| Objective:To develop a research protocol for clinical observation of acupoint sensitization of knee osteoarthritis(KOA),to explore the characteristics of acupoint sensitization in knee osteoarthritis,and to provide a basis for the treatment of knee osteoarthritis with sensitized acupoints.Methods:1.Modern literature on acupoint sensitization research of knee osteoarthritis were comprehensively collected and managed,to analyze the rule of sensitization phenomenon.Then,methods of information collection on KOA acupoint sensitization were initially established,and a pilot study was carried out by 50 patients with KOA and 30 healthy controls.Ultimately,we improved and developed an evaluation scheme for KOA acupoint sensitization2.1138 eligible participants including 916 KOA patients and 222 healthy subjects were recruited from clinical setting.The temperature,mechanical pain threshold and pressure pain threshold(PPT)of acupoint were detected.Cut-off value for diagnosis of acupoint sensitization or non-sensitization by using the ROC curve method,additionally,the characteristics of cut-off values of the acupoints on different meridians and regions were analyzed.3.With 916 KOA patients as research objects,and the temperature,mechanical pain threshold and PPT of acupoint as observation indexes.WOMAC scale was used to evaluate severity of KOA.Then,the occurrence rate of acupoint sensitization and degree of acupoint sensitization of each acupoint were analyzed,and summarize the acupoints with high occurrence rate and degree of acupoint sensitization in the patients with different TCM syndrome differentiation and severity of illness,so as to recommend a better choice of acupoint selection for clinical treatment of KOA.Results:1.Methodology study results of acupoint sensitization assessment of KOA:(1)Modern literature on acupoint sensitization of KOA suggest that the study of acupoint sensitization of KOA is mainly focused on thermal sensitivity,followed by pain sensitivity,and the sensitized acupoints are mainly on the region of the knee joint.On a base of this result,the collection scheme of information on KOA acupoint sensitization was preliminarily established.(2)The results of preliminary study showed that the temperature of acupoint rose generally,and pain threshold value declined,and tendness sensitive point were mainly distributed in 1,4,7 and 11,12 regions of the scratchable latex,which prompted the initial scheme was feasible.(3)Combined with literature and pilot study results,evaluation scheme of KOA acupoint sensitization was improved and developed:(1)the acupoints,including ones on the regions of knee joint(SP-10,EX-LE2,ST-34,LR-8,EX-LE4,ST-35,SP-9,LR-7,KI-10,ST-36,GB-34,BL-40,BL-39)and distant to regions of knee joint(GB-40,GB-39,BL-23,BL-11,DU-4,DU-3);(2)observation indexes including emperature,mechanical pain threshold,PPT of acupoints;(3)The regions of tenderness sensitive points: ranged around 3 inches above the patellar bottom and the level of ST-36.(4)The basic information of the subject and the assessment information of the condition were also collected.2.Study on diagnostic criteria for acupoint sensitization of knee osteoarthritis.(1)Using ROC curve to analyze cut-off value for diagnostic acupoint sensitization,then calculated sensitization rate of each acupoint among patients and healthy subjects.The results showed that the former were significantly higher than that of the latter,indicating with taking whether attacked by KOA as the "gold standard",the ROC curve analysis method for cut-off value of acupoint sensitization is feasible.(2)There were differences in cut-off values of acupoint sensitization among different acupoints,which were related to the location and the meridians-tropism of acupoints.Cut-off values of temperature,mechanical pain threshold,and pressurethreshold of acupoint on lower back were higher,with temperature 34.5 ℃,mechanical pain threshold 104.5 g and tenderness threshold 3582.5 gf,respectively.There was little difference between the cut-off value of temperature and pain threshold of acupoints in the extremities and knee joints.The cut-off value of temperature of the acupoints along foot-yangming meridian on the knee region showed higher,with 33.4 ℃,meanwhile,the cut-off values of mechanical pain threshold and PPT were relatively lower,with 40.22 g and 1812.5 gf,respectively.3.Characteristics of acupoint sensitization of knee osteoarthritis.(1)The characteristics of incidence rate of acupoint sensitization.1)The incidence rate of thermal sensitivity of acupoint was 54.26~81.00%,ones of mechanical pain threshol was 80.78%~99.02%,and ones of PPT was76.09%~97.93%.2)The incidence pain and thermal sensitivity of acupoint of KOA were both high(both greater than 60%),indicating that acupoint sensitization was universality.EX-LE3 was the acupoint with higher incidence of both temperature sensitization and pain sensitization.3)The incidence rate of thermal sensitivity of acupoint was related to syndrome differentiation of TCM(p<0.05,B>0).The patients with Yang deficiency and cold coagulation hold the higher incidence rate of thermal sensitivity(p<0.05,B>0).SP-10,EX-LE3,ST-35,ST-34,KI-10 and GB-40 hold higher incidence rate of thermal sensitivity(more than 70%).4)The incidence rate of pain sensitization of acupoints was positively related with the severity of disease(p < 0.05,B > 0),and the ones of thermal sensitivity of acupoint were tend to increase with the severity of disease(p > 0.05,B > 0).The incidence rate of pain sensitization in most the acupoints were higer(more than 70%).(2)Characteristic analysis of acupoint sensitization degree.1)Compared with tenderness threshold,average degree of temperature sensitization had no statistically significant difference(p < 0.05);Compared with mechanical pain threshold,there was statistically significant(p < 0.05),and lower8 than average degree of sensitization of mechanical pain threshold.(P > 0.05,B=0.014 > 0)。2)With the illness aggravating,degree of temperature sensitization and tenderness sensitization of acupoints increased,and the difference was statistically significant(P < 0.05),additionally,the mechanical pain sensitization degree increased with disease progression,but without statistically significant difference(P > 0.05,B =0.05 > 0).3)Points with Ⅲ level sensitization degree of temperature were SP10,GV-4,GV-3,EX-LE-3,and ones of mechanical pain threshold were EX-LE3,GV-4,ST-34,SP-9,GB-39,BL-23,BL-11,GV-3,ST-35,additionally,ones of PPT were EX-LE-3,GB-34,SP-9,GB-40,ST-35.The sensitization degree of the three indexes all higher was EX-LE3.4)Sensitization acupoints for clinical guidelines(1)The acupoints EX-LE-3,ST-35,GB-34,SP-9,GV-4,GV-3 are suitable for acuupuncture,moxibustion and Tuina.(2)EX-LE3 hold the higher incidence rate of sensitization and degree of sensitization,which was the advantage acupoint for KOA treatment.(3)In consideration of incidence rate of sensitization and degree of sensitization,the patients with Yang deficiency and cold coagulation could select SP-10,EX-LE-3,ST-35,GV-3,and(or)KI-10,BL-23.(4)Points with Ⅲ level sensitization degree of temperature were SP-10、GV-4、GV-3、EX-LE-3 in all different condition of patients,and ST-36、LR-7reached to Ⅲlevel sensitization in moderate and severe patients.Points with Ⅲ level sensitization degree of the mechanical pain threshold were EX-LE-3,GV-4,ST-34,SP-9,GB-39,GB-39,BL-11,GV-3,ST-35 in all different condition of patients.Points with Ⅲlevel sensitization degree of PPT were EX-LE-3,GB-40 in all different condition of patients,and GB-34,SP-9,ST-35 reached to Ⅲ level sensitization in moderate and severe patients.Conclusion:1.The assessment scheme of KOA acupoint sensitization established in thisstudy is practical,operable and normative.2.The cut-off value for diagnosis of acupoint sensitization is related to location and meridian of acupoints.The diagnostic cut-off value of temperature,mechanical pain and tenderness threshold sensitization of the lower back were higher,while the points around the knee have higher value of temperature sensitization and lower pain threshold sensitization.3.The incidence pain and thermal sensitivity of acupoint of KOA were both high,indicating that acupoint sensitization was universality.4.EX-LE3 hold the higher incidence rate of sensitization and degree of sensitization,which was the advantage acupoint for KOA treatment.The sensitization degree and incidence are related to syndrome differentiation of TCM and the condition of disease.The patients with Yang deficiency and cold coagulation hold the higher incidence rate of temperature sensitization.As the disease gets worse,the incidence rate of sensitization and degree of sensitization of acupoints increased.5.According to the incidence rate of sensitization and degree of sensitization of acupoints of KOA,we can set out guidance for selection of acupoints and treatment method,so as to provide reference for the clinical treatment of KOA with sensitized points. |
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