、调理冲任；川芎活血行气、祛风止痛；桑寄生祛风湿、补肝肾、强筋骨；独活祛风湿、解表、通痹止痛；甘草补脾益气，缓急止痛，调和诸药。以上中药组分共同发挥祛风湿、补气血、益肝肾、止痹痛的功效，利于膝骨关节炎患者的症状缓解，促进膝关节功能恢复。随着膝骨关节炎研究的不断深入，炎性因子及相关信号通路在其发病机制中的作用逐渐被认识，炎性因子与骨性关节炎发生发展密切相关，同时也是病情加重的重要促进因素[20-21]。研究中治疗组炎症因子各项指标改善更明显，致炎因子通过激活相关信号通路，促进炎性反应的发生，炎性反应又加重骨及软骨的退变，炎症因子IL-1、IL-6、TNF-α水平均显著下降，炎性反应降低，有利于维持软骨细胞功能及细胞外基质的完整性，减轻骨及软骨的退变。现代药理学研究也提示，细辛挥发油类物质作为其主要有效成分，具有麻醉、解热、镇痛、抗炎等药理作用[22-24]；独活、牛膝对膝骨关节炎的治疗机制可能是通过肿瘤坏死因子信号通路、白细胞介素信号通路等抑制炎症反应、影响软骨代谢及细胞增殖凋亡的结果[25]。
综上所述，针灸联合中药汤剂治疗膝骨关节炎的疗效显著，能够降低炎症因子水平，更好地缓解患者膝关节疼痛、增加膝关节活动度，从而改善膝关节状况，具有良好的应用价值。
基金
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  • 河北省中医药类科研计划项目(2021203)
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2025年第43卷第2期
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doi: 10.13193/j.issn.1673-7717.2025.02.044
  • 首发时间：2026-10-30
  • 出版时间：2025-02-10
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河北省中医药类科研计划项目(2021203)
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    承德医学院附属医院，河北 承德 067000

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孟爱霞（1981-），女，河北衡水人，副主任医师，硕士，研究方向：全科医疗。E-mail：。
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
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红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
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