温针灸治疗肺气虚寒型持续性变应性鼻炎的临床研究

发布时间：2018-06-30 11:00

本文选题：温针灸 + 肺气虚寒证　；参考：《成都中医药大学》2016年博士论文

【摘要】：目的：变应性鼻炎(Allergic Rihnitis,AR)是特异性机体接触致敏原后由IgE介导的鼻黏膜高反应性疾病,具有反复发作、难治愈的特点。近年来AR发病率呈明显增加趋势,严重影响了人们的工作效率和生活质量,已成为一个全球性多发疾病。导师张勤修认为AR发病主要是以肺卫不固为本,外感风寒邪气为标,临床以肺气虚寒型常见,宜以温肺散寒、益气固表为治法。针灸治疗变应性鼻炎历史悠久,具有独特的优势,受到越来越多的关注。本研究旨在评价温针灸治疗肺气虚寒型持续性变应性鼻炎的临床疗效和安全性,探讨温针灸治疗变应性鼻炎的作用机制,为温针灸治疗变应性鼻炎的临床广泛应用提供科学依据。方法：本研究采用随机、对照的临床试验方法,通过计算机产生的随机数字表,将符合纳入标准的60名肺气虚寒型持续性AR患者分为A组(温针灸组)、B组(针刺组)和C组(针刺加艾灸组)。三组均采用相同的取穴方法,5次为一个疗程,连续治疗2个疗程,疗程之间间隔1周,共10次,分别于治疗后4周和8周进行短期随访。以视觉模拟评分量表(visual analogue scale,VAS)积分及鼻眼结膜相关生活质量问卷调查量表(Rhinocoujunctivitis Quality of Life Questionaire,RQLQ)(中文版自测版本)作为主要的主观疗效评价指标,以鼻内镜检查鼻甲肿胀程度,血清特异性IgE和IL-10和IL-4实验室检测指标作为客观评价指标。在治疗前、治疗结束、随访期间进行VAS、RQLQ评分,治疗前后进行鼻内镜、血清特异性IgE和IL-10和IL-4检查,比较温针灸组、单纯针刺组、针刺加灸法组在主要、次要疗效观察指标之间数据差异,评价温针灸、单纯针刺、针刺加灸法治疗AR的安全性和有效性。治疗期间记录患者的合并用药和不良反应发生的情况。结果：1.三组受试者的人口学特征和病史病情等基线资料具有可比性。2.VAS量表评分结果显示：总体症状评分方面：组间比较,三组患者在治疗后、第1次随访、第2次随访差异均有统计学意义(P0.05)。组内比较：三组在治疗前vs治疗结束、治疗前vs随访结束方面,差异均具有统计学意义(P0.05)。典型过敏症状评分方面：组间比较：温针组与针刺组、针刺加艾灸相比较,在鼻痒、喷嚏、清水涕、鼻塞四个方面,治疗后、两次随访期间评分差异均具有统计学意义(P0.05)。组内比较：三组各典型症状在治疗前vs治疗结束、治疗前vs随访结束,差异均具有统计学意义(P0.05)。3.RQLQ问卷调查表比较结果：组间比较：治疗前各组数据比较均无显著性差异,治疗后,温针组与针刺加艾灸组无显著性差异,余均有统计学意义；第一次随访,温针组与针刺加艾灸组无显著性差异外,余均有统计学意义：第二次随访,温针组分别与针刺组和针刺加艾灸组之间比较P均0.05,差异具有统计学意义。组内比较：温针组治疗前vs治疗结束、治疗前vs随访结束比较数据P0.05,提示RQLQ值在不同时间点比较时,数据呈现下降趋势,表明差异具有统计学意义。针刺组与针刺加艾灸组,治疗前与治疗结束、第二次随访结束,两次比较数据均呈现显著性差异,表明差异均具有统计学意义。4.下鼻甲肿胀程度(鼻内镜检查)比较结果显示：组间比较：治疗前后鼻甲肿胀程度评分均未呈现显著性差异。组内比较：各组治疗前vs治疗结束P值均0.05,表明各组内治疗前后差异具有统计学意义。5.中医证候积分比较结果：三组受试者治疗后、第1次随访、第2次随访中医症候客观量化评分不完全相同(P0.05),差异具有统计学意义。组间比较：温针组与针刺组、针刺加艾灸组相比较,治疗后、第1次随访、第2次随访P0.05,差异均有统计学意义。组内比较：各组在治疗前vs治疗结束、治疗前vs随访结束P0.05,差异均有统计学意义。6.实验室检查指标比较结果： (1)血清特异性IgE比较结果：组间比较：温针组vs针刺组治疗后差异无统计学意义(P0.05),温针组VS针刺加艾灸组差异有统计学意义(P0.05)。在组内对比方面,治疗前后SIgE除艾灸组外,温针组与针刺组治疗前后SIgE差异均有统计学意义(P0.05)。(2)IL-4比较结果：组间比较：治疗后温针组VS针刺组差异无统计学意义(P0.05),温针组VS针刺加艾灸组差异有统计学意义(P0.05)。组内比较：温针组差异均有统计学意义(P0.05),针刺组、针刺加艾灸组治疗前后的差异无统计学意义。(3)IL-10比较结果：组内比较和组间比较治疗前后均未出现显著性差异。7.在治疗期间,三组受试者均未发生严重不良反应结论：1.温针灸、针刺和针刺加艾灸均有助于改善变应性鼻炎患者的症状和病情(VAS评分)及相关的生活质量(RQLQ评分)。与针刺和艾灸相比较,温针灸组患者的症状(VAS评分)及相关的生活质量(RQLQ评分)以及体征的改善较针刺组和针刺加艾灸组更加显著,在改善患者病情和各项症状和生活质量方面具有明显优势,差异具有统计学意义。2.温针灸、针刺和针刺加艾灸均有助于改善肺气虚寒型持续性变应性鼻炎患者的主要过敏症状和全身症状,但就数据下降趋势而言,温针灸较其它两组更具有明显的优势,且随访期的控制性更好。3.温针组与针刺组和针刺加艾灸组比较而言,可以明显降低患者外周血清中的SIgE和IL-4的含量水平,究其机制,可能是通过对不同细胞因子的调节,间接调控Thl/Th2平衡,减轻AR患者鼻腔变态反应性炎症。4.温针灸治疗及随访期间未出现不良反应和严重不良事件,表明其治疗肺气虚寒型AR的安全性较好。
[Abstract]:Objective: Allergic Rihnitis (AR) is a specific body contact sensitized source of allergic rhinitis, which is mediated by IgE. It has the characteristics of recurrent attacks and difficult to cure. In recent years, the incidence of AR has been obviously increasing, which has seriously affected people's work efficiency and quality of life. It has become a global multiple disease. Teacher Zhang Qinxiu thinks that the main disease of AR is based on the lung and Wei, the external sense of wind and cold and evil is the standard, the clinical with lung qi deficiency cold type is common, it is suitable to warm the lung to disperse cold and the Qi fixation is the treatment method. The acupuncture treatment of allergic rhinitis has a long history, has a unique advantage, and has attracted more and more attention. This study aims to evaluate the treatment of lung qi deficiency cold type with warm acupuncture and moxibustion. The clinical effect and safety of continuous allergic rhinitis, discuss the mechanism of warming acupuncture and moxibustion in treating allergic rhinitis, provide scientific basis for the clinical application of allergic rhinitis with warm acupuncture and moxibustion. Methods: This study adopts a randomized, controlled clinical trial method and a random number table produced by the computer, which will meet the standard of 60. The patients with lung qi deficiency cold type persistent AR were divided into group A (warm acupuncture group), group B (acupuncture group) and group C (acupuncture plus moxibustion group). The three groups all adopted the same method of acupoint extraction, 5 times a course of treatment, 2 courses of continuous treatment, 1 weeks interval between the courses, 10 times after 4 and 8 weeks respectively. The visual analogue scale (visual a) Nalogue scale, VAS) integral and nasal conjunctival related quality of life questionnaire (Rhinocoujunctivitis Quality of Life Questionaire, RQLQ) (Chinese version of self test version) as the main subjective evaluation index, nasal endoscope examination of the degree of nasal turbinate swelling, serum specific IgE and IL-10 and IL-4 laboratory test indicators as an objective evaluation. Before treatment, the end of treatment, VAS, RQLQ score, nasal endoscopy, serum specific IgE and IL-10 and IL-4 before and after treatment, compared with the temperature acupuncture group, simple acupuncture group, acupuncture plus moxibustion group in the main, secondary therapeutic observation index data difference, evaluation of warm acupuncture, simple acupuncture, acupuncture plus moxibustion for AR Safety and effectiveness. Records of patients' combined use of drugs and adverse reactions during the treatment. Results: the baseline data of the demographic and medical history of 1. groups of subjects in the three groups showed a comparable.2.VAS scale score: the overall symptom score: the comparison between the groups, the three groups of patients after the treatment, first follow-up, second The differences in the secondary follow-up were statistically significant (P0.05). The three groups were compared with the end of vs treatment before treatment and the end of vs follow-up before treatment. The differences were statistically significant (P0.05). The typical anaphylactic symptoms score: the comparison between the group and the acupuncture group, the acupuncture plus moxibustion and the nasal itching, sneezing, the clear water and the nose, and the nasal congestion. After two follow-up, the differences were statistically significant (P0.05). Group comparison: the three groups of the typical symptoms were completed before the treatment of VS and vs follow-up before treatment, the difference was statistically significant (P0.05).3.RQLQ questionnaire survey results: group comparison: there was no significant difference between the groups before treatment. After treatment, there was no significant difference between the warm needling group and the acupuncture group and the moxibustion group. The first follow-up, there was no significant difference between the warm needling group and the acupuncture plus moxibustion group, and the residual all had statistical significance: second times follow-up, the temperature acupuncture group compared with the acupuncture group and the acupuncture group of moxibustion and the moxibustion group, the P was 0.05, the difference was statistically significant. Intra group comparison: the end of vs treatment before treatment in the warm needle group and the comparison data of P0.05 before the follow-up of vs follow-up, the results showed that the data showed a downward trend when the value of RQLQ was compared at different time points, indicating that the difference was statistically significant. The acupuncture group and the acupuncture plus moxibustion group, the treatment before and the end of the treatment, the end of the second follow-up, and the two comparison data showed obvious. The difference showed that the difference was statistically significant in the degree of nasal turbinate swelling (nasal endoscopy) in.4. (nasal endoscopy). The results showed that there was no significant difference between the groups before and after treatment. In group comparison, the P value of vs treatment in each group was 0.05 before treatment, indicating that the differences in each group were statistically significant before and after treatment. .5. traditional Chinese medicine syndrome score comparison results: three groups of subjects after treatment, first follow-up, second follow-up of the TCM syndrome objective quantitative score is not exactly the same (P0.05), the difference has statistical significance. The comparison between the group and the acupuncture group, acupuncture plus moxibustion group, first follow-up, second follow-up P0.05, the difference was statistically significant In group comparison: each group was finished with vs treatment before treatment and P0.05 was completed before vs follow-up. The difference was statistically significant in.6. laboratory examination: (1) comparison of serum specific IgE: comparison between groups: there was no significant difference between vs acupuncture group in warm needle group (P0.05), VS acupuncture plus moxibustion group in warm needling group. The difference was statistically significant (P0.05). In the group before and after treatment SIgE except moxibustion group, the difference in SIgE between the warm needling group and the acupuncture group was statistically significant (P0.05). (2) IL-4 comparison results: the comparison between groups: there was no statistical difference between the group VS acupuncture group after treatment (P0.05), and the difference of the VS acupuncture plus moxibustion group in the warm needling group was statistically significant. Study meaning (P0.05). In group comparison: there was significant difference in the temperature acupuncture group (P0.05), there was no significant difference between the acupuncture group, acupuncture plus moxibustion group before and after treatment. (3) IL-10 comparison results: there was no significant difference between the group and the group before and after the treatment. The three groups did not have serious adverse reactions during the treatment. Conclusion: 1. warm acupuncture, acupuncture and acupuncture plus moxibustion can help to improve the symptoms and conditions of allergic rhinitis (VAS score) and the related quality of life (RQLQ score). Compared with acupuncture and moxibustion, the symptoms of the patients in the warm acupuncture and moxibustion group (VAS score) and the related quality of life (RQLQ score) as well as the improvement of the physical signs are compared with the acupuncture and acupuncture plus acupuncture. The moxibustion group is more significant in improving the patient's condition, all the symptoms and the quality of life. The difference has statistical significance.2. warm acupuncture, acupuncture and acupuncture plus moxibustion can help to improve the main allergic symptoms and general symptoms of patients with persistent allergic rhinitis in lung qi deficiency cold type, but the trend of data decline is a warm needle. Moxibustion has more obvious advantages than the other two groups, and the control of the follow-up period is better than that in the.3. warm needle group and the acupuncture group and the acupuncture plus moxibustion group. The level of SIgE and IL-4 in the peripheral serum of the patients can be significantly reduced. The mechanism may be indirectly controlled by the regulation of different cell factors and indirectly regulating the balance of Thl/Th2 and alleviated the AR patients. There was no adverse reaction and serious adverse events during the.4. warm acupuncture treatment of allergic inflammation of the nasal cavity and the severe adverse events during the follow-up period, which showed that the safety of the treatment of lung qi deficiency type AR was better.
【学位授予单位】：成都中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R246.81

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