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冷え性湿潤性変形性膝関節症の治療における電気鍼灸と雷火灸の併用の臨床効果：無作為化比較試験
[Clinical effect of thunder-fire moxibustion combined with electroacupuncture in the treatment of cold-dampness knee osteoarthritis: a randomized controlled trial].
PMID: 32643886 DOI: 10.13702/j.1000-0607.190682.
抄録
目的:
冷え性湿潤性変形性膝関節症の治療において、電気鍼灸を併用した雷鳴灸の臨床効果を検討する。
OBJECTIVE: To investigate the clinical effect of thunder-fire moxibustion combined with electroacupuncture in the treatment of cold-dampness knee osteoarthritis.
方法:
コンピュータソフトで生成した乱数により、合計72名の冷湿性変形性膝関節症患者を観察群と対照群に無作為に分け、各群36名の患者を対象とした。観察群では、杜碧（ST35）、内渓（EX-LE4）、瑞山里（ST36）、陽陵泉（GB34）、陰陵泉（SP9）、雪海（SP10）、梁丘（ST34）の主なツボに電気鍼治療を行った。及びヘディング（EX-LE2）で1日1回、針保持時間30分、雷火灸はシェンク（CV8）及び観音（CV4）で1日1回、各回30分の懸垂灸の形で実施した。対照群の患者には、ジクロフェナクナトリウム二重放出型腸管被覆カプセル75mgを1回75mgずつ1日1回経口投与したほか、福貴霖カプセル6カプセルを1回6カプセルずつ1日3回経口投与した。各コースの治療期間は14日間で、両群ともに2コースの治療を行い、2コース間に2日の間隔をあけて治療を行った。治療前、治療直後、治療後4ヶ月の時点でVisual Analogue Scale（VAS）スコア、Western Ontario and McMaster Universities Osteoarthritis Index（WOMAC）スコア、Lequesne indexを観察し、治療後の漢方（TCM）症候群の転帰を両群間で比較した。
METHODS: A total of 72 patients with cold-dampness knee osteoarthritis were randomly divided into observation group and control group according to the random numbers generated by computer software, with 36 patients in each group. For the observation group, electroacupuncture was performed at the main acupoints of Dubi (ST35), Neixiyan (EX-LE4), Zusanli (ST36), Yanglingquan (GB34), Yinlingquan (SP9), Xuehai (SP10), Liangqiu (ST34), and Heding (EX-LE2) once a day, with a needle retaining time of 30 min, and thunder-fire moxibustion was performed at Shenque (CV8) and Guanyuan (CV4) in the form of suspended moxibustion once a day, with 30 min each time. The patients in the control group were given oral administration of diclofenac sodium double-release enteric-coated capsules, 75 mg each time, once a day, and Fugui Gutong capsules, 6 capsules a time and 3 times a day. Each course of treatment was 14 days, and both groups were treated for 2 courses, with an interval of 2 days between the two courses. Visual Analogue Scale (VAS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and Lequesne index were observed before the treatment, immediately after the treatment, and at 4 months after the treatment, and the outcome of traditional Chinese medicine (TCM) syndrome was compared between the two groups after treatment.
結果:
両群ともに、治療直後と治療後4ヶ月時点でVASスコア、WOMACスコア、Lequesne指数が有意に低下していた（＜0.05）。対照群と比較して、観察群では、治療直後および治療後4ヵ月後にVASスコア、Lequesne index、WOMACスコア（疼痛、機能、総合スコアのスコア）の有意な低下が認められた（<0.05）。有効率は観察群で97.1％（34/35），対照群で78.8％（26/33）であった。観察群の有効率は対照群よりも明らかに高かった(<0.05)。
RESULTS: Both groups had significant reductions in VAS score, WOMAC score, and Lequesne index immediately and at 4 months after the treatment (<0.05). Compared with the control group, the observation group had significant reductions in VAS score, Lequesne index, and WOMAC score (scores of pain, function and total score) immediately and at 4 months after the treatment (<0.05). The effective rate was 97.1% (34/35) in the observation group, and was 78.8% (26/33) in the control group. The effective rate of the observation group was obviously higher than that of the control group (<0.05).
結論:
雷火灸と電気鍼灸を併用することで、冷え性湿潤性変形性膝関節症の治療において、薬剤よりも優れた持続性のある臨床効果が得られ、副作用も少ないことがわかった。
CONCLUSION: Thunder-fire moxibustion combined with electroacupuncture has a better, more durable clinical effect and fewer adverse reactions than the drugs in the treatment of cold-dampness knee osteoarthritis.