王孝艳 景明 卢佳 郭佳 吉德磊
（玉溪市中医医院）
【摘要】目的：观察短刺联合艾灸治疗原发性骨质疏松的临床疗效。方法：将120例原发性骨质疏松患者随机分成3组，每组40例。单纯药物治疗组采用碳酸钙胶囊和骨化三醇胶囊治疗；基础药物联合短刺艾灸组在单纯药物治疗的基础上在T1-T12夹脊穴采用短刺法，在大杼、肾俞、足三里、悬钟穴常规针刺行捻转补法，针刺结束在命门穴行艾灸法；基础药物联合常规针刺组在单纯药物治疗基础上采用常规针刺联合艾灸，每组共进行三个疗程。观察治疗前后患者疼痛VAS评分、中医症候量化积分、骨密度、25-羟维生素D的变化。结果：三组治疗原发性骨质疏松症均有效（P＜0.05），从疼痛VAS评分、中医症候改善的疗效看药物联合短刺艾灸组疗效较好（P＜0.05）。且在治疗各时间点药物联合短刺艾灸组在减轻疼痛、改善临床症状评分方面优于其他两组（P＜0.05）。但三组均不能改善骨密度，组间无明显差异（P＞0.05）；但血清25-羟维生素D水平方面，药物联合短刺艾灸组优于其他两组（P＜0.05）。结论：药物联合短刺艾灸组、药物联合常规针刺艾灸组及基础药物治疗组均可以改善原发性骨质疏松患者的疼痛症状，且短刺联合艾灸组明显优于后两者。
【关键词】原发性骨质疏松；短刺；艾灸；骨代谢；疼痛
A Clinical Study on the Effect of Short Thorn Combined with Moxibustion in the Treatment of Primary Osteoporosis.
WANG Xiao-yan1, JING Ming, LU-Jia, GUO-Jia, JI De-lei
（1Department of Acupuncture Yuxi Municipal Hospital of TCM, Yuxi653100, Yunnan Provice, China）
[Abstract] The paper observes the clinical efficacy of short thorn combined with moxibustion in the treatment of primary osteoporosis. Methods: 120 patients with primary osteoporosis were randomly divided into 3 groups, 40 in each group. The drug-only group was treated with calcium carbonate capsules and calcitriol capsules; The basic medicine combined with the short-stab moxibustion group used the short-stab method at the T1-T12 Jiaji points on the basis of simple drug treatment, and the conventional acupuncture and sputum-removal method in Datun, Shenshu, Zusanli and Hangzhong points, and after the acupuncture, moxibustion method is ued at Mingmen joint. The basic drug combined with the conventional acupuncture group used conventional acupuncture with moxibustion on the basis of simple drug therapy, and each group performed a total of three courses. The changes of pain VAS score, TCM symptom quantitative score, bone mineral density and 25-hydroxyvitamin D were observed before and after treatment. RESULTS: All the three groups were effective in the treatment of primary osteoporosis (P<0.05). From the pain VAS score and the improvement of TCM symptom, the drug combined with short thorn moxibustion group was better (P<0.05). What’s more, at different stages of the treatment, the drug combined with short-stab moxibustion group was superior to the other two groups in reducing pain and improving clinical symptom score (P<0.05). However, the three groups could not improve the bone density, and there was no significant difference between the groups (P>0.05). In terms of serum 25-hydroxyvitamin D levels, the drug combination with the short-stab moxibustion group was superior to the other two groups (P<0.05). Conclusion: The combination of drugs with short-stab moxibustion group, drugs combined with conventional acupuncture moxibustion group and basic drug treatment group can improve the pain symptoms of patients with primary osteoporosis, and the short-stab combined with moxibustion group is better than the latter two.
[Key words] primary osteoporosis; short thorn; moxibustion; bone metabolism; pain
骨质疏松症（OP）是一种以低骨量和骨组织微结构破坏为特征，导致骨质脆性增加和易于骨折的全身性骨代谢性疾病,可分为原发性和继发性两类。2016-2018年以来笔者运用常规药物联合短刺艾灸治疗该病，与药物联合常规针刺艾灸、基础药物治疗进行对照，观察治疗前后患者疼痛、中医症候、骨密度、25-羟维生素D的变化，现将研究结果报告如下。
1 临床资料
1.1 一般资料
本研究120例患者均来自于玉溪市中医医院针灸科，采用随机数字表法，将符合纳入标准的120例骨质疏松症受试者分为3组，其中40例为单纯基础药物治疗组，40例为基础药物联合常规针刺艾灸组，40例为基础药物联合短刺艾灸组。三组患者在性别、年龄、疼痛VAS评分、中医证候评分、骨密度、血清25-羟维生素D差异无统计学意义（P＞0.05），具有可比性。
1.2 诊断标准
西医诊断标准：参照《中药新药治疗骨质疏松的临床研究指导原则》和《原发性骨质疏松症诊治指南》提出的诊断标准：
（1）全身乏力，多以腰背部疼痛明显，进行性加重，轻微外伤可导致骨折。
（2）脊椎常有后突畸形。
（3）骨密度检测出阳性征象，如双能X线（Dexa）等。
中医诊断标准：参照中国医药科技出版社2002出版的《中药新药治疗骨质疏松的临床研究指导原则》提出的诊断标准：
肝肾亏虚证：
主症：腰背部和/或下肢疼痛，酸软少力，步履艰难。
次症：不能持重，目眩，舌质偏红或偏淡。
1.3 纳入标准
符合上述中西医诊断标准，以腰背痛为主诉者，绝经后妇女和50岁以上的男性，能配合检查及坚持治疗者；均自愿参加并且签署知情同意书。
1.4 排除标准
排除继发性和特发性骨质疏松症；排除骨折未愈、合并胸、腰椎压缩性新鲜骨折，椎间盘突出及其他原因导致的腰背疼痛者；过敏体质及晕针者。
2 治疗方法
2.1 单纯药物治疗组：
以多进行日照，骨健康补充剂为主：碳酸钙胶囊和骨化三醇软胶囊，连续服用3个月。
2.2 药物联合短刺艾灸组：
药物使用同前；患者俯卧位，先针夹脊穴，取0.4×40mm的不锈钢毫针，以90°角进针，快速刺入皮下，针刺入穴后，由浅入深，直至针尖直抵骨面，在骨面上行提插泻法，针感以患者能耐受为度；余穴位行捻转补法。针刺结束，加电针，留针30分钟。盒灸双侧肾俞20分钟。入组后每天治疗一次，7天为一疗程，每疗程结束休息3天，共治疗三个疗程；药物连续口服3个月。
2.3 药物联合常规针刺艾灸组：
药物使用同前；患者俯卧位，常规消毒后，取0.3×25mm的不锈钢毫针，以45°角进针，快速刺入皮下，针刺入穴后，由浅入深，边进针，边行捻转泻法，针感以患者能耐受为度；夹脊穴行捻转泻法，余穴位行捻转补法。针刺结束，加电针，留针30分钟。盒灸双侧肾俞20分钟。入组后每天治疗一次，7天为一疗程，每疗程结束休息3天，共治疗三个疗程；药物连续口服3个月。