内科

目的探究温针灸联合中药熏蒸治疗风寒湿痹型膝骨关节炎（KOA）的效果，并分析联合治疗对患者关节液炎症因子的影响。方法纳入72例风寒湿痹型KOA患者，并将其随机分为两组，每组36例。对照组接受口服依托考昔片治疗，观察组在对照组治疗基础上加用温针灸和中药熏蒸治疗，两组均治疗4周。比较两组治疗前后疼痛视觉模拟评分法（VAS）评分，西安大略与麦克马斯特大学骨关节炎指数（WOMAC）关节疼痛、关节僵硬、关节生理功能维度评分，关节液C-反应蛋白（CRP）、肿瘤坏死因子（TNF）-α、白细胞介素-1β（IL-1β）水平，以及临床疗效。结果治疗前，两组疼痛VAS评分、WOMAC各维度评分，以及关节液CRP、TNF-α、IL-1β水平差异均无统计学意义（均P>0.05）。治疗4周后，两组疼痛VAS评分、WOMAC各维度评分及关节液CRP、TNF-α、IL-1β水平均较治疗前降低，且观察组上述评分及指标均低于对照组（均P<0.05）；观察组治疗总有效率高于对照组，疗效分级优于对照组（均P<0.05）。结论温针灸联合中药熏蒸可有效地缓解风寒湿痹型KOA患者的膝关节疼痛与僵硬，改善关节功能，其作用机制可能与抑制促炎细胞因子分泌、阻断核因子-κB通路介导的软骨基质降解有关。

Objective To investigate the efficacy of warming needle moxibustion combined with traditional Chinese medicine herbal fumigation in the treatment of knee osteoarthritis (KOA) of wind-cold-dampness bi syndrome, and to analyze the effects of the combined therapy on patients' inflammatory factors in synovial fluid. Methods A total of 72 patients with KOA of wind-cold-dampness bi syndrome were enrolled and randomly divided into two groups, with 36 cases in each group. The control group received oral administration of etoricoxib tablets, based on which the observation group received additional warming needle moxibustion combined with traditional Chinese medicine herbal fumigation, and both groups were treated for 4 weeks. The Visual Analogue Scale (VAS) score for pain; the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) dimension scores for joint pain, stiffness, and physical function; and the levels of C-reactive protein (CRP), tumor necrosis factor (TNF)-α, and interleukin (IL)-1β in synovial fluid were compared between the two groups before and after treatment, as well as the clinical efficacy. Results Before treatment, there were no statistically significant differences between the two groups in the VAS score for pain, WOMAC dimension scores, or levels of CRP, TNF-α, and IL-1β in synovial fluid (all P>0.05). After 4 weeks of treatment, the VAS score for pain, WOMAC dimension scores, and levels of CRP, TNF-α, and IL-1β in synovial fluid decreased in both groups compared with before treatment, and the above scores and indicators in the observation group were lower than those in the control group (all P<0.05); the total effective rate in the observation group was higher than that in the control group, and the efficacy grade of the observation group was superior to that of the control group (all P<0.05). Conclusion Warming needle moxibustion combined with traditional Chinese medicine herbal fumigation can effectively alleviate knee pain and stiffness and improve joint function in patients with KOA of wind-cold-dampness bi syndrome. Its mechanism may be associated with inhibition of pro-inflammatory cytokine secretion and blockade of nuclear factor-κB pathway-mediated cartilage matrix degradation.