循经取穴穴位埋线治疗变应性鼻炎（AR）的临床观察及其脑功能成像（fMRI）的中枢响应特征的初步探究

发布时间：2018-06-17 08:53

本文选题：循经取穴 + 穴位埋线　；参考：《成都中医药大学》2016年硕士论文

【摘要】：目的：评价循经取穴穴位埋线治疗变应性鼻炎(Allegic Rhinitis, AR)的临床疗效,并在此基础上初步探究循经取穴穴位埋线治疗AR的中枢响应特征,为循经取穴穴位埋线治疗AR的临床应用提供科学的试验依据。方法：1.采用单盲、随机、对照的临床研究方法,通过电脑随机数字表法进行受试者的纳入,并将符合纳入标准的30例患者随机分为实验A组／(埋线组)、对照组/B组(假埋线组)。按照循经取穴的原则,各组患者接受相同穴位的埋线治疗,其中假埋线组的操作是不埋任何线,仅仅是针具刺激。共埋线1次,接受随访2次(第2周和第6周)。以RQLQ评分、鼻腔症状的VAS评分、以及鼻内镜检查和血清指标作为疗效评价指标,分别于治疗前、治疗结束后2周、治疗结束后6周3个时间点进行指标的观察,以此评价循经取穴穴位埋线治疗AR的临床疗效和安全性。2.从临床研究的埋线组中纳入5例符合脑功能磁共振成像纳入标准的患者,以脑功能磁共振成像(fMRI)技术为研究手段,通过对比AR患者自身前后脑功能区的效应区域,总结和探讨循经取穴穴位埋线治疗AR患者静息状态下脑功能活动的中枢响应特征,筛选与病情相关的重点(靶点)脑区,初步探讨循经取穴穴位埋线治疗AR的中枢响应特征。结果：1.穴位埋线治疗AR的临床疗效评价结果(1)2组受试者的人口学特征、生命体征、病史病情等基线资料具有可比性。(1)鼻腔VAS评分项在治疗结束后6周,两组间差异具有统计学意义。(3)RQLQ评分项在治疗结束后2周及治疗后6周两组间的差异均有统计学意义。(4)下鼻甲肿胀程度评分项在治疗后2周、6周时间点,两组间存在统计学差异(其中,下鼻甲肿胀程度评分项两组治疗后6周与治疗前自身前后对照有统计学差异)。(5)埋线组(A组)的血清指标IFN-γ治疗前与治疗后2周比较有统计学意义。(6)本次试验没有出现有记录意义的严重的不良反应。2.AR患者静息态脑功能活动特征研究结果。埋线前后在脑功能静息状态下对比反应显著性增强区域的脑区有：双侧的距状皮层(BA17)、前扣带回(ACC) (BA32)、中扣带回(MCC) (BA23)、后扣带回(PCC) (BA30)、豆状核、楔回(BA23)、脑岛(BA13)、颞上回(STG) (BA41)、颞中回(MTG) (BA21)、颞下回(ITG) (BA20)、额下回(IFG) (BA47)、额中回(MFG) (BA10)、额上回(SFG) (BA8)、中央前回(BA4)、中央后回(BA3)、前运动皮层(BA6)、缘上回(BA40)、角回(BA39)、小脑扁桃体,右侧尾状核,左侧梭状回(BA37)。结论：(1)循经取穴穴位埋线治疗AR疗效优于假埋线组,循经取穴穴位埋线治疗AR安全有效。(2)循经取穴穴位埋线治疗AR的疗效机制存在中枢效应机制路线。(3)循经取穴穴位埋线治疗AR的中枢效应机制具有以下特点：①广泛性调动中枢脑区,包括边缘系统网络、内侧痛觉系统网络、高级中枢网络路径；②具有靶向性的特点,如杏仁核和前扣带回；③具有先驱于临床的特点。(4)具体的中枢效应路径或者效应模式的明晰化有待更进一步的研究。(5)假说“穴位-神经信号调节-中枢-社神经信号调节-器官”具有一定的可信度。
[Abstract]:Objective: To evaluate the clinical efficacy of acupoint catgut embedding therapy for allergic rhinitis (Allegic Rhinitis, AR), and to explore the central response characteristics of AR by acupoint catgut embedding therapy on the basis of meridian acupoints, and to provide scientific experimental basis for the clinical application of acupoint catgut embedding therapy for AR. Method: 1. a single blind, random, control method was used. The clinical study method was carried out by the computer random digital table, and 30 patients were randomly divided into the experimental A group / (embedding group), the control group /B group (fake catgut embedding group). According to the principle of taking acupoints along the meridian, the patients in each group were treated with the same acupoint catgut embedding therapy, and the operation of the fake catgut embedding group was not buried any more. The line, only needle stimulation, 1 times, was followed up for 2 times (second weeks and sixth weeks). RQLQ score, VAS score of nasal symptoms, nasal endoscopy and serum indexes were used as evaluation indexes, before treatment, 2 weeks after the end of treatment, and 3 time points at 6 weeks after the end of treatment, to evaluate acupoint acupoints along meridian points. The clinical efficacy and safety of catgut embedding in the treatment of AR.2. from the clinical study of the catgut embedding group, 5 patients were included in the brain functional magnetic resonance imaging (fMRI), and the brain functional magnetic resonance imaging (fMRI) technique was used as the research method. By comparing the effect region of the brain function area of the patients with AR, the treatment of AR with acupoint catgut embedding therapy was summarized and discussed in the treatment of AR. The central response characteristics of the brain functional activities under resting state, screening the focal point of the disease and the brain area related to the disease, and preliminarily discuss the central response characteristics of the treatment of AR by acupoint catgut embedding therapy. Results: 1. acupoint catgut embedding therapy for the clinical efficacy of AR (1) the demographic characteristics of the 2 subjects, the vital signs, the history of the disease, and other baseline funds The material had comparability. (1) the VAS score of the nasal cavity was statistically significant between the two groups at the end of the 6 week after the end of the treatment. (3) the difference between the 2 weeks after the treatment and the 6 weeks after the treatment was statistically significant. (4) there was a statistical difference between the 2 weeks and 6 weeks of the lower turbinate swelling degree score at the 2 and 6 weeks after the treatment (among them, the lower RQLQ) There was a statistical difference between the two groups of the two groups after treatment and before and after treatment. (5) the serum index of the catgut embedding group (group A) was statistically significant before and 2 weeks after the treatment. (6) the study of the resting state of resting brain function in patients with serious adverse reaction of.2.AR did not appear in this trial. Results. The brain areas of the contrasting region of the contrast reaction in the brain function resting state before and after the catgut embedding were: bilateral cortex (BA17), anterior cingulate gyrus (ACC) (BA32), cingulate gyrus (MCC) (BA23), posterior cingulate gyrus (PCC) (BA30), lenticular nucleus, wedge gyrus (BA23), insula (BA13), upper temporal gyrus (BA41), middle temporal gyrus (MTG), and inferior temporal gyrus, Lower frontal gyrus (IFG), MFG (BA10), upper gyrus (SFG) (BA8), anterior central gyrus (BA4), central posterior gyrus (BA3), anterior motor cortex (BA6), upper gyrus (BA40), angular gyrus (BA39), cerebellar tonsil, right caudate nucleus and left fusiform gyrus (BA37). Conclusion: (1) the effect of acupoint catgut embedding therapy along meridian acupoint acupoint catgut embedding therapy is better than that of the fake catgut embedding group and Acupoint Catgut Embedding The treatment of AR is safe and effective. (2) the mechanism of central effect exists in the therapeutic mechanism of acupoint catgut embedding therapy for AR. (3) the central effect mechanism of the acupoint catgut embedding therapy for AR has the following characteristics: (1) extensive mobilization of the central brain area, including the marginal system network, the medial pain system network, the advanced central network path; and the target of the target. The characteristics such as the amygdala and the anterior cingulate gyrus; (4) the specific pathways of the central effect or the clarity of the effect pattern need to be further studied. (5) the hypothesis that "acupoint nerve signal regulation - Central - Social neuromodulation - organ" has certain credibility.
【学位授予单位】：成都中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.81

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