目的 基于TCA循环（三羧酸循环，tricarboxylic acid cycle）关键酶测定研究督灸治疗早期强直性脊柱炎（AS）肾虚督寒证患者关节活动度的疗效及生物学机制。方法 110例早期AS肾虚督寒证患者随机分为观察组和对照组，各55例。对照组口服甲氨蝶呤+洛索洛芬钠，观察组在对照组治疗基础上给予督灸，疗程均为12周。观察治疗前后患者的病情活动指数（bath ankylosing spondylitis disease activity index，BASDAI）、功能指数（bath ankylosing spondylitis fundation index，BASFI）、活动度衡量指数（bath ankylosing measure index activity index，BASMI）、总和指数（bath ankylosing spondylitis patient slobal，BAS-G）、指-地距、枕-墙距、胸廓活动度、Schober试验水平和早期AS肾虚督寒证中医辨证（肾虚督寒证）评分；检测血清炎症因子肿瘤坏死因子-α（TNF-α）、白细胞介素-18（IL-18）、血沉（ESR）和C-反应蛋白（CRP）含量；检测TCA循环关键酶柠檬酸合成酶（citrate synthase，CS）、异柠檬酸脱氢酶（isocitrate dehydrogenase，IDH）及α-酮戊二酸脱氢酶（α-ketoglutarate dehydrogenase，α-KGDHC）的水平；比较治疗12周患者的临床疗效及随访6个月复发率。结果 临床研究过程脱落6例。观察组总有效率96.2%，明显高于观察组的82.4%（P<0.05）；观察组随访6个月复发率5.7%，明显低于对照组的21.6%（P<0.05）。治疗12周后，观察组患者BASDAI、BASFI、BASMI、BAS-G、指-地距、枕-墙距和肾虚督寒证评分较对照组明显下降（P<0.05），胸廓活动度和Schober试验较对照组明显升高（P<0.05）；观察组患者TNF-α、IL-18、ESR、CRP、CS和IDH水平较对照组明显下降（P<0.05），α-KGDHC水平较对照组明显升高（P<0.05）。结论 督灸可以有效改善早期AS肾虚督寒证患者的临床症状，复发率低，值得临床推广应用。

Objective To determine the effect of du-moxibustion on improving the motion of joints in early ankylosing spondylitis based on TCA key enzyme.Method 110 patients with early AS kidney deficiency and cold syndrome were randomly divided into du-moxibustion group and control group, 55 cases in each group. The control group was treated with methotrexate and loxoprofen sodium the du-moxibustion group was treated with methotrexate, loxoprofen sodium and du-moxibustion, a course of 12 weeks. And observeBASDAI, BASFI, BASMI, BAS-G, finger-ground distance, occipal-wall distance, thoracic activity, schober test level and the TCM syndrome differentiation score (renal deficiency and cold syndrome) of the patients before and after treatment. The serum levels of inflammatory factors including TNF-α, IL-18, ESR and CRP were measured. The key enzymes of TCA cycle including CS, IDH, andα-KGDHC were detected. The clinical efficacy of 12 weeks of treatment and the recurrence rate of 6 months of follow-up were compared.Result 6 cases were lost during the study period. The total effective rate of the du-moxibustion group was 96.2%, significantly higher than the 82.4% in the observation group (P<0.05). The recurrence rate of the du-moxibustion group at 6 months of follow-up was 5.7%, which was significantly lower than the 21.6% in the control group (P<0.05). To compare with before treatment, the scores of BASDAI, BASFI, BASMI, BAS-G and renal deficiency and cold syndrome in the du-moxibustion group at 4, 8 and 12 weeks were significantly decreased (P<0.05). The clinical symptoms of the du-moxibustion group at 12 weeks were significantly lower than those of the control group (P<0.05). Compared with that before treatment, the finger-ground distance, occipal-wall distance and thoracic activity level of patients in the treatment group of 8 and 12 weeks were significantly decreased (P<0.05), and the schober test level was significantly increased (P<0.05). The clinical signs of the du-moxibustion group at 12 weeks showed more obvious improvement than the control group (P<0.05). Compared with that before treatment, the contents of serum inflammatory factors TNF-α, IL-18, ESR and CRP in the treatment group at 12 weeks after treatment were significantly decreased (P<0.05), and the improvement was more obvious than that in the control group (P<0.05). Compared with that before treatment, CS and IDH levels of the du-moxibustion group were significantly decreased (P<0.05), and levels of quee-kgdhc were significantly increased (P<0.05), and the improvement was more obvious than that of the control group (P<0.05).Conclusion Du-moxibustion could effectively improve the clinical symptoms of early AS renal deficiency and cold syndrome , the recurrence rate is low, which is worthy of clinical application.

]河南省科技攻关计划项目(162102310447)