本文關鍵詞：三種針刺綜合療法治療慢性蕁麻疹的優(yōu)化方案和臨床研究　出處：《廣州中醫(yī)藥大學》2017年博士論文　論文類型：學位論文

  更多相關文章： 針刺綜合療法 慢性蕁麻疹 文獻計量 數(shù)據(jù)挖掘 方案優(yōu)化

【摘要】：目的:1.采用文獻計量與數(shù)據(jù)挖掘技術,分析古代醫(yī)籍與現(xiàn)代醫(yī)學文獻中不同刺法灸法治療慢性蕁麻疹的常見證型及其常用干預措施、穴位、治療量、檢測指標等,形成臨床三種常用針刺綜合療法治療常見證型(血虛風燥型)慢性蕁麻疹的優(yōu)化方案;2.運用隨機對照試驗的研究方法,采用優(yōu)化方案開展三種常用針刺綜合療法(針刺分別結(jié)合自血療法、刺絡拔罐和耳穴貼壓)治療血虛風燥型慢性蕁麻疹的臨床研究,以評價三種針刺綜合療法的有效性和探討優(yōu)勢針刺綜合療法。方法:1.采用文獻計量與數(shù)據(jù)挖掘技術,形成治療慢性蕁麻疹的臨床優(yōu)化方案(1)古代醫(yī)籍:以《中華醫(yī)典》(第5版)收錄的1156部古代醫(yī)籍為基礎,通過對不同刺法灸法治療蕁麻疹的文獻進行較全面的搜集和整理,根據(jù)頻次分析常用干預措施、穴位、處方特點等。(2)現(xiàn)代醫(yī)學文獻:以知網(wǎng)、萬方、維普、中國生物醫(yī)學文獻數(shù)據(jù)庫、SCI-EXPANDED、PubMed、Embase等數(shù)據(jù)庫中不同刺法灸法治療慢性蕁麻疹的文獻為研究對象(截止至2015.11),結(jié)合CiteSpace軟件進行文獻類型、關鍵詞的頻次和中心性分析,總結(jié)慢性蕁麻疹的常見證型,常用干預措施和檢測指標。應用Excel建立常用干預措施(針刺、自血療法、刺絡拔罐和耳穴貼壓)治療常見證型(血虛風燥型)慢性蕁麻疹數(shù)據(jù)庫,給合SPSS22.0和Clementine 12.0軟件對穴位、治療時間、療程進行頻次、關聯(lián)規(guī)則及聚類分析,挖掘常用穴位處方和治療量。2.三種針刺綜合療法治療血虛風燥型慢性蕁麻疹的隨機對照臨床研究采用簡單隨機法將符合納入標準的99例受試者,分為A組(針刺+自血療法)、B組(針刺+刺絡拔罐)和C組(針刺+耳穴貼壓);針刺處方參考優(yōu)化方案,自血療法、刺絡拔罐和耳穴貼壓處方參考王啟才主編的《針灸治療學》(第2版);療程均為每周治療3次,共4周;隨訪期為治療結(jié)束后8周;評價指標以蕁麻疹活動度評分(UAS)為主,以皮膚病生活質(zhì)量量表(DLQI)、蕁麻疹癥狀分級量表為輔,分別在治療前、第4、8、12周末進行量表評估;其中,第4周末根據(jù)治療前后UAS評分進行總有效率評估,根據(jù)治療前后血清總IgE含量變化探討起效機制;第12周末根據(jù)UAS評分分析復發(fā)率;記錄各種干預措施的不良事件并作安全性分析。結(jié)果:1.優(yōu)化方案結(jié)果(1)古代醫(yī)籍:共檢索到涉及不同刺法灸法治療蕁麻疹的古代醫(yī)籍28部,條文132條。根據(jù)頻次分析常用干預措施、穴位、處方特點如下:①常用干預措施:依次為針刺結(jié)合艾灸(41個處方),艾灸(31個處方)、針刺(22個處方)。②常用穴位:依次為曲池(43次)、合谷(18次)、肩毭(17次)。③取穴特點:處方以單穴為主(117個處方),經(jīng)絡以手陽明大腸經(jīng)為主(84次),特定穴以五輸穴為主(105次),部位以上肢部為主(120次)。(2)現(xiàn)代醫(yī)學文獻:共獲得不同刺法灸法治療慢性蕁麻疹的文獻225篇,其中針刺、自血療法、刺絡拔罐和耳穴貼壓治療血虛風燥型慢性蕁麻疹的臨床文獻26篇。根據(jù)頻次、中心性、關聯(lián)規(guī)則及聚類分析,挖掘常見證型,常用干預措施、檢測指標、穴位處方、治療量如下:①常見證型:為血虛風燥型(5次)。②常用干預措施:依次為自血療法(114次)、刺絡拔罐/刺絡放血(14次)、針刺療法/針灸療法(12次),耳穴貼壓(8次)。③常規(guī)檢測指標:血清總IgE(15次)。④常用穴位處方:針刺以曲池—血�！闳铩瞎取幗粸橹餮�;以肺俞—風池—脾俞—外關—膈俞為配穴。⑤常規(guī)治療量:留針時間為30分鐘(15次),自血療法為每穴注血lml(2次),耳穴貼壓每日按壓4次(4次)。療程為每周3次,共12次(5次)。(3)綜合古代醫(yī)籍與現(xiàn)代醫(yī)學文獻的優(yōu)化方案:針刺以曲池—血�！闳铩瞎�-三陰交為主穴,以肺俞-風池—脾俞—外關—膈俞為配穴,留針時間為30分鐘;自血療法為每穴注血lml;耳穴貼壓為每日按壓4次;檢測指標為血清總IgE;療程均為每周3次,共12次。2.臨床研究結(jié)果(1)完成情況:本研究共納入合格受試者99例,A組脫落1例,B組脫落3例,C組脫落4例,最終完成91例。(2)基線情況:完成研究的受試者中,男性39例,女性52例;年齡最小22歲,最大46歲;病程最短6個月,最長36個月。性別、年齡、病程、臨床分型、UAS評分,DLQI評分、癥狀分級評分、血清總IgE差異均無統(tǒng)計學意義(P0.05);提示三組治療前基線平衡,具有可比性。(3)UAS評分:三組治療后即第4周末UAS評分與治療前比較,差異均有統(tǒng)計學意義(P0.05),提示治療后三組綜合療法均能改善蕁麻疹活動度。三組患者在第4、8、12周末分別進行了 3個時點的UAS評分,提示三組治療后的UAS評分隨評估時點的變化趨勢相同,在第4周末評分最低,隨訪期逐漸上升趨于平穩(wěn);不分時點組間比較,提示A組(針刺+自血療法)改善蕁麻疹活動度優(yōu)于C組(針刺+耳穴貼壓)。(4)DLQI評分:三組治療后即第4周末DLQI評分與治療前比較,差異均有統(tǒng)計學意義(P0.05),提示治療后三組綜合療法均能改善受試者生活質(zhì)量。三組患者在第4、8、12周末分別進行了 3個時點的DLQI評分,提示三組治療后的DLQI評分隨評估時點的變化趨勢相同,在第4周末評分最低,隨訪期逐漸上升,第12周末比第8周末明顯;不分時點組間比較,提示三組綜合療法改善受試者生活質(zhì)量程度相當。(5)蕁麻疹癥狀分級量表評分:三組治療后即第4周末分級評分與治療前比較,差異均有統(tǒng)計學意義(P0.05),提示治療后三組綜合療法均能改善蕁麻疹癥狀分級程度。三組患者在第4、8、12周末分別進行了 3個時點的分級評分,提示三組治療后的分級評分隨評估時點的變化趨勢相同,在第4周末評分最低,隨訪期逐漸上升,第12周末比第8周末明顯;不分時點組間比較,提示A組(針刺+自血療法)改善蕁麻疹分級程度優(yōu)于C組(針刺+耳穴貼壓)。(6)總有效率與療效分布:治療后總有效率分別為A組90.63%,B組86.67%和C組82.76%,組間比較差異有統(tǒng)計學意義(P0.05),經(jīng)兩兩比較,A組與C組、A組與B組均有差異,B組與C組無差異,提示治療后A組(針刺+自血療法)的總有效率高于B組(針刺+刺絡拔罐)和C組(針刺+耳穴貼壓),B組與C組療效相當。A組療效主要分布于痊愈與顯效,B組和C組療效主要分布于有效。(7)血清總IgE含量變化:治療后三組均可降低血清總IgE含量(P0.05),組間差異無統(tǒng)計學意義(P0.05),提示三組降低總IgE情況相當。(8)復發(fā)率:三組第12周末復發(fā)率分別為A組9.39%,B組13.33%和C組17.24%,差異無統(tǒng)計學意義(P0.05),提示三組隨訪期復發(fā)情況一致。(9)安全性分析:針刺治療未引起不良反應,自血療法、刺絡拔罐和耳穴貼壓治療可引起輕度瘀腫、瘀斑、表皮破損和疼痛等不良反應,均不需作特殊處理可消退。結(jié)論:1.采用文獻計量和數(shù)據(jù)挖掘技術分析古代醫(yī)籍與現(xiàn)代醫(yī)學文獻,提示現(xiàn)代應用不同刺法灸法治療慢性蕁麻疹是對古代的傳承和發(fā)展,治療方面更注重辨證論治與豐富腧穴治療技術。常用干預措施為針刺+自血療法、針刺+刺絡拔罐和針刺+耳穴貼壓,常見證型為血虛風燥型,優(yōu)化方案中針刺以手陽明大腸經(jīng)、足太陰脾經(jīng)的曲池、血海等為主穴共奏養(yǎng)血祛風的功效,起效機制常依據(jù)血清總IgE含量變化進行探討。2.采用優(yōu)化方案的三種不同針刺綜合療法是治療血虛風燥型慢性蕁麻疹的有效療法,均可改善血虛風燥型慢性蕁麻疹的風團與瘙癢等主要癥狀,可提高社交、學習、勞動等相關的生活質(zhì)量水平,能降低慢性蕁麻疹的風團大小、頻率、持續(xù)時間等的分級程度,—定程度上降低血清總IgE含量;第12周末復發(fā)率均低于20%。安全性等級均屬于第二級,提示在臨床應用上比較安全,治療期間可有輕度不良反應,但不需作任何特殊處理且不影響后續(xù)的治療。3.采用優(yōu)化方案的針刺+自血療法具有療效好、復發(fā)率低、安全的特點,在改善癥狀和分級程度方面,A組(針刺+自血療法)優(yōu)于C組(針刺+耳穴貼壓),第4周末A組(針刺+自血療法)總效率可達90%%,均高于B組(針刺+刺絡拔罐)和C組(針刺+耳穴貼壓),提示針刺結(jié)合自血療法是治療血虛風燥型慢性蕁麻疹的優(yōu)勢針刺綜合療法,值得臨床推廣與應用。
[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.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：博士
【學位授予年份】：2017
【分類號】：R246.7

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