低功率氦氖激光照射内迎香穴治疗过敏性鼻炎的临床研究
发布时间：2018-08-09 15:02
【摘要】：目的:过敏性鼻炎(Allergic Rhinitis,AR)是特应性个体接触致敏原后,由IgE介导的,多种免疫活性细胞和细胞因子参与的鼻黏膜慢性炎症反应性疾病。保守估计,全世界的过敏性鼻炎患者在5亿左右。过去的20年间,AR的发病率在逐年上升,不同地区不同人群中的发病率在1%_40%。现代医学治疗过敏性鼻炎主要使用药物干预机体体内超敏反应过程,从而减缓各类症状,然而药物存在一定的副反应作用。中医针灸在世界范围的大热,证明其广泛被患者所接受,然而因其是依靠金属针具,且创伤刺激性,部分患者惧怕这种刺激。因此,激光针灸应运而生。激光针灸是利用低功率的氦氖激光照射在特定穴位上,在保留利用中医经络腧穴理论治疗疾病和无副作用等优点的基础上,使受术者免受传统针具的创伤刺激,使惧针者也可以进行针灸治疗。因此,探讨低功率的氦氖激光照射特定穴位治疗过敏性鼻炎,具有很好的研究和应用前景。本研究将利用临床随机对照试验,对低功率的氦氖激光照射迎香穴治疗过敏性鼻炎的作用效应进行观察,并对其作用机制进行初步探讨,以为临床推广使用提供理论依据。方法:于2015年10月至2016年10月在广东省罗岗黄陂医院耳鼻喉科及针灸科收集持续性中重度过敏性鼻炎患者共讨60例。所有纳入病例的诊断标准参照2008年世界卫生组织关于"过敏性鼻炎及其对哮喘的影响"(ARIA)指南中制定的过敏性鼻炎的诊断标准拟定,并根据研究需要制定一系列的纳入标准、排除标准、终止标准等。所有病例按照简单随机方法分为治疗组和对照组各30例。治疗组使用低功率氦氖激光照射内迎香穴,每次10分钟,每日一次,五次为一疗程:休息两日后开始下一疗程,共治疗两个疗程。对照组使用西替利嗪进行口服,每日一次,每次1Omg,五次为一疗程,停药两日后开始下一疗程,共服用两个疗程。治疗前后观察以下指标变化。以鼻症状总积分表(Total Nasal Symptom Score,TNSS)为主要观察指标,在治疗及随访期间每曰记录,鼻症状总分表分为鼻塞、流涕、鼻痒、喷嚏四个症状,每个症状按轻重程度分为5个等级:0=无症状,1=轻微,2=中度,3=较重,4=非常重。累积总分即为鼻症状总分。最高分为16分。由评价者于评价时点进行记录,同时患者采用日记形式每天进行自评。次要观察指标包括鼻伴随症状总分表(TNNSS)、鼻结膜炎生命质量调查问卷(RQLQ)。炎伴随症状总分表(TNNSS):按鼻涕从咽部流过、流泪、鼻或眼部痒、鼻或口腔上额疼痛、头痛等症状的有或无获得评分:0=无,1=有,累积总分即为伴随症状总分,最高分为5分。由评价者于评价时点进行记录,同时患者采用曰记形式每天进行自评。鼻结膜炎生命质量调查问卷(RQLQ):分为活动、睡眠、非鼻眼症状、实际问题、鼻部症状、眼部症状、情感等7个维度,共24项提问,每一项分别按0=无困扰,1=几乎无困扰,2=有些困扰,3=中等程度困扰,4=十分困扰,5=很困扰,6=极度困扰进行打分。各维度单独记分,并算总分即为RQLQ总分。最高分为144分。由评价者对患者进行询问后记录。于第2次访视(第1次治疗前)、第8次访视(第7次治疗前)、第13次访视(第12次治疗后的第一到三天)。并以实验室指标嗜酸性细胞计数EOS,总IgE水平对激光针灸治疗过敏性鼻炎的机制进行初步探讨。结果:共纳入符合入选标准的患者60例,完成试验55例,其中治疗组27例,对照组28例。治疗前,治疗组和对照组的性别构成、年龄结构、病程等经过统计分析,均没有显示显著的统计学差异(P0.05);所有的观测指标包括TNSS主要症状评分和TNNSS伴随症状评分、RQLQ生活质量评分、嗜酸性细胞计数EOS,总IgE水平等两组对比均没有显示显著的统计学差异(P0.05),即观察基线一致。治疗后,治疗组和对照组两组病例的TNSS主要症状评分和TNNSS伴随症状评分、RQLQ生活质量评分、总IgE水平对比治疗前均有明显统计学差异(P0.05),即两组治疗方法都能明显改善过敏性鼻炎的鼻塞、流涕、鼻痒、喷嚏四个主要症状,改善伴随症状和患者的生存质量,并下调患者外周血液中的总IgE水平。在治疗2周的时候,治疗组的TNSS主要症状评分和TNNSS伴随症状评分、RQLQ生活质量评分都要差于对照组,但在治疗4周后,两组的三种评分趋于一致(P0.05),即在整个疗程结束后,激光针灸可以获得和药物治疗相类似的作用效果。在实验室指标方法,治疗组和对照组在治疗后均未见对嗜酸性细胞计数EOS有明显的改变(P0.05);而对于血清总IgE水平,治疗组和对照组都可以明显降低血清总IgE水平(P0.05),且两组互相对比没有明显区别(P0.05)。结论:本试验通过随机对照的方法,收集两组过敏性鼻炎病例,并各自采用激光针灸和西药治疗的方法进行干预,并对比分析,得出以下结论:低功率的氦氖激光照射迎香穴治疗过敏性鼻炎,可以有效改善患者的各种临床症状和生活质量,并能降低机体内超敏反应,从而治疗过敏性鼻炎。
[Abstract]:Objective: Allergic Rhinitis (AR) is a chronic inflammatory response disease of nasal mucosa with IgE mediated, multiple immunoreactive cells and cytokines. Conservative estimation of allergic rhinitis in the world is around 500 million. The incidence of AR has increased year by year in the past 20 years. The incidence of different population in the area is in 1%_40%. modern medical treatment of allergic rhinitis, mainly using drugs to interfere with the body hypersensitivity process, thus slowing down all kinds of symptoms. However, the drugs have certain side effects. The great heat of acupuncture and moxibustion in the world has proved that it is widely accepted by the patients. However, it depends on the metal needle. As a result, some patients are afraid of this stimulus. Therefore, laser acupuncture has emerged as the times require. Laser acupuncture is the use of low power helium neon laser irradiation on specific acupoints, on the basis of preserving the advantages of using the theory of meridians and acupoints in the treatment of diseases and no side effects, so as to protect the recipient from the trauma of the traditional needle. Therefore, the study of low power helium neon laser irradiation of specific acupoints to treat allergic rhinitis is promising. This study will use a clinical randomized controlled trial to observe the effect of low power helium neon laser irradiation on allergic rhinitis. A preliminary discussion was made to provide a theoretical basis for clinical application. Methods: 60 cases of persistent moderate to severe allergic rhinitis were collected from the Department of ENT and the Department of acupuncture and moxibustion at Luo Gang Huangpi hospital in Guangdong province from October 2015 to October 2016. The diagnostic criteria of all the cases included in the WHO on "allergic rhinitis" in 2008. The diagnostic criteria for allergic rhinitis in the "(ARIA) guidelines" guidelines were formulated and a series of inclusion criteria, exclusion criteria, and termination criteria were formulated according to the needs of the study. All cases were divided into treatment and control groups in 30 cases according to simple random methods. The treatment group was irradiated with low power helium neon laser. 10 minutes, once a day, five times for a course of treatment: after two days of rest, the next course of treatment, a total of two courses of treatment. The control group used cetirizine oral, once a day, 1Omg, five times a course of treatment, after two days to start the next course of treatment, a total of two courses. The table (Total Nasal Symptom Score, TNSS) was the main observation index. During each period of treatment and follow-up, the total nasal symptom score was divided into four symptoms: nasal congestion, runny nose, nose itching and sneezing. Each symptom was divided into 5 grades according to the degree of severity: 0= was asymptomatic, 1= was mild, 2= was moderate, 3= was heavy, 4= was very heavy. The cumulative total score was the total score of nasal symptoms. The highest score was divided. 16 points were recorded by the evaluator at the time point, and the patient was given a daily self-assessment in the form of a diary. The secondary observation index included the nasal concomitant symptom checklist (TNNSS), the nasal conjunctivitis life quality questionnaire (RQLQ). The inflammation associated symptom checklist (TNNSS): runny nose from the pharynx, tears, nose or eye itching, nasal or oral frontal pain, There was no score or score for the symptoms such as headache: 0=, 1=, and the cumulative total score was associated with the total score of 5. The evaluators were recorded at the time points, and the patients were self-rated daily by the Japanese form. The nasal conjunctivitis life quality questionnaire (RQLQ) was divided into activities, sleep, non nasal symptoms, actual problems, nasal symptoms. 7 dimensions, such as eye symptoms and emotions, 24 questions, each of which is not plagued by 0=, 1= is almost untroubled, 2= has some troubles, 3= is perplexed, 4= is plagued, 5= is very plagued, and 6= is extremely troubled to score. Each dimension is scored separately, and the total score is a total of 144 points. The assessor records the patient after asking for a record. The second visits (first times before treatment), eighth visits (seventh times before treatment), thirteenth visits (the first to three days after twelfth treatment), and a preliminary study on the mechanism of laser acupuncture and moxibustion for allergic rhinitis treated by the laboratory index eosinophil count EOS and the total IgE level. 55 cases were tested, including 27 cases in the treatment group and 28 cases in the control group. Before treatment, the gender composition, age structure and course of disease in the treatment group and the control group were statistically analyzed, and there was no significant statistical difference (P0.05). All the observation indexes included the TNSS main symptom score and the TNNSS accompanying symptom score, the RQLQ quality of life score, and eosinophil. Count EOS, total IgE level and other two groups did not show significant statistical differences (P0.05), that is, the baseline of the same observation. After treatment, the treatment group and the control group of two groups of major symptom scores and TNNSS symptoms score, RQLQ quality of life score, the total IgE level was significantly different than before the treatment (P0.05), that is, two groups of treatment. The four main symptoms of nasal congestion, runny nose, nasal itching and sneezing can improve the four main symptoms of allergic rhinitis, improve the accompanying symptoms and the patient's quality of life, and reduce the total IgE level in the peripheral blood of the patients. At the 2 week of treatment, the main symptom scores and the TNNSS accompanying symptom score of the treatment group are less than that of the RQLQ quality of life score. The control group, but after 4 weeks of treatment, the three scores of the two groups were consistent (P0.05), that is, after the whole course of treatment, laser acupuncture can obtain similar effect to the drug treatment. In the laboratory index method, the treatment group and the control group have not changed the eosinophilic cell count EOS significantly after the treatment (P0.05); and for the serum. Total IgE level, both the treatment group and the control group can significantly reduce the total serum IgE level (P0.05), and the two groups are not significantly different from each other (P0.05). Conclusion: this test, through a random control method, collect two groups of allergic rhinitis cases, and the use of laser acupuncture and Western medicine treatment methods to intervene, and comparative analysis, draw the following Conclusion: the treatment of allergic rhinitis by low-power He Ne laser irradiation on allergic rhinitis can effectively improve the clinical symptoms and life quality of the patients, and can reduce the hypersensitivity reaction in the body, so as to treat allergic rhinitis.
【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】：R246.81
本文编号：2174464
[Abstract]:Objective: Allergic Rhinitis (AR) is a chronic inflammatory response disease of nasal mucosa with IgE mediated, multiple immunoreactive cells and cytokines. Conservative estimation of allergic rhinitis in the world is around 500 million. The incidence of AR has increased year by year in the past 20 years. The incidence of different population in the area is in 1%_40%. modern medical treatment of allergic rhinitis, mainly using drugs to interfere with the body hypersensitivity process, thus slowing down all kinds of symptoms. However, the drugs have certain side effects. The great heat of acupuncture and moxibustion in the world has proved that it is widely accepted by the patients. However, it depends on the metal needle. As a result, some patients are afraid of this stimulus. Therefore, laser acupuncture has emerged as the times require. Laser acupuncture is the use of low power helium neon laser irradiation on specific acupoints, on the basis of preserving the advantages of using the theory of meridians and acupoints in the treatment of diseases and no side effects, so as to protect the recipient from the trauma of the traditional needle. Therefore, the study of low power helium neon laser irradiation of specific acupoints to treat allergic rhinitis is promising. This study will use a clinical randomized controlled trial to observe the effect of low power helium neon laser irradiation on allergic rhinitis. A preliminary discussion was made to provide a theoretical basis for clinical application. Methods: 60 cases of persistent moderate to severe allergic rhinitis were collected from the Department of ENT and the Department of acupuncture and moxibustion at Luo Gang Huangpi hospital in Guangdong province from October 2015 to October 2016. The diagnostic criteria of all the cases included in the WHO on "allergic rhinitis" in 2008. The diagnostic criteria for allergic rhinitis in the "(ARIA) guidelines" guidelines were formulated and a series of inclusion criteria, exclusion criteria, and termination criteria were formulated according to the needs of the study. All cases were divided into treatment and control groups in 30 cases according to simple random methods. The treatment group was irradiated with low power helium neon laser. 10 minutes, once a day, five times for a course of treatment: after two days of rest, the next course of treatment, a total of two courses of treatment. The control group used cetirizine oral, once a day, 1Omg, five times a course of treatment, after two days to start the next course of treatment, a total of two courses. The table (Total Nasal Symptom Score, TNSS) was the main observation index. During each period of treatment and follow-up, the total nasal symptom score was divided into four symptoms: nasal congestion, runny nose, nose itching and sneezing. Each symptom was divided into 5 grades according to the degree of severity: 0= was asymptomatic, 1= was mild, 2= was moderate, 3= was heavy, 4= was very heavy. The cumulative total score was the total score of nasal symptoms. The highest score was divided. 16 points were recorded by the evaluator at the time point, and the patient was given a daily self-assessment in the form of a diary. The secondary observation index included the nasal concomitant symptom checklist (TNNSS), the nasal conjunctivitis life quality questionnaire (RQLQ). The inflammation associated symptom checklist (TNNSS): runny nose from the pharynx, tears, nose or eye itching, nasal or oral frontal pain, There was no score or score for the symptoms such as headache: 0=, 1=, and the cumulative total score was associated with the total score of 5. The evaluators were recorded at the time points, and the patients were self-rated daily by the Japanese form. The nasal conjunctivitis life quality questionnaire (RQLQ) was divided into activities, sleep, non nasal symptoms, actual problems, nasal symptoms. 7 dimensions, such as eye symptoms and emotions, 24 questions, each of which is not plagued by 0=, 1= is almost untroubled, 2= has some troubles, 3= is perplexed, 4= is plagued, 5= is very plagued, and 6= is extremely troubled to score. Each dimension is scored separately, and the total score is a total of 144 points. The assessor records the patient after asking for a record. The second visits (first times before treatment), eighth visits (seventh times before treatment), thirteenth visits (the first to three days after twelfth treatment), and a preliminary study on the mechanism of laser acupuncture and moxibustion for allergic rhinitis treated by the laboratory index eosinophil count EOS and the total IgE level. 55 cases were tested, including 27 cases in the treatment group and 28 cases in the control group. Before treatment, the gender composition, age structure and course of disease in the treatment group and the control group were statistically analyzed, and there was no significant statistical difference (P0.05). All the observation indexes included the TNSS main symptom score and the TNNSS accompanying symptom score, the RQLQ quality of life score, and eosinophil. Count EOS, total IgE level and other two groups did not show significant statistical differences (P0.05), that is, the baseline of the same observation. After treatment, the treatment group and the control group of two groups of major symptom scores and TNNSS symptoms score, RQLQ quality of life score, the total IgE level was significantly different than before the treatment (P0.05), that is, two groups of treatment. The four main symptoms of nasal congestion, runny nose, nasal itching and sneezing can improve the four main symptoms of allergic rhinitis, improve the accompanying symptoms and the patient's quality of life, and reduce the total IgE level in the peripheral blood of the patients. At the 2 week of treatment, the main symptom scores and the TNNSS accompanying symptom score of the treatment group are less than that of the RQLQ quality of life score. The control group, but after 4 weeks of treatment, the three scores of the two groups were consistent (P0.05), that is, after the whole course of treatment, laser acupuncture can obtain similar effect to the drug treatment. In the laboratory index method, the treatment group and the control group have not changed the eosinophilic cell count EOS significantly after the treatment (P0.05); and for the serum. Total IgE level, both the treatment group and the control group can significantly reduce the total serum IgE level (P0.05), and the two groups are not significantly different from each other (P0.05). Conclusion: this test, through a random control method, collect two groups of allergic rhinitis cases, and the use of laser acupuncture and Western medicine treatment methods to intervene, and comparative analysis, draw the following Conclusion: the treatment of allergic rhinitis by low-power He Ne laser irradiation on allergic rhinitis can effectively improve the clinical symptoms and life quality of the patients, and can reduce the hypersensitivity reaction in the body, so as to treat allergic rhinitis.
【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】：R246.81
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