来源：风湿病与关节炎,2020,9（11）:19-23.

红外热成像对子午流注合辨证取穴火针治疗风湿性多肌痛疗效评价（临床研究）

温伟强，解金枝，张洪玉，方　亚，刘小香，刘海燕

　　【摘　要】目的：观察子午流注合辨证取穴火针治疗风湿性多肌痛的疗效、安全性，探讨应用红外热成像仪评价临床疗效的可行性。方法：将90例风湿性多肌痛患者随机分为治疗组、对照1组、对照2组，每组30例。治疗组采用子午流注加辨证取穴火针治疗，对照1组采用辨证取穴火针治疗，对照2组采用醋酸泼尼松治疗。3组均以4周为1个疗程，治疗2个疗程。观察3组临床疗效，治疗前后疼痛视觉模拟评分法（VAS）评分、晨僵时间、上肢失举度，测定红细胞沉降率（ESR）、C-反应蛋白（CRP），以及3组患者痛区与非痛区红外热成像，并记录痛区与非痛区的温差（△T = T非痛区-T痛区）在治疗前后的变化，同时观察不良反应。结果：治疗组、对照1组、对照2组总有效率分别为90.00%、76.67%、70.00%，治疗组优于对照1组、对照2组，差异有统计学意义（P < 0.05）。治疗后，3组VAS评分、晨僵时间、上肢失举度等较治疗前均有明显改善，ESR、CRP明显下降，红外热成像及痛区与非痛区的温差变化治疗前后比较，差异有统计学意义（P < 0.05）；治疗组观察指标改善值与对照组比较，差异有统计学意义（P < 0.05）。红外热成像图数据与临床综合疗效具有显著相关性。不良反应发生率治疗组为6.67%，对照1组为3.33%，对照2组为20.00%。结论：子午流注合辨证取穴火针治疗风湿性多肌痛疗效显著，且不良反应较少；红外热成像仪的测定结果可准确客观地反映临床疗效。

　　【关键词】　风湿性多肌痛；子午流注；火针；辨证取穴；红外热成像；疗效评价

Evaluation of Therapeutic Effect of Ziwu Liuzhu Combined with Fire Acupuncture based on Syndrome Differentiation on Polymyalgia Rheumatica by Infrared Thermal Imaging

WEN Wei-qiang,XIE Jin-zhi,ZHANG Hong-yu,FANG Ya,LIU Xiao-xiang,LIU Hai-yan

　　【ABSTRACT】Objective:To observe the efficacy and safety of Ziwu Liuzhu combined with fire acupuncture based on syndrome differentiation in the treatment of rheuma,and to explore the feasibility of using infrared thermal imaging instrument to evaluate the clinical efficacy.Methods:Ninety patients with polymyalgia rheumatica were randomly divided into a treatment group,control group 1 and control group 2,30 cases in each.The treatment group was treated with Ziwu Liuzhu combined with fire acupuncture based on syndrome differentiation,while control group 1 was treated with fire acupuncture based on syndrome differentiation,and control group 2 was treated with prednisone acetate.All the three groups were treated for two courses of treatment,four weeks as a course.The clinical efficacy,VAS score,morning stiffness time,upper limb lifting loss degree were observed,ESR,CRP,infrared thermography of pain area and non pain area were measured before and after treatment,the changes of temperature difference between pain area and non pain area（△T = T non pain area-T pain area）were recorded before and after treatment,and adverse reactions were observed.Results:The total effective rates of the treatment group,control group 1 and control group 2 were 90.00%,76.67% and 70.00% respectively.The treatment group was better than control group 1 and control group 2,and the difference was statistically significant（P < 0.05）.After treatment,VAS score,morning stiffness time,upper limb lifting loss degree of the three groups were significantly improved,ESR and CRP were significantly decreased,and infrared thermal imaging and temperature difference between pain area and non pain area before and after treatment were statistically significant（P < 0.05）.The improvement value of observation indexes in the control group was significantly different from that in the treatment group（P < 0.05）.There is a significant correlation between the data of infrared thermography and clinical comprehensive curative effect.The incidence of adverse reactions was 6.67% in the treatment group,3.33% in control group 1 and 20.00% in control group 2.Conclusion:Ziwu Liuzhu combined with fire acupuncture based on syndrome differentiation has a significant curative effect on polymyalgia rheumatica with less adverse reactions.The results of infrared thermography can accurately and objectively reflect the clinical curative effect.

　　【Keywords】 rheuma;Ziwu Liuzhu;fire acupuncture;acupoint selection based on syndrome differentiation;infrared thermography;evaluation of curative effect