| ObjectiveThis paper aims to acupuncture combined Lingguibafa and chinese herbs impact on knee osteoarthritis efficacy and serum cytokines, and with the simple acupuncture group, in contrast to traditional Chinese medicine group. By combining objective evaluation Lingguibafa acupuncture and chinese herbs treatment of knee osteoarthritis efficacy and safety in order to further explore the possible mechanism of action of acupuncture treatment of this disease, to provide guidance for the prevention and treatment of osteoarthritis of the knee.MethodsThe clinical case study collection source for outpatient clinical diagnosis of knee osteoarthritis patients met the inclusion criteria, and 90 patients were all optimistic Taiwan clinic patients, collection time for the January 2014 January 2015. A randomized controlled trial study were collected 90 patients with knee osteoarthritis, according to a 1:1:1 ratio distribution, divided into acupuncture combined Lingguibafa, acupuncture, traditional Chinese medicine group,30 cases in each group.Western diagnostic criteria for knee osteoarthritis to the American College of Rheumatology (ACR) diagnostic criteria for knee osteoarthritis. X-ray of knee osteoarthritis disease classification criteria:reference Kellgren classification method, Ⅳ grade were excluded. TCM syndrome type with the State Drug Administration of the People’s Republic of China established by the pharmaceutical industry standard "Chinese disease diagnosis and efficacy standards" bone Arthralgia Syndrome Classification, efficacy evaluation of degenerative osteoarthritis of the knee will be divided into three syndromes. Acupuncture combined Lingguibafa acupuncture group acupoints main point of Ashi, knee eyes, Liang Qiu, Yang Ling Quan, Chinese medicine treatment to spur soup (Epimedium, Drynaria, Cistanche, Millettla, South five plus, pangolin, etc.) based. Acupuncture, traditional Chinese medicine and acupuncture treatment group with acupuncture combined with Chinese medicine treatment Lingguibafa groups.3 times a week acupuncture, traditional Chinese medicine on the 1st one, four weeks for a course of treatment, a total of two courses. After two courses evaluated. The evaluation includes a general recording project, knee osteoarthritis clinical symptoms and signs assessment (WOMAC knee osteoarthritis rating scale), patient 15 m walking time (T15), peripheral blood IL-1, IL-6, TNF-a Detection of cytokines indicators; total WOMAC score based on clinical criteria, reference nimodipine law. Three groups of patients after 8 weeks of treatment were followed up four weeks after treatment follow-up period.ResultsThis study were collected from 90 patients with osteoarthritis of the knee, which qualified 87 cases,3 cases excluded and off.Through acupuncture combined Lingguibafa, acupuncture, Chinese medicine group sex, age, disease duration, disease classification, TCM typing, WOMAC knee osteoarthritis Rating Scale,15 m walking time (T15), the outer periphery serum IL-1, IL-6, TNF-a cytokine index detection statistical tests, showing no significant difference between the three groups (P> 0.05) on the clinical data, suggesting that acupuncture combined Lingguibafa group, needles acupuncture group, TCM group comparable data base.LA comparison WOMAC osteoarthritis of the knee rating scale before and after treatment①Three groups were compared before and after treatment WOMAC pain index Before treatment, the pain showed no significant difference in the three groups of patients WOMAC scale, comparable. After two courses of treatment, acupuncture combined Lingguibafa patients WOMAC pain scale score compared with the traditional Chinese medicine group, the difference was more significant (P<0.05), but with the acupuncture group was not statistically significant (P> 0.05). At follow-up, acupuncture combined Lingguibafa patients WOMAC pain scale scores than acupuncture, traditional Chinese medicine group has been reduced (P<0.05), between groups and between groups of Chinese medicine acupuncture group was not significantly different (P> 0.05).Conclusion:These data suggest that, after the end of two courses, three groups of patients WOMAC pain scale score has improved to varying degrees, of which acupuncture combined Lingguibafa combination therapy in patients with osteoarthritis of the knee pain symptoms improved the most obviously, and the effect is more significant than simply medicine treatment. Follow-up survey data show that acupuncture combined Lingguibafa combination therapy can relieve pain in patients with osteoarthritis of the knee over a longer period of time, and simple acupuncture treatment or medicine treatment in terms of timeliness maintain analgesia, ineffective.②Three WOMAC stiffness index before and after treatmentBefore treatment, no significant difference in stiffness index WOMAC scale for the three groups of patients, comparable. After two courses of treatment, acupuncture combined Lingguibafa patients WOMAC stiffness score scale acupuncture group compared with no significant difference (P> 0.05), compared with the traditional Chinese herbs to reduce the score was statistically different (P< 0.05). At follow-up, three groups of patients WOMAC stiffness score scale pairwise comparison, is no significant difference (P> 0.05). Conclusion:After two courses, acupuncture combined Lingguibafa group, acupuncture group were WOMAC scale for the symptoms have been alleviated stiff, traditional Chinese medicine to improve the symptoms of osteoarthritis of the knee stiff little effect. Follow-up survey data showed that acupuncture combined Lingguibafa and simple acupuncture over a longer period of time can improve the patient’s rigid state to a better long-term efficacy of combination therapy. But traditional Chinese medicine to improve stiffness state, whether it is short-term efficacy, or long-term effect, is not obvious.③Comparison of the three groups before and after treatment WOMAC index of physiological functionsBefore treatment, the physiological function of the three groups showed no significant difference between patients WOMAC scale, comparable. After two courses of treatment, compared to acupuncture group and Chinese herbs group, acupuncture combined Lingguibafa patients WOMAC physical function scale score was significantly lower than that, there was statistical difference (P<0.05). At follow-up, three groups of patients WOMAC physical function score scale pairwise comparison, is no significant difference (P> 0.05).Conclusion:After two courses of treatment, acupuncture combined Lingguibafa therapy, acupuncture group and traditional Chinese herbs to improve the physiological function of patients with osteoarthritis of the knee, above, down the stairs, ride, bending, doing housework, etc., are have a certain effect, the degree of combination therapy over monotherapy improve physiological function is more significant. However, to maintain the efficacy of timeliness, the combination therapy and monotherapy was no significant difference.④ The three groups before and after WOMAC osteoarthritis treatment Rating Scale total scoreBefore treatment, no significant difference in the total score of the three groups of patients WOMAC osteoarthritis rating scale, comparable. After two courses of treatment, acupuncture combined Lingguibafa WOMAC osteoarthritis patients Rating Scale score lower than acupuncture group and Chinese medicine group obviously, with a significant difference (P<0.05). At follow-up, acupuncture combined Lingguibafa WOMAC osteoarthritis patients Rating Scale scores and acupuncture group was not statistically significant (P> 0.05), compared to the traditional Chinese herbs group was significantly (P<0.05). CONCLUSION:These data showed that after two courses of treatment, therapy can improve in three different degrees of knee osteoarthritis pain, stiffness, and improve their quality of life, overall efficacy of acupuncture combined Lingguibafa longer available time play a therapeutic role. In the short-term efficacy of acupuncture treatment alone is acceptable, but poor long-term outcome. Chinese medicine treatment for patients with joint stiffness improvement status had no significant effect.2. Before and after two,15 m walking time treatmentBefore treatment, the three groups of patients 15 m walking time no significant difference between comparable. After two courses of treatment, acupuncture combined Lingguibafa patients walk 15 meters longer than obvious than medicine group decreased significantly different (P<0.05). At follow-up, acupuncture combined Lingguibafa patients compared with traditional Chinese herbs group, there are statistically significant differences (P<0.05).Conclusion:In terms of improving walking in patients with osteoarthritis of the knee, either combination therapy, or a single acupuncture or Chinese medicine therapies have some success. In contrast to the effect, the efficacy of acupuncture combined Eight turtle best, followed by acupuncture, traditional Chinese medicine treatment is poor. Acupuncture combined Lingguibafa, acupuncture for osteoarthritis of the knee to improve long-term outcome in patients with better time to walk 15 meters, while the long-term efficacy of traditional Chinese medicine therapy is not ideal. 3. The comparison of cytokines in peripheral blood before and after treatment①IL-1 in peripheral blood Compare Whether it is the end of the two courses of treatment, or follow-up, acupuncture combined Lingguibafa peripheral blood of patients with IL-1 content acupuncture group, Chinese herbs group, the difference was statistically significant (P<0.05).Conclusion:Osteoarthritis can cause patients to maintain high serum levels of IL-1, which was significantly higher than in normal healthy people,, these results indicate that acupuncture combined Lingguibafa, acupuncture, herbal therapy can to a certain extent reduce patient on IL-1, in which the effect of combination therapy significantly, and in the long-term effect is significant.②Comparison of IL-6 in peripheral bloodAfter two courses of treatment, acupuncture combined Lingguibafa content in peripheral blood of patients with acupuncture group compared with IL-6 decreased, the difference was statistically significant (P<0.05). At follow-up, acupuncture combined Lingguibafa patients peripheral blood levels of IL-6 is also less than in the acupuncture group was statistically significant (P<0.05)Conclusion:acupuncture combined Lingguibafa, acupuncture, herbal therapy in patients with osteoarthritis of the knee can be reduced expression of IL-6, acupuncture combined impact Lingguibafa of IL-6 than simple acupuncture obvious. Acupuncture combined Lingguibafa, herbal therapy for controlling the expression of IL-6 has long-term efficacy, simple acupuncture poor long-term outcome.③Peripheral blood TNF-α comparisonAfter two courses of treatment, acupuncture combined Lingguibafa patients peripheral blood TNF-a levels less than in traditional Chinese medicine group, statistically significant between the two groups (P<0.05). At follow-up, the three groups were not statistically significant pairwise comparisons (P> 0.05).Conclusion:acupuncture combined Lingguibafa reduce TNF-a expression in patients with a certain extent, but long-term effect is not obvious. Simple acupuncture, Chinese medicine treatment of poor patients on the regulation of the expression of TNF-a treatment.4. The treatment of knee osteoarthritis overall efficacy evaluation of three groupsThe research used the Kruskal-Wallis H rank sum test, the effect of the treatment of knee osteoarthritis compare the three groups were significantly different (P> 0.05), with details as follows:acupuncture combined Lingguibafa group cure rate was 13.8%; significant efficiency rate was 44.8%; the effective rate of acupuncture combined Lingguibafa group was 31.1%; the invalid rate was 10.3%; the total effective rate was 89.7%. Acupuncture group, the cure rate was 6.7%; the effective rate of acupuncture group was 26.7%; the effective rate of acupuncture group was 36.6%; invalid rate of acupuncture group was 30.0%; the total effective rate of acupuncture group was 70.0%. Cure rate was 10.8%; effective rate is 25.0%; the effective rate was 32.1%; invalid rate was 32.1%; the total effective rate was 67.9%. Conclusions show that acupuncture combined Lingguibafa overall efficacy for knee osteoarthritis best, simple acupuncture therapy and acupuncture combined with Chinese medicine treatment is better Lingguibafa, where the worst overall efficacy of traditional Chinese medicine therapy.ConclusionFirst, from the overall treatment efficacy evaluation of patients with osteoarthritis of the knee, the acupuncture combined Lingguibafa total effective rate was 89.7%, acupuncture group, the total effective rate 70.0%, traditional Chinese medicine group, the total effective rate was 67.9% Conclusions show that acupuncture combined Lingguibafa.overall efficacy for knee osteoarthritis best, simple acupuncture therapy and acupuncture combined with Chinese medicine treatment is better Lingguibafa, where the worst overall efficacy of traditional Chinese medicine therapy.Second, acupuncture combined Lingguibafa, acupuncture, traditional Chinese medicine can improve knee pain in patients with osteoarthritis, in varying degrees, stiffness symptoms and improve their quality of life, promote walking function in patients, acupuncture combined Lingguibafa better long-term efficacy method, can play a therapeutic role in a long time; in the short-term efficacy of acupuncture treatment alone is acceptable, but poor long-term efficacy; traditional Chinese medicine treatment for patients with joint stiffness and improve the state had no significant effect, and for improving Knee pain is poor patient outcomes.Third, osteoarthritis can cause the patient to maintain a high serum levels of IL-1, IL-6, TNF-a, three treatments may be reduced in patients with the IL-1, IL-6 content in timeliness comparisons to acupuncture combined Lingguibafa more lasting effect. Acupuncture combined Lingguibafa reduce expression of TNF-a in patients with a certain extent, but the long-term effect is not obvious. Simple acupuncture, Chinese medicine treatment of poor patients on the regulation of the expression of TNF-a treatment. |
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