温针灸联合乌头汤治疗不同分期类风湿性关节炎寒湿痹阻证临床疗效及对巨噬细胞极化的影响OA

Objective To observe the clinical efficacy of warm acupuncture and moxibustion combined with Wutou Decoction on patients of rheumatoid arthritis(RA)with cold-dampness obstruction pattern at different stages,explore its impact on macrophage polarization markers and analyze its correlation with RA related indicators.Methods A total of 100 patients of RA with cold-dampness obstruction pattern admitted to Beijing Gulou Hospital of Traditional Chinese Medicine from February 2023 to July 2025 were selected and were divided into a treatment group and a control group using a random number table,with 50 cases in each group.The disease progression of patients was evaluated according to Disease Activity Score in 28 joints(DAS28),with 26 cases classified as mild,41 as moderate,and 33 as high disease activity.The control group received conventional acupuncture combined with Wutou Decoction,while the treatment group was administered warm acupuncture and moxibustion combined with Wutou Decoction.Both groups were treated for 8 weeks.Before and after treatment,rheumatoid factor(RF),erythrocyte sedimentation rate(ESR),C reactive protein(CRP),macrophage polarization marker(CD86 and CD206)levels,and visual analogue scale(VAS)scores were measured and compared between the two groups,as well as the total clinical effective rates.Multiple linear regression was used to analyze the relationship between CD86,CD206 and RA related indicators.Generalized estimating equations(GEE)were used to analyze the changes in CD86 and CD206 at different time points,groups and stages.Results The total clinical effective rates were 80%(40/50)in the control group and 94%(47/50)in the treatment group.The difference between the two groups was statistically significant(P<0.05).Compared with the control group,the treatment group had lower levels of RF,ESR,CRP,and VAS score in patients at different stages after treatment(P<0.05).The expression levels of CD86 were also significantly lower(P<0.05),whereas those of CD206 were significantly higher(P<0.05).Multiple linear regression analysis showed that higher expression levels of CD86 were positively associated with increased levels of RF,ESR,and CRP(β>0,P<0.05),while higher expression levels of CD206 were negatively associated with decreased levels of RF,ESR,and CRP.(β<0,P<0.05).GEE analysis showed that the treatment group was more effective than the control group in reducing CD86 and elevating CD206 expression levels at both 6 and 8 weeks of the treatment.This superior effect was consistent across all disease activity stages,including mild,moderate,and high.Conclusion Warm acupuncture and moxibustion combined with Wutou Decoction can significantly improve the clinical efficacy for patients of RA with cold-dampness obstruction pattern,and regulate macrophage polarization to M2 type.This therapy has certain application value in different stages of RA.