Sato Masami, Inubushi Masayuki, Shiga Tohru, Hirata Kenji, Okamoto Shozo, Kamibayashi Tomohito, Tanimura Kazuhide, Tamaki Nagara
Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
Ann Nucl Med. 2009 May;23(3):311-6. doi: 10.1007/s12149-009-0238-4. Epub 2009 Apr 1.
The purpose of this study was to investigate whether improvement of regional inflammatory findings in knee joints of rheumatoid arthritis (RA) could be detected by positron-emission tomography (PET) using (18)F-Fluorodeoxyglucose (FDG) after acupuncture treatments, as well as improvement of systemic inflammatory markers.
Six RA patients (all female, 61 +/- 12 years old) received 10 acupuncture treatments in 2 months, to 11 traditional acupuncture points around a knee joint considered effective on RA. A visual analogue scale (VAS) for intensity of pain, knee joint range of motion (ROM), face scale for patient mood, and modified health assessment questionnaire (MHAQ) for disability of daily activities were assessed just before and after acupuncture. Maximum standardized uptake value (SUV(max)) and the volume with SUV more than 1.0 [Volume(SUV > 1)] on FDG-PET images as well as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were also measured before and after the treatments.
VAS, ROM, face scale and MHAQ improved in all patients and significantly after acupuncture, but no significant change was detected in ESR, CRP, SUV(max), or Volume(SUV > 1).
Acupuncture relieves symptom, remedies physical function, and improves quality of life in RA patients, but may have no or very limited anti-inflammatory effect systemically. The regional effects of acupuncture are unlikely to be induced through reduction of regional inflammation. We believe this clinical study is the first step for elucidating therapeutic mechanisms of acupuncture, which must be important for the rational use and further development of acupuncture.
本研究旨在调查针刺治疗后，采用正电子发射断层扫描（PET）结合（18）F-氟脱氧葡萄糖（FDG）能否检测到类风湿关节炎（RA）膝关节局部炎症表现的改善以及全身炎症标志物的改善情况。
6例RA患者（均为女性，61±12岁）在2个月内接受了10次针刺治疗，针刺部位为膝关节周围11个被认为对RA有效的传统穴位。在针刺前后分别评估疼痛强度视觉模拟量表（VAS）、膝关节活动范围（ROM）、患者情绪面部量表以及日常生活活动能力改良健康评估问卷（MHAQ）。同时测量治疗前后FDG-PET图像上的最大标准化摄取值（SUV(max)）以及SUV大于1.0的体积[Volume(SUV > 1)]，还有红细胞沉降率（ESR）和C反应蛋白（CRP）水平。
所有患者的VAS、ROM、面部量表和MHAQ均有改善，针刺后改善显著，但ESR、CRP、SUV(max)或Volume(SUV > 1)未检测到显著变化。
针刺可缓解RA患者的症状，改善身体功能，提高生活质量，但全身抗炎作用可能不明显或非常有限。针刺的局部效应不太可能通过减轻局部炎症来诱导。我们认为这项临床研究是阐明针刺治疗机制的第一步，这对于针刺的合理应用和进一步发展至关重要。
