目的 观察温针灸配合白仙风汤剂治疗对类风湿关节炎(RA)患者外周血miR-146a、高迁移率族蛋白l (HMGB1)、CXC趋化因子配体16(CXCL16)水平的影响,并探讨其机制.方法 选取本院收治的RA患者134例作为研究对象,按照随机数字表法分为观察组和对照组,各67例,两组均给予健康教育、饮食和运动指导等基础干预,在此基础上对照组给予温针灸治疗,观察组在对照组基础上配合白仙风汤剂治疗.观察两组中医证候积分、疼痛程度、手握力量、晨僵时间、15m步行时间、类风湿因子(RF)、血沉(ESR)和C反应蛋白(CRP)水平、临床疗效、miR-146a、HMGB1、CXCR16水平.结果 两组治疗后中医证候积分显著低于治疗前(P＜0.05),且观察组显著低于对照组(P＜0.05);两组治疗后视觉模拟量表(VAS)、晨僵时间、15m步行时间显著低于治疗前(P＜0.05),且观察组显著低于对照组(P＜0.05),两组手握力量显著高于治疗前(P＜0.05),且观察组显著高于对照组(P＜0.05);两组治疗后RF、ESR、CRP显著低于治疗前(P＜0.05),且观察组显著低于对照组(P＜0.05);观察组总有效率为92.54％,显著高于对照组80.60％ (P＜ 0.05);两组治疗后miR-146a显著高于治疗前(P＜0.05),且观察组显著高于对照组(P＜0.05),两组HMGB1、CXCL16显著低于治疗前(P＜0.05),且观察组显著低于对照组(P＜0.05).结论 温针灸配合白仙风汤剂可有效改善RA患者临床症状,调节miR-146a、HMGB1、CXCR16水平,提高临床疗效.%Objective:To observe the influence of warming acupuncture combined with Baixianfeng Decoction on peripheral blood miR-146a,HMGB1 and CXCL16 of patients with rheumatoid arthritis (RA).Methods:134 cases with RA were selected as the study objects,and were divided into the observation group and the control group according to random number table method,67 cases in each group.Two groups were given basic intervention,such as health education,diet and exercise guidance.On this basis,the control group were given wanning acupuncture treatment,and the observation group were combined with Baixianfeng Decoction on the basis of the control group.TCM symptoms scores and the degree of pain,hand grip,morning stiffness,15 rmin walking time,rheumatoid factor (RF),erythrocyte sedimentation rate (ESR) and C reactive protein (CRP),clinical effect,miR-146a,HMGB1,CXCR16 levels were observed in the two groups.Results:After treatment,TCM symptoms scores were significantly lower than those before treatment in the two groups (P ＜ 0.05),and those in the observation group were significantly lower than those in the control group (P＜ 0.05).VAS,morning stiffness,15 min walking time were significantly lower than those before treatment in the two groups (P ＜ 0.05),and those in the observation group were significantly lower than those in the control group (P＜ 0.05).Holding power was significantly higher than that before treatment in the two groups (P＜ 0.05),and that in the observation group was significantly higher than that in the control group (P＜ 0.05).After treatment,RF,ESR and CRP were significantly lower than those before treatment in the two groups (P＜0.05),and those in the observation group were significantly lower than those in the control group (P ＜ 0.05).The total effective rate in the observation group was 92.54％,significantly higher than that of the control group (80.60％)(P ＜ 0.05).miR-146a was significantly higher than that before treatment in the two groups (P＜0.05),and that in the observation group was significantly higher than that in the control group(P＜ 0.05).HMGB1 and CXCL16 were significantly lower than those before treatment (P＜ 0.05),and those in the observation group were significant lower than those in the control group (P ＜ 0.05).Conclusion:Warming acupuncture combined with Baixianfeng Decoction can effectively improve clinical symptoms and miR-146a,HMGB1,CXCR16,and clinical efficacy of patients with RA.
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