六味地黄丸汤剂联合针刀治疗绝经后女性膝骨关节炎的临床研究*

作者：张 奇，孔丽峰，陈启鹏，柳卓言，吴舒莹，宋寒冰

单位：黑龙江中医药大学附属第一医院，黑龙江 哈尔滨 150008

引用：引用：张奇，孔丽峰，陈启鹏，柳卓言，吴舒莹，宋寒冰.六味地黄丸汤剂联合针刀治疗绝经后女性膝骨关节炎的临床研究[J].中医药导报,2025,31(9):107-112.

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摘要：

目的：研究六味地黄丸汤剂联合针刀治疗绝经后女性膝骨关节炎的临床疗效及作用机制。方法：将80例绝经后女性膝骨关节炎患者随机分为针刀组与针药结合组，每组40例。针刀组予针刀治疗，针药组予六味地黄丸汤剂联合针刀治疗。比较治疗前后两组患者视觉模拟（VAS）评分、膝关节功能（WOMAC）评分、妇女更年期症状（改良Kupperman）评分；检测两组患者治疗前后基质金属蛋白酶-13（MMP-13）、白细胞介素-1β（IL-1β)、肿瘤坏死因子-α（TNF-α）、雌二醇（E2）、卵泡刺激素（FSH）含量；比较两组患者治疗前后滑膜厚度及关节积液范围。结果：治疗后两组患者VAS评分、WOMAC评分均低于治疗前，且针药组患者改良Kupperman评分低于治疗前，且针药组患者各评分均低于针刀组，差异均有统计学意义（P<0.05）。治疗后两组患者MMP-13、IL-1β、TNF-α水平低于治疗前，且针药组低于针刀组，差异均有统计学意义（P<0.05）。治疗后针药组患者E2水平高于治疗前，FSH水平低于治疗前，且针药组E2水平高于针刀组、FSH水平低于针刀组，差异均有统计学意义（P<0.05）。治疗后两组患者滑膜厚度和关节积液数值范围均低于治疗前，且针药组低于针刀组，差异均有统计学意义（P<0.05）。针药组临床疗效优于针刀组，差异有统计学意义（P<0.05）。结论：六味地黄丸汤剂联合针刀能够改善绝经后女性膝骨关节炎患者的膝关节功能、减轻疼痛、减少滑膜厚度及关节积液，其疗效显著优于单用针刀治疗，作用机制可能为降低炎症因子水平，调节性激素水平。

关键词：膝骨关节炎；绝经；六味地黄丸；针刀；临床研究

Abstract：

Objective: To investigate the clinical efficacy and potential mechanism of decoction of Liuwei Dihuang Wan combined with acupotomy in treating knee osteoarthritis (KOA) in postmenopausal women. Methods: Eighty postmenopausal women with KOA were randomly divided into an acupotomy group (n=40, receiving acupotomy only) and a combination group (n=40, receiving both decoction of Liuwei Dihuang Wan and acupotomy). Visual Analog Scale (VAS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and modified Kupperman index (for menopausal symptoms) were compared before and after treatment. Levels of matrix metalloproteinase-13 (MMP-13), interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), estradiol (E2), and follicle-stimulating hormone (FSH) were measured. Synovial thickness and joint effusion range were assessed via ultrasound. Results: After treatment, VAS and WOMAC scores decreased significantly in both groups compared to baseline (P<0.05). The modified Kupperman score decreased in the combination group (P<0.05), and all scores were lower in the combination group than in the acupotomy group (P<0.05). Levels of MMP-13, IL-1β, and TNF-α decreased in both groups post-treatment (P<0.05), with lower levels in the combination group (P<0.05). In the combination group, E2 levels increased and FSH levels decreased after treatment (P<0.05), and these changes were significantly more pronounced compared to the acupotomy group (P<0.05). Synovial thickness and joint effusion range decreased in both groups (P<0.05), with greater reduction in the combination group (P<0.05). The clinical efficacy of the combination group was superior to that of the acupotomy group (P<0.05). Conclusion: The combination of Liuwei Dihuang Pills and acupotomy can improve knee joint function, alleviate pain, and reduce synovial thickness and joint effusion in postmenopausal women with KOA. Its efficacy is significantly better than acupotomy alone. The mechanism may involve reducing inflammatory factor levels and regulating sex hormone levels.

Key words：knee osteoarthritis; menopause; Liuwei Dihuang Wan; acupotomy; clinical study

发布时间：2026-01-08

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