基于“热证可灸”的悬灸对热痹型RA大鼠特异自身抗体表达的干预机制

Rheumatoid arthritis is one of autoimmune disorders which have a high morbidity and a poor prognosis. Change of serum autoantibody is an important clinical characteristic of early RA activity and provides a reliable basis for clinical diagnosis and therapeutic evaluation of early RA. This project, based on the argument foundation of close relationship between early RA activity and heat bi syndrome and in light of the research hypothesis of "Giving moxibustion to heat syndrome" in combination with the previous research basis and clinical practice, selects the early RA activity of typical excess-heat syndrome characteristics as object of treatment and the three different suspended moxibustion methods which are commonly used in clinical acupuncture practice with a relatively simple effect of moxibustion to intervene in, based on the efficient replication of RA syndrome combined with model rats. Combined test with the four specific serum autoantibody RF, ACCP, AKA and APF expression of early RA activity and observation on syndrome morphological changes of local redness, swelling, heat and pain, and joint range of motion as well as pathomorphological change of synovial tissue of joint, it analyzes key mechanism of suspended moxibustion in anti-inflammation and immunization, and stabilizing internal environment, and makes clear the effectiveness of suspended moxibustion intervention in early RA activity, so as to choose a rational clinical applicable scheme and provide a scientific basis for the theory of "Giving moxibustion to heat syndrome" from the perspective of suspended moxibustion intervention in heat bi syndrome.

类风湿关节炎（RA）是发病率高、预后不佳的自身免疫性疾病之一。血清特异自身抗体改变是活动性RA的重要临床特征，也是对RA早期进行临床诊断、疗效评价的可靠依据。本项目基于早期活动性RA与热痹证相关的立论基础，围绕“热证可灸”的研究假说，结合前期研究基础和临床实践，选择具备实热证典型证候特征的早期活动性RA为治疗对象，在有效复制热痹型RA病证结合模型大鼠基础上，选择临床常用且艾灸效应单纯的三种悬灸操作方法进行干预，联合检测类风湿因子（RF）、抗环瓜氨酸抗体（抗CCP）、抗角蛋白抗体（AKA）和抗核周因子抗体（APF）四种血清特异自身抗体表达，结合观察局部红、肿、热、痛和关节活动度等证候形态变化及滑膜组织病理改变，分析悬灸实现抗炎免疫作用并稳定内环境的关键机制，明确悬灸对早期活动性RA干预的有效性，为疾病早期针灸治疗选择合理的临床应用方案，并从悬灸干预热痹证角度为“热证可灸”理论提供科学依据。

类风湿关节炎（RA）是一种发病率和致残率较高的自身免疫性疾病。RA早期以急性滑膜炎症为主，表现为对称性关节红、肿、热、痛及功能受限，这与祖国医学湿热痹阻型痹证证候特征相似。血清特异自身抗体的异常表达是早期活动性RA的重要临床特征，也是RA早期诊断、疗效评价和预后判断的可靠依据。RA早期病情较轻，如在此期进行治疗，可有效扭转滑膜炎症，避免关节破坏，是RA治疗的重要举措。.本项目基于“热证可灸”理论，在前期研究和临床应用基础上，选择湿热痹阻型RA大鼠这一具备典型“热证”证候特征的动物模型为研究对象，选择临床常用且艾灸效应单纯的三种悬灸操作方法进行干预，联合检测干预前后血清中类风湿因子（RF）、抗环瓜氨酸抗体（Anti-CCP）、抗角蛋白抗体（AKA）和抗核周因子抗体（APF）四种自身抗体的表达含量。结合观察关节局部红、肿、热、痛和关节活动度等证候形态变化及滑膜组织病理改变，分析、探讨悬灸实现抗炎免疫作用的关键机制，为“热证可灸”理论提供科学依据，并为RA早期的悬灸治疗选择适宜的临床操作方法，为临床应用提供依据和参考。.研究结果表明：“胶原诱导＋风、湿、热环境刺激”复合造模法可致大鼠关节局部出现红、肿、热、痛及活动受限等滑膜炎症反应，同时血清自身抗体RF、Anti-CCP、AKA和APF表达异常升高，表明RA发病与自身抗体的异常表达密切相关。三种悬灸法均能显著改善RA大鼠踝关节局部红、肿、热、痛及关节活动受限等症状，改善滑膜炎症，具有显著的抗炎效应；并能降低血清特异自身抗体RF、Anti-CCP、AKA和APF，这可能是悬灸干预早期活动性RA的重要机制。三种悬灸法干预RA效果存在明显差异，其中以温和灸效应最佳，这为“热证可灸”理论以及合理选择灸法干预RA提供客观依据。