The Effect Of Electropuncture Combined With Warm Needling Method On The Levels Of Serum Cytokines And Quality Of Life Of Knee Osteoarthritis Patients

BackgroundKnee osteoarthritis(KOA) is one of osteoarthritis(OA). It is the most common seen musculoskeletal system disease among seniors above age 50. Its feature symptoms is occurrence or disappearance of progressive articular cartilage degeneration joint edge of the osteophyte formation and subchondral bone reactive changes, disease process involves the entire joint, including subchondral bone, ligaments, joints, and joint synovium the surrounding muscles. The results are usually eventually lead to joint dysfunction or disability. These are the main cause to senior pain and handicap. In recent years, with the world increasing aging population, the incidence of OA increased year by year. However, medical field has not exactly found its pathogenesis yet. Recently, the OA pathogenesis studies have focused on inflammatory cytokines, apoptosis and growth factor and so on. The study found that IL-1, TNF-α, NO, MMPs such as exists in the bone, cartilage and synovial membrane. In manner of autocrine or paracrine they play a part in bone and cartilage formation and repair in order to regulate the coupled dynamic balance of "bone resorption-bone formation" and maintain normal articular cartilage morphology and function. If its activity is changed, it will result in the loss of articular cartilage matrix components and progressive damage. At present the conservative treatment of this disease has some defects, or medication side effects, or has no means of popularization. And it also has uncertain post-operative treatment, heavy economic burden, seriously affect of health and quality of life; In contrast, as a traditional means of medical treatment of the disease acupuncture not only has a high rate of clinical improvement and fewer side effects, convenient, is also widely used in clinical and scientific research in China.ObjectiveIn view of this, based on the previous study this subject aim to observe of electro acupuncture combined with warm acupuncture treatment of KOA clinical efficacy and to compare three different treatment effects, as well as quality of life of KOA patients; meanwhile, we detect serum levels of interleukin-1(IL-1), tumor necrosis factor-α(TNF-α) of patients, in order to further explore the possible role of acupuncture mechanism of KOA in expectation of providing a safe and effective measures in clinical treatment, and contributing to improve the quality of life of patients through this study in the future.MethodWe selected 90 outpatients of acupuncture and orthopedic clinic of the Guangzhou University of Traditional Chinese Medicine, First Affiliated Hospital of May 2010-2010 in December. According to the principle of randomization, the 90 patients met the inclusion criteria of KOA were divided into treatment group were 30 cases (electropuncture combined with warm needling method group),30 patients in the control groupⅠ(electropuncture group),30 cases were the control groupⅡ(Celebrex group). Specific research methods of each group are:1.Treatment groups:To adopt acupuncture treatment with electropuncture combined with warm needling method, according to the corresponding channel acupoints selection and differentiation of symptoms acupoints selection. The main point:taking the inner and outer Xiyan,EX-LE2,GB33,LR8,Ashi points. Matching acupoints:Loss of kidney marrow type, with GB39,KI3,GB34; Yang deficiency and cold accumulation type, with ST34,ST36,SP9; Blood stasis type, with SP10. Operation:After routine disinfection of the acupoints, we take 1.5-inch needles for treatment, adopting excess syndrome with supplementation, deficiency syndrome with draining. The wave of condensation and rarefaction of the electronic acupunctoscope was selceted after the operation of acupuncture. The amperage was fit for the comfortable feeling of patients. At the same time,2cm long moxa roll was plugged into the needle handle of the main points. Then we lighted the moxa roll till it w as burned out then we rem(?)ove the ash after burned moxa. Two consistent moxa-cones should be used and period of retaining the needles was 30minutes. 2. The control group I:We adopted electropuncture treatment. Acupoints selection and needling methods and time of treatment were as same as treatment group.3. Control groupⅡ:The patients were given oral celecoxib (brand name Celebrex capsules)0.2g Qd therapy.In case of discomfort of the gastrointestinal tract, patients should be given Omeprazole the protectant of gastrointestinal tract 20mg Qd depending on the particular circumstances. The observation time is also 4 weeks.Three groups before and after treatments should be observed with the following aspects:(1) SF-36 quality of life questionnaire (Chinese version), which are widely used in clinical scale and it has good reliability, validity and representativeness as the main outcome measures quality of life. Among them, physical health (PF), physical role function (RP), bodily pain (BP), general health (GH), vitality (VT), social function(SF), emotional role function ing (RE), mental health (MH) other 8 dimensions, each dimension contains a number of issues, a total of 35 projects; another item changes for health self-assessment (HT), for the simple analysis; (2) KOA quantified Chinese quality of life score table, which mainly refer to international standards of quality of life and make a improvement.The selected items are closer to the actual living conditions of patients, so we take them as secondary outcomes. Its content can be divided into physiological function (shape), psychological (feelings), social function (spirit), and healthy self-awareness (general subjective health) and other four parts. (3) According to the provisions of laboratory, IL-1,TNF-αlevels of peripheral blood of samples are tested before and after treatment. At the same time take 15 healthy people (above 40 years) as the healthy control group then have them serum IL-1,TNF-αtested. (4) Safety testing. Inspection of blood,urine,liver and kidney function,ECG, etc should be taken before and after treatment. During the treatment adverse reactions must be recorded. After completing course of treatment the patients should fill safety evaluation form. Additionally three groups of patients before treatment and after 4 weeks are asked for treatment telephone follow-up and the questionnaire score. We enter all data into SPSS13.0 the statistical software for data processing and analysis of statistical data and finally draw conclusions.ResultDuring the experiment, there was 2 patients lost in the treatment group; 3 were lost in the control groupⅠto follow; 2 cases were lost in the control groupⅡ. There were 2 patients withdrew due to adverse reaction test. The total lost cases were 9, so the there were 81 cases actually after completion of the experiment, which of 28 cases in treatment group and 27 cases in control groupⅠ,26 cases in the control groupⅡ. Specific treatment was as follows:1. There was no significantly difference among the three groups of patients in aspect of gender, age, disease duration, disease location, X ray classification and syndromes, and other basic information (P>0.05), suggesting a better comparability among them.2. Comparision of quality of life before and after treatment three groups.(1) SF-36 quality of life questionnaire:The three groups in the 8 dimensions had no significant differences (P > 0.05), It means that is comparability among the three groups. The results showed that the treatment group which was adopted the method of electropuncture combined with warm acupuncture have an advantage over the simple acupuncture and oral use of Celebrex (P<0.01) in improving the quality of life of patients, such as vitality, social functioning, mental health and overall health and so on. However there was no significant difference between the three groups in improving physical health and pain (P>0.05). It indicated that both three groups of patients with knee osteoarthritis have similar effect on the control joint pain and improve the efficacy of clinical signs.(2) KOA quantified Chinese quality of life score table:There were no significant differences in physiological function psychological condition,social function general and comprehensive integration of subjective health of three groups before the treatment (P> 0.05). There was comparability among the three groups. The results showed that the treatment group in improving the quality of life of patients is more offective than other control groups (P<0.01); In addition, the data also suggest using electropuncture for osteoarthritis of the knee to improve physical function in patients with state of mind, can indeed play a certain effect.3. Comparasion of physical sign indicators of three groups before and after treatment.The physical sign indicators of three groups had no significant differences (P>0.05) before treatment. It means that is comparability among the three groups. The results showed that, both time and walk in the straight leg raising to improve on the 15-meter time of the treatment group was superior to the other control groups (P<0.01).4. Comparasion of serum IL-1, TNF-αof three groups before and after treatment.The KOA IL-1 and TNF-αof three groups before treatment were significantly higher than normal people, which meant significant difference compared with the normal group (P<0.01); However, IL-1,TNF-αlevels have no significantly differences among the three groups before treatment (P>0.05), which indicated that three groups of patients before treatment were comparable in levels of cytokines. The results presented that the serum IL-1 and TNF-αdecreased significantly, with significant differences (P<0.01). The control groupⅠafter treatment also has differences (P<0.05), while the control groupⅡafter treatment has no statistical significance (P>0.05); Comparison among the three groups, the treatment group and control groupⅠ,Ⅱgroup control had significant differences (P<0.01), while the two control groups did not differ between the effect (P>0.05). The data of electropuncture combined with warm needling method group in terms of serum cytokine levels, significantly superior to the control group.5. Comparaion of curative effect of the three groups after treatment.After treatment, the total effective rate of treatment group was 92.9%, total effective rate of the control groupⅠwas 70.4%, total effective rate of the control groupⅡwas 65.4%, indicating that the effective rate of treatment group was significantly higher than the control group. Statistical differences among the three groups had significance (P<0.05). Statistical results indicate that the use of electropuncture combined with warm needling method treatment of KOA patients, significantly better than using electropuncture treatment and oral medicine.6. Comparasion of adverse reactions of the three groups after treatment.Throughout the study, the electropuncture combined with warm needling method group and the electropuncture group had no case of adverse reactions, while 1 patient had headache and 5 patients of the Celebrex group had gastrointestinal symptoms. Three groups of patients, were not found liver and kidney dysfunction, inhibition of blood and signs and symptoms of gastrointestinal bleeding after 4 weeks of treatment.ConclusionClinical observation confirmed that acupuncture can enhance a sense of EA to promote the blood running, eliminate inflammatory edema, has a strong central analgesic effect; The temperature of the thermal effects produced by warm needling method, can promote blood circulation, improve the effectiveness of local tissue metabolism. Therefore, the combination of the two treatments used in KOA can indeed play a role in promoting qi and blood circulation and warming channel and expelling cold, reduce swelling and alleviate pain, improve joint function. The results show that electropuncture combined with warm needling method in treating KOA, not only can ease the physical discomfort of patients, the quality of life such as their emotions, vitality, activity of daily life is also improved even more significantly. Moreover obvious side effects had reported. In addition, according to the tips of decreasing IL-1,TNF-αof patients under treatment, we suggest that the mechanism of acupuncture treatment of KOA may be in relation to reduce excess IL-1,TNF-αlevels. Therefore it can delay osteoarthritis development, and reduce joint osteophyte formation.