三种针刺综合疗法治疗慢性荨麻疹的优化方案和临床研究

发布时间：2017-12-28 16:10

本文关键词：三种针刺综合疗法治疗慢性荨麻疹的优化方案和临床研究　出处：《广州中医药大学》2017年博士论文　论文类型：学位论文

【摘要】：目的:1.采用文献计量与数据挖掘技术,分析古代医籍与现代医学文献中不同刺法灸法治疗慢性荨麻疹的常见证型及其常用干预措施、穴位、治疗量、检测指标等,形成临床三种常用针刺综合疗法治疗常见证型(血虚风燥型)慢性荨麻疹的优化方案;2.运用随机对照试验的研究方法,采用优化方案开展三种常用针刺综合疗法(针刺分别结合自血疗法、刺络拔罐和耳穴贴压)治疗血虚风燥型慢性荨麻疹的临床研究,以评价三种针刺综合疗法的有效性和探讨优势针刺综合疗法。方法:1.采用文献计量与数据挖掘技术,形成治疗慢性荨麻疹的临床优化方案(1)古代医籍:以《中华医典》(第5版)收录的1156部古代医籍为基础,通过对不同刺法灸法治疗荨麻疹的文献进行较全面的搜集和整理,根据频次分析常用干预措施、穴位、处方特点等。(2)现代医学文献:以知网、万方、维普、中国生物医学文献数据库、SCI-EXPANDED、PubMed、Embase等数据库中不同刺法灸法治疗慢性荨麻疹的文献为研究对象(截止至2015.11),结合CiteSpace软件进行文献类型、关键词的频次和中心性分析,总结慢性荨麻疹的常见证型,常用干预措施和检测指标。应用Excel建立常用干预措施(针刺、自血疗法、刺络拔罐和耳穴贴压)治疗常见证型(血虚风燥型)慢性荨麻疹数据库,给合SPSS22.0和Clementine 12.0软件对穴位、治疗时间、疗程进行频次、关联规则及聚类分析,挖掘常用穴位处方和治疗量。2.三种针刺综合疗法治疗血虚风燥型慢性荨麻疹的随机对照临床研究采用简单随机法将符合纳入标准的99例受试者,分为A组(针刺+自血疗法)、B组(针刺+刺络拔罐)和C组(针刺+耳穴贴压);针刺处方参考优化方案,自血疗法、刺络拔罐和耳穴贴压处方参考王启才主编的《针灸治疗学》(第2版);疗程均为每周治疗3次,共4周;随访期为治疗结束后8周;评价指标以荨麻疹活动度评分(UAS)为主,以皮肤病生活质量量表(DLQI)、荨麻疹症状分级量表为辅,分别在治疗前、第4、8、12周末进行量表评估;其中,第4周末根据治疗前后UAS评分进行总有效率评估,根据治疗前后血清总IgE含量变化探讨起效机制;第12周末根据UAS评分分析复发率;记录各种干预措施的不良事件并作安全性分析。结果:1.优化方案结果(1)古代医籍:共检索到涉及不同刺法灸法治疗荨麻疹的古代医籍28部,条文132条。根据频次分析常用干预措施、穴位、处方特点如下:①常用干预措施:依次为针刺结合艾灸(41个处方),艾灸(31个处方)、针刺(22个处方)。②常用穴位:依次为曲池(43次)、合谷(18次)、肩毭(17次)。③取穴特点:处方以单穴为主(117个处方),经络以手阳明大肠经为主(84次),特定穴以五输穴为主(105次),部位以上肢部为主(120次)。(2)现代医学文献:共获得不同刺法灸法治疗慢性荨麻疹的文献225篇,其中针刺、自血疗法、刺络拔罐和耳穴贴压治疗血虚风燥型慢性荨麻疹的临床文献26篇。根据频次、中心性、关联规则及聚类分析,挖掘常见证型,常用干预措施、检测指标、穴位处方、治疗量如下:①常见证型:为血虚风燥型(5次)。②常用干预措施:依次为自血疗法(114次)、刺络拔罐/刺络放血(14次)、针刺疗法/针灸疗法(12次),耳穴贴压(8次)。③常规检测指标:血清总IgE(15次)。④常用穴位处方:针刺以曲池—血海—足三里—合谷—三阴交为主穴;以肺俞—风池—脾俞—外关—膈俞为配穴。⑤常规治疗量:留针时间为30分钟(15次),自血疗法为每穴注血lml(2次),耳穴贴压每日按压4次(4次)。疗程为每周3次,共12次(5次)。(3)综合古代医籍与现代医学文献的优化方案:针刺以曲池—血海—足三里—合谷-三阴交为主穴,以肺俞-风池—脾俞—外关—膈俞为配穴,留针时间为30分钟;自血疗法为每穴注血lml;耳穴贴压为每日按压4次;检测指标为血清总IgE;疗程均为每周3次,共12次。2.临床研究结果(1)完成情况:本研究共纳入合格受试者99例,A组脱落1例,B组脱落3例,C组脱落4例,最终完成91例。(2)基线情况:完成研究的受试者中,男性39例,女性52例;年龄最小22岁,最大46岁;病程最短6个月,最长36个月。性别、年龄、病程、临床分型、UAS评分,DLQI评分、症状分级评分、血清总IgE差异均无统计学意义(P0.05);提示三组治疗前基线平衡,具有可比性。(3)UAS评分:三组治疗后即第4周末UAS评分与治疗前比较,差异均有统计学意义(P0.05),提示治疗后三组综合疗法均能改善荨麻疹活动度。三组患者在第4、8、12周末分别进行了 3个时点的UAS评分,提示三组治疗后的UAS评分随评估时点的变化趋势相同,在第4周末评分最低,随访期逐渐上升趋于平稳;不分时点组间比较,提示A组(针刺+自血疗法)改善荨麻疹活动度优于C组(针刺+耳穴贴压)。(4)DLQI评分:三组治疗后即第4周末DLQI评分与治疗前比较,差异均有统计学意义(P0.05),提示治疗后三组综合疗法均能改善受试者生活质量。三组患者在第4、8、12周末分别进行了 3个时点的DLQI评分,提示三组治疗后的DLQI评分随评估时点的变化趋势相同,在第4周末评分最低,随访期逐渐上升,第12周末比第8周末明显;不分时点组间比较,提示三组综合疗法改善受试者生活质量程度相当。(5)荨麻疹症状分级量表评分:三组治疗后即第4周末分级评分与治疗前比较,差异均有统计学意义(P0.05),提示治疗后三组综合疗法均能改善荨麻疹症状分级程度。三组患者在第4、8、12周末分别进行了 3个时点的分级评分,提示三组治疗后的分级评分随评估时点的变化趋势相同,在第4周末评分最低,随访期逐渐上升,第12周末比第8周末明显;不分时点组间比较,提示A组(针刺+自血疗法)改善荨麻疹分级程度优于C组(针刺+耳穴贴压)。(6)总有效率与疗效分布:治疗后总有效率分别为A组90.63%,B组86.67%和C组82.76%,组间比较差异有统计学意义(P0.05),经两两比较,A组与C组、A组与B组均有差异,B组与C组无差异,提示治疗后A组(针刺+自血疗法)的总有效率高于B组(针刺+刺络拔罐)和C组(针刺+耳穴贴压),B组与C组疗效相当。A组疗效主要分布于痊愈与显效,B组和C组疗效主要分布于有效。(7)血清总IgE含量变化:治疗后三组均可降低血清总IgE含量(P0.05),组间差异无统计学意义(P0.05),提示三组降低总IgE情况相当。(8)复发率:三组第12周末复发率分别为A组9.39%,B组13.33%和C组17.24%,差异无统计学意义(P0.05),提示三组随访期复发情况一致。(9)安全性分析:针刺治疗未引起不良反应,自血疗法、刺络拔罐和耳穴贴压治疗可引起轻度瘀肿、瘀斑、表皮破损和疼痛等不良反应,均不需作特殊处理可消退。结论:1.采用文献计量和数据挖掘技术分析古代医籍与现代医学文献,提示现代应用不同刺法灸法治疗慢性荨麻疹是对古代的传承和发展,治疗方面更注重辨证论治与丰富腧穴治疗技术。常用干预措施为针刺+自血疗法、针刺+刺络拔罐和针刺+耳穴贴压,常见证型为血虚风燥型,优化方案中针刺以手阳明大肠经、足太阴脾经的曲池、血海等为主穴共奏养血祛风的功效,起效机制常依据血清总IgE含量变化进行探讨。2.采用优化方案的三种不同针刺综合疗法是治疗血虚风燥型慢性荨麻疹的有效疗法,均可改善血虚风燥型慢性荨麻疹的风团与瘙痒等主要症状,可提高社交、学习、劳动等相关的生活质量水平,能降低慢性荨麻疹的风团大小、频率、持续时间等的分级程度,—定程度上降低血清总IgE含量;第12周末复发率均低于20%。安全性等级均属于第二级,提示在临床应用上比较安全,治疗期间可有轻度不良反应,但不需作任何特殊处理且不影响后续的治疗。3.采用优化方案的针刺+自血疗法具有疗效好、复发率低、安全的特点,在改善症状和分级程度方面,A组(针刺+自血疗法)优于C组(针刺+耳穴贴压),第4周末A组(针刺+自血疗法)总效率可达90%%,均高于B组(针刺+刺络拔罐)和C组(针刺+耳穴贴压),提示针刺结合自血疗法是治疗血虚风燥型慢性荨麻疹的优势针刺综合疗法,值得临床推广与应用。
[Abstract]:Objective: 1. using bibliometric analysis and data mining technology, analysis and common interference syndromes in ancient medical books and modern medical literature in different acupuncture and moxibustion in the treatment of chronic urticaria, treatment measures, points, detection indicators, the formation of three kinds of commonly used clinical acupuncture comprehensive therapy of common syndromes (blood deficiency and wind dryness) the optimization scheme of chronic urticaria; research methods 2. using randomized controlled trials, the optimization scheme is used to carry out three kinds of commonly used synthetic acupuncture (acupuncture combined with self blood therapy, cupping and auricular plaster) clinical study on the treatment of blood deficiency and wind dryness type chronic urticaria, to evaluate three kinds of acupuncture therapy and the effectiveness of the study the advantage of combined acupuncture therapy. Methods: 1. using bibliometric analysis and data mining technology, the formation of the clinical optimization scheme in the treatment of chronic urticaria (1): the ancient medical book "Chinese medical classics" (Fifth Edition) included 1156 ancient medical books based on the different acupuncture and moxibustion treatment of urticaria literature were comprehensively collected and according to the frequency analysis of commonly used interventions, acupoints and prescription characteristics. (2) modern medical literature: Wan Fang, CNKI, VIP, SCI-EXPANDED, China biomedical literature databases, PubMed, Embase and other databases of different acupuncture and moxibustion in the treatment of chronic urticaria literature as the research object (up to 2015.11), literature type, combined with CiteSpace software and the center of the keyword frequency analysis, the common syndromes summary chronic urticaria, commonly used intervention measures and indicators. The application of Excel to establish common interventions (self blood therapy, acupuncture, cupping and auricular plaster) treatment of common syndromes (blood deficiency and wind dryness) database of chronic urticaria, analysis to SPSS22.0 and Clementine 12 software on acupoints and treatment time, treatment frequency, association rule mining and clustering, and commonly used acupoints prescription the amount of treatment. 2. three kinds of acupuncture combined therapy in the treatment of blood deficiency and wind dryness type chronic urticaria randomized controlled clinical studies using simple random method will meet the inclusion criteria of the 99 subjects, divided into A group (acupuncture + self blood therapy), group B (acupuncture plus cupping) and group C (acupuncture plus auricular) acupuncture prescription; reference optimization scheme, self blood therapy, acupuncture and moxibustion cupping and auricular plaster prescription reference Wang Qicai editor of the "" (Second Edition); the treatment course was 3 times a week, a total of 4 weeks; the follow-up period was 8 weeks after the end of treatment; the evaluation index with urticaria activity score (UAS) mainly to dermatology quality of life scale (DLQI), urticaria symptom rating scales were assessed as before treatment and fourth, eighth, twelfth weeks; among them, fourth weeks according to the UAS score before and after treatment of the total efficiency evaluation, according to the change of blood before and after treatment, the total IgE content of working machine cleaning At the end of the twelfth week, the recurrence rate was analyzed based on the UAS score; the adverse events of various interventions were recorded and the safety analysis was made. Results: 1. optimization results (1) the ancient medical books: the search involves the ancient medical books of different acupuncture and moxibustion treatment of urticaria in 28, and 132 clauses. According to frequency analysis, the common interventions, acupoints and prescriptions are as follows: (1) commonly used interventions: Acupuncture plus moxibustion (41 prescriptions), moxibustion (31 prescriptions) and acupuncture (22 prescriptions). The common points as follows: (43) Quchi and Hegu (18), shoulder Dou (17 times). (3) the characteristics of acupoint selection: the prescription is mainly single point (117 prescriptions), the meridian is mainly based on the Yangming and large intestine meridian (84 times), the specific points are mainly five Shu Points (105 times), and the above parts of the limbs are mainly (120 times). (2) modern medical literature: different acupuncture and moxibustion in the treatment of chronic urticaria with 225 references, including self blood therapy, acupuncture, cupping and auricular plaster therapy on blood deficiency and wind dryness type chronic urticaria clinical literature 26. According to the frequency, centrality, association rules and cluster analysis, the common syndromes were excavated. The usual intervention measures, detection indexes, acupoint prescriptions and treatment volume were as follows: (1) common syndromes: blood deficiency and wind dryness type (5 times). (2) the common intervention measures were self blood therapy (114 times), puncture and cupping / blood letting puncture (14 times), acupuncture therapy / acupuncture therapy (12 times), ear acupoint pressure (8 times). (3) routine test index: serum total IgE (15 times). The commonly used acupoints prescription: Acupuncture in Quchi Zusanli Xuehai - - - - Sanyinjiao acupoints Hegu; lung Yu - - - closed Fengchi Pishu - Geshu for acupoints. The conventional treatment: needle for 30 minutes (15 times), self blood therapy for each acupoint injection of blood LML (2 times), auricular acupressure daily press 4 times (4 times). The course was 3 times a week, 12 times (5 times). (3) the comprehensive optimization scheme of ancient medical books and modern medical literature: Acupuncture in Quchi Zusanli Xuehai - - - - Gu Sanyinjiao acupoints, lung - spleen Yu - - Yu Fengchi Waiguan - Geshu for acupoints, needle retention time is 30 minutes; self blood therapy for each acupoint injection of blood LML; ear sticking to the daily press 4 times; indicator for the detection of serum total IgE; the course of treatment was 3 times a week, a total of 12 times. 2. clinical study results (1) completion of the situation: This study included 99 qualified subjects, 1 cases in group A, 3 cases in group B, 4 in group C, and 91 in the end. (2) baseline: among the subjects who had completed the study, 39 men and 52 women, the minimum age of 22, the maximum of 46 years, the shortest course of 6 months, and the longest 36 months. There was no significant difference in gender, age, course of disease, clinical classification, UAS score, DLQI score, symptom grading score and serum total IgE (P0.05), indicating that the baseline balance of the three groups was comparable before treatment. (3) UAS score: there was a statistically significant difference between the three groups in the fourth weekend UAS score before treatment (P0.05), suggesting that three groups of comprehensive therapies can improve urticaria activity after treatment. Three groups of patients at the fourth, eighth, twelfth weekend, respectively, conducted 3 time points of UAS score, suggesting that three groups of UAS scores after treatment with the change of the time point of the same trend, at fourth weekends.
【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R246.7

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