Objective: To observe the effects of moxibustion on the contents of leukotriene B4 (LTB4), interleukin-17 (IL-17), tumor necrosis factor-α (TNF-α) and matrix metalloproteinase -9 (MMP-9) in serum, and explore the protection mechanisms of moxibustion in the patients with rheumatoid arthritis (RA).
Methods: A total of 64 patients with RA were randomly divided into treatment group (n=31) and control group (n=33). The patients in the control group were treated with conventional medication for consecutive 5 weeks. Based on the treatment in the control group, the patients in the treatment group were treated with moxibustion at bilateral Shenshu (BL23), Zusanli (ST36) and Ashi points, 3 times a week, for consecutive 5 weeks. Separately, the visual analogue scale (VAS) score, morning stiffness score, the number of tender joints, the number of swollen joints, the score of the disease activity score of 28 joints (DAS28) were observed; the contents of rheumatoid factor (RF), erythrocyte sedimentation rate (ESR) and C-reative protein (CRP) in serum were determined by biochemical method; and the contents of LTB4, IL-17, TNF-α and MMP-9 in serum were detected by using ELISA before and after treatment in the patients of both groups.
Results: After treatment, VAS score, morning stiffness score, the number of tender joints, the number of swollen joints, DAS28 score, the contents of serum RF in both groups, and contents of serum CRP, ESR, LTB4, IL-17, TNF-α and MMP-9 in the treatment group were significantly reduced when compared with those before treatment (P<0.01, P<0.05). After treatment, VAS score, morning stiffness score, the number of tender joints, the number of swollen joints, DAS28 score, and the levels of LTB4, IL-17 and MMP-9 in serum were obviously lower in the treatment group when compared with the control group (P<0.01, P<0.05). In the treatment group, the changes before and after treatment in the levels of LTB4, IL-17 and TNF-α were positively correlated with that of MMP-9 (P<0.05, r>0).
Conclusion: Moxibustion at BL23 and ST36 combined with conventional medication significantly relieves joint pain and reduce disease activity in RA patients, which may be related to the modulation of LTB4, IL-17 and MMP-9 by moxibustion.
目的：观察艾灸对类风湿关节炎(RA)患者血清中白三烯B4(LTB4)、白细胞介素-17(IL-17)、肿瘤坏死因子-α(TNF-α)和基质金属蛋白酶-9(MMP-9)含量的影响，探讨艾灸对RA的骨保护机制。方法：将RA患者随机分为对照组33例和治疗组31例。对照组予常规药物治疗，连续治疗5周；治疗组在对照组基础上予双侧肾俞、足三里及阿是穴艾灸治疗，每周3次，连续治疗5周。观察两组患者治疗前后视觉模拟量尺(VAS)评分、晨僵评分、关节压痛数、关节肿胀数、28关节疾病活动度(DAS28)评分，生化法检测血清中类风湿因子(RF)、血沉(ESR)、C反应蛋白(CRP)含量，ELISA法检测血清中LTB4、IL-17、TNF-α、MMP-9的含量。结果：治疗后，治疗组和对照组VAS评分、晨僵评分、关节压痛数、关节肿胀数、DAS28评分和血清中RF含量均较治疗前明显降低（P<0.01, P<0.05）, 治疗组CRP、ESR、LTB4、IL-17、TNF-α、MMP-9含量均较治疗前明显降低(P<0.01)；治疗后，治疗组VAS评分、晨僵评分、关节压痛数、关节肿胀数、DAS28评分和血清中LTB4、IL-17和MMP-9含量明显低于对照组(P<0.01，P<0.05)；治疗组治疗前后血清中LTB4、IL-17、TNF-α含量变化与MMP-9含量变化存在正相关性(P<0.05，r>0)。结论：艾灸肾俞、足三里、阿是穴并联合常规西药能明显改善RA患者关节疼痛和疾病活动度，对RA有潜在的骨保护作用，其机制可能与艾灸调控LTB4水平、抑制炎性因子IL-17产生，减少MMP-9生成有关。.
Keywords: Interleukin -17; Leukotriene B4; Matrix metalloproteinase-9; Moxibustion; Rheumatoid arthritis; Tumor necrosis factor-α.