艾灸广泛应用于包括膝骨性关节炎(knee osteoarthritis, KOA) 在内的各种疾病治疗中，并且效果良好。但是对其研究多局限于临床疗效观察，而艾灸治疗过程中对动态病理变化规律、艾灸作用机制机理等方面研究几近空白。课题组前期提出了经筋理论并系统阐述了其与KOA的关系，发现了15个结筋病灶点与KOA密切相关。初步实验表明艾灸阳明经筋治疗KOA患者有很好的疗效。本课题拟在前期研究基础上，周期性艾灸40-80岁等四个不同年龄段KOA患者阳明经筋的髌下、髌外上与鹤顶次穴位，经SF-MPQ疼痛评估、JOA关节功能评估与Lysholm 问卷等指标综合评估艾灸治疗KOA患者的临床疗效。采用血清代谢组学的技术，比较KOA患者艾灸治疗前以及治疗后血清代谢组学图谱变化。

Moxibustion, as a vital part of acupuncture is widely used in the treatment of a wide variety of diseases including knee osteoarthritis (KOA) disorders and has achieved good therapeutic effect. However, most of the research was restricted to clinical efficacy; little was known about the patterns of the dynamically pathological changes and the mechanisms of how moxibustion cure KOA patients. Previously, the applicant proposed the theory of meridian-muscle regions and described its relationship with KOA. Furthermore, fifteen specific sites for meridian-muscle regions had been identified to be associated with KOA by the applicant’s team. We also found that moxibustion treatment on the “Yangming ” Meridian tendon of KOA patients has effective clinical therapy in our pre-tests. So we aims to evaluate the clinical efficacy of periodical moxibustion therapy on the three specific acupuncture points of lower patellar, outer on patellar and Hedingci in KOA patients ranging from four different age ranging in age from 40 to 80 in detail. Clinical efficacy will be evaluated by pain score of SF-MPQ, JOA assessment and Lysholm knee questionnaire. Using serum metabolomics technology, the dynamitic serum metabolomics profiles of the KOA patients before and after moxibustion treatment will be compared.

本研究根据患者病情，设定40-80岁为年龄范围，按10年年龄段均分4组，每组收入20例患者，共纳入80例患者作为研究样本，以阳明经筋3个结筋病灶点为施治部位，开展2个疗程的艾灸干预，采用简化McGill 疼痛评分表、膝关节功能评分标准（JOA）、Lysholm膝关节严重程度计分进行疗效评估，统计分析了患者治疗前后相关评估指标的变化，同时对15例伴有膝关节腔积液的患者抽取病理样本，开展代谢组学分析。研究结果显示：（1）经过2个疗程的干预，所有患者的评分均显著改善，40-50岁年龄组评分表现优于其他组别，证明艾灸治疗方案不仅适用可行，对于本病更应重视早期治疗；（2）通过对膝关节腔积液的代谢组学核磁图谱分析，我们筛选出46种代谢物，并对具体浓度特征进行分析。发现代谢物浓度在治疗前后无显著差异，出现阴性结果。本研究组认为不能仅凭代谢组学阴性结果评判治疗方案，有鉴于此，我们会调整方案，在加强随访时，贯彻标准周期治疗，同时对46种代谢物进一步细化分析，初步阐述积液产生机制。