低功率氦氖激光照射內(nèi)迎香穴治療過(guò)敏性鼻炎的臨床研究
發(fā)布時(shí)間：2018-08-09 15:02
【摘要】：目的:過(guò)敏性鼻炎(Allergic Rhinitis,AR)是特應(yīng)性個(gè)體接觸致敏原后,由IgE介導(dǎo)的,多種免疫活性細(xì)胞和細(xì)胞因子參與的鼻黏膜慢性炎癥反應(yīng)性疾病。保守估計(jì),全世界的過(guò)敏性鼻炎患者在5億左右。過(guò)去的20年間,AR的發(fā)病率在逐年上升,不同地區(qū)不同人群中的發(fā)病率在1%_40%�，F(xiàn)代醫(yī)學(xué)治療過(guò)敏性鼻炎主要使用藥物干預(yù)機(jī)體體內(nèi)超敏反應(yīng)過(guò)程,從而減緩各類癥狀,然而藥物存在一定的副反應(yīng)作用。中醫(yī)針灸在世界范圍的大熱,證明其廣泛被患者所接受,然而因其是依靠金屬針具,且創(chuàng)傷刺激性,部分患者懼怕這種刺激。因此,激光針灸應(yīng)運(yùn)而生。激光針灸是利用低功率的氦氖激光照射在特定穴位上,在保留利用中醫(yī)經(jīng)絡(luò)腧穴理論治療疾病和無(wú)副作用等優(yōu)點(diǎn)的基礎(chǔ)上,使受術(shù)者免受傳統(tǒng)針具的創(chuàng)傷刺激,使懼針者也可以進(jìn)行針灸治療。因此,探討低功率的氦氖激光照射特定穴位治療過(guò)敏性鼻炎,具有很好的研究和應(yīng)用前景。本研究將利用臨床隨機(jī)對(duì)照試驗(yàn),對(duì)低功率的氦氖激光照射迎香穴治療過(guò)敏性鼻炎的作用效應(yīng)進(jìn)行觀察,并對(duì)其作用機(jī)制進(jìn)行初步探討,以為臨床推廣使用提供理論依據(jù)。方法:于2015年10月至2016年10月在廣東省羅崗黃陂醫(yī)院耳鼻喉科及針灸科收集持續(xù)性中重度過(guò)敏性鼻炎患者共討60例。所有納入病例的診斷標(biāo)準(zhǔn)參照2008年世界衛(wèi)生組織關(guān)于"過(guò)敏性鼻炎及其對(duì)哮喘的影響"(ARIA)指南中制定的過(guò)敏性鼻炎的診斷標(biāo)準(zhǔn)擬定,并根據(jù)研究需要制定一系列的納入標(biāo)準(zhǔn)、排除標(biāo)準(zhǔn)、終止標(biāo)準(zhǔn)等。所有病例按照簡(jiǎn)單隨機(jī)方法分為治療組和對(duì)照組各30例。治療組使用低功率氦氖激光照射內(nèi)迎香穴,每次10分鐘,每日一次,五次為一療程:休息兩日后開(kāi)始下一療程,共治療兩個(gè)療程。對(duì)照組使用西替利嗪進(jìn)行口服,每日一次,每次1Omg,五次為一療程,停藥兩日后開(kāi)始下一療程,共服用兩個(gè)療程。治療前后觀察以下指標(biāo)變化。以鼻癥狀總積分表(Total Nasal Symptom Score,TNSS)為主要觀察指標(biāo),在治療及隨訪期間每曰記錄,鼻癥狀總分表分為鼻塞、流涕、鼻癢、噴嚏四個(gè)癥狀,每個(gè)癥狀按輕重程度分為5個(gè)等級(jí):0=無(wú)癥狀,1=輕微,2=中度,3=較重,4=非常重。累積總分即為鼻癥狀總分。最高分為16分。由評(píng)價(jià)者于評(píng)價(jià)時(shí)點(diǎn)進(jìn)行記錄,同時(shí)患者采用日記形式每天進(jìn)行自評(píng)。次要觀察指標(biāo)包括鼻伴隨癥狀總分表(TNNSS)、鼻結(jié)膜炎生命質(zhì)量調(diào)查問(wèn)卷(RQLQ)。炎伴隨癥狀總分表(TNNSS):按鼻涕從咽部流過(guò)、流淚、鼻或眼部癢、鼻或口腔上額疼痛、頭痛等癥狀的有或無(wú)獲得評(píng)分:0=無(wú),1=有,累積總分即為伴隨癥狀總分,最高分為5分。由評(píng)價(jià)者于評(píng)價(jià)時(shí)點(diǎn)進(jìn)行記錄,同時(shí)患者采用曰記形式每天進(jìn)行自評(píng)。鼻結(jié)膜炎生命質(zhì)量調(diào)查問(wèn)卷(RQLQ):分為活動(dòng)、睡眠、非鼻眼癥狀、實(shí)際問(wèn)題、鼻部癥狀、眼部癥狀、情感等7個(gè)維度,共24項(xiàng)提問(wèn),每一項(xiàng)分別按0=無(wú)困擾,1=幾乎無(wú)困擾,2=有些困擾,3=中等程度困擾,4=十分困擾,5=很困擾,6=極度困擾進(jìn)行打分。各維度單獨(dú)記分,并算總分即為RQLQ總分。最高分為144分。由評(píng)價(jià)者對(duì)患者進(jìn)行詢問(wèn)后記錄。于第2次訪視(第1次治療前)、第8次訪視(第7次治療前)、第13次訪視(第12次治療后的第一到三天)。并以實(shí)驗(yàn)室指標(biāo)嗜酸性細(xì)胞計(jì)數(shù)EOS,總IgE水平對(duì)激光針灸治療過(guò)敏性鼻炎的機(jī)制進(jìn)行初步探討。結(jié)果:共納入符合入選標(biāo)準(zhǔn)的患者60例,完成試驗(yàn)55例,其中治療組27例,對(duì)照組28例。治療前,治療組和對(duì)照組的性別構(gòu)成、年齡結(jié)構(gòu)、病程等經(jīng)過(guò)統(tǒng)計(jì)分析,均沒(méi)有顯示顯著的統(tǒng)計(jì)學(xué)差異(P0.05);所有的觀測(cè)指標(biāo)包括TNSS主要癥狀評(píng)分和TNNSS伴隨癥狀評(píng)分、RQLQ生活質(zhì)量評(píng)分、嗜酸性細(xì)胞計(jì)數(shù)EOS,總IgE水平等兩組對(duì)比均沒(méi)有顯示顯著的統(tǒng)計(jì)學(xué)差異(P0.05),即觀察基線一致。治療后,治療組和對(duì)照組兩組病例的TNSS主要癥狀評(píng)分和TNNSS伴隨癥狀評(píng)分、RQLQ生活質(zhì)量評(píng)分、總IgE水平對(duì)比治療前均有明顯統(tǒng)計(jì)學(xué)差異(P0.05),即兩組治療方法都能明顯改善過(guò)敏性鼻炎的鼻塞、流涕、鼻癢、噴嚏四個(gè)主要癥狀,改善伴隨癥狀和患者的生存質(zhì)量,并下調(diào)患者外周血液中的總IgE水平。在治療2周的時(shí)候,治療組的TNSS主要癥狀評(píng)分和TNNSS伴隨癥狀評(píng)分、RQLQ生活質(zhì)量評(píng)分都要差于對(duì)照組,但在治療4周后,兩組的三種評(píng)分趨于一致(P0.05),即在整個(gè)療程結(jié)束后,激光針灸可以獲得和藥物治療相類似的作用效果。在實(shí)驗(yàn)室指標(biāo)方法,治療組和對(duì)照組在治療后均未見(jiàn)對(duì)嗜酸性細(xì)胞計(jì)數(shù)EOS有明顯的改變(P0.05);而對(duì)于血清總IgE水平,治療組和對(duì)照組都可以明顯降低血清總IgE水平(P0.05),且兩組互相對(duì)比沒(méi)有明顯區(qū)別(P0.05)。結(jié)論:本試驗(yàn)通過(guò)隨機(jī)對(duì)照的方法,收集兩組過(guò)敏性鼻炎病例,并各自采用激光針灸和西藥治療的方法進(jìn)行干預(yù),并對(duì)比分析,得出以下結(jié)論:低功率的氦氖激光照射迎香穴治療過(guò)敏性鼻炎,可以有效改善患者的各種臨床癥狀和生活質(zhì)量,并能降低機(jī)體內(nèi)超敏反應(yīng),從而治療過(guò)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.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R246.81
本文編號(hào)：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.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R246.81
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