發(fā)布時(shí)間：2018-06-17 08:53

  本文選題：循經(jīng)取穴 + 穴位埋線　； 參考：《成都中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的：評(píng)價(jià)循經(jīng)取穴穴位埋線治療變應(yīng)性鼻炎(Allegic Rhinitis, AR)的臨床療效,并在此基礎(chǔ)上初步探究循經(jīng)取穴穴位埋線治療AR的中樞響應(yīng)特征,為循經(jīng)取穴穴位埋線治療AR的臨床應(yīng)用提供科學(xué)的試驗(yàn)依據(jù)。方法：1.采用單盲、隨機(jī)、對(duì)照的臨床研究方法,通過電腦隨機(jī)數(shù)字表法進(jìn)行受試者的納入,并將符合納入標(biāo)準(zhǔn)的30例患者隨機(jī)分為實(shí)驗(yàn)A組／(埋線組)、對(duì)照組/B組(假埋線組)。按照循經(jīng)取穴的原則,各組患者接受相同穴位的埋線治療,其中假埋線組的操作是不埋任何線,僅僅是針具刺激。共埋線1次,接受隨訪2次(第2周和第6周)。以RQLQ評(píng)分、鼻腔癥狀的VAS評(píng)分、以及鼻內(nèi)鏡檢查和血清指標(biāo)作為療效評(píng)價(jià)指標(biāo),分別于治療前、治療結(jié)束后2周、治療結(jié)束后6周3個(gè)時(shí)間點(diǎn)進(jìn)行指標(biāo)的觀察,以此評(píng)價(jià)循經(jīng)取穴穴位埋線治療AR的臨床療效和安全性。2.從臨床研究的埋線組中納入5例符合腦功能磁共振成像納入標(biāo)準(zhǔn)的患者,以腦功能磁共振成像(fMRI)技術(shù)為研究手段,通過對(duì)比AR患者自身前后腦功能區(qū)的效應(yīng)區(qū)域,總結(jié)和探討循經(jīng)取穴穴位埋線治療AR患者靜息狀態(tài)下腦功能活動(dòng)的中樞響應(yīng)特征,篩選與病情相關(guān)的重點(diǎn)(靶點(diǎn))腦區(qū),初步探討循經(jīng)取穴穴位埋線治療AR的中樞響應(yīng)特征。結(jié)果：1.穴位埋線治療AR的臨床療效評(píng)價(jià)結(jié)果(1)2組受試者的人口學(xué)特征、生命體征、病史病情等基線資料具有可比性。(1)鼻腔VAS評(píng)分項(xiàng)在治療結(jié)束后6周,兩組間差異具有統(tǒng)計(jì)學(xué)意義。(3)RQLQ評(píng)分項(xiàng)在治療結(jié)束后2周及治療后6周兩組間的差異均有統(tǒng)計(jì)學(xué)意義。(4)下鼻甲腫脹程度評(píng)分項(xiàng)在治療后2周、6周時(shí)間點(diǎn),兩組間存在統(tǒng)計(jì)學(xué)差異(其中,下鼻甲腫脹程度評(píng)分項(xiàng)兩組治療后6周與治療前自身前后對(duì)照有統(tǒng)計(jì)學(xué)差異)。(5)埋線組(A組)的血清指標(biāo)IFN-γ治療前與治療后2周比較有統(tǒng)計(jì)學(xué)意義。(6)本次試驗(yàn)沒有出現(xiàn)有記錄意義的嚴(yán)重的不良反應(yīng)。2.AR患者靜息態(tài)腦功能活動(dòng)特征研究結(jié)果。埋線前后在腦功能靜息狀態(tài)下對(duì)比反應(yīng)顯著性增強(qiáng)區(qū)域的腦區(qū)有：雙側(cè)的距狀皮層(BA17)、前扣帶回(ACC) (BA32)、中扣帶回(MCC) (BA23)、后扣帶回(PCC) (BA30)、豆?fàn)詈�、楔�?BA23)、腦島(BA13)、顳上回(STG) (BA41)、顳中回(MTG) (BA21)、顳下回(ITG) (BA20)、額下回(IFG) (BA47)、額中回(MFG) (BA10)、額上回(SFG) (BA8)、中央前回(BA4)、中央后回(BA3)、前運(yùn)動(dòng)皮層(BA6)、緣上回(BA40)、角回(BA39)、小腦扁桃體,右側(cè)尾狀核,左側(cè)梭狀回(BA37)。結(jié)論：(1)循經(jīng)取穴穴位埋線治療AR療效優(yōu)于假埋線組,循經(jīng)取穴穴位埋線治療AR安全有效。(2)循經(jīng)取穴穴位埋線治療AR的療效機(jī)制存在中樞效應(yīng)機(jī)制路線。(3)循經(jīng)取穴穴位埋線治療AR的中樞效應(yīng)機(jī)制具有以下特點(diǎn)：①?gòu)V泛性調(diào)動(dòng)中樞腦區(qū),包括邊緣系統(tǒng)網(wǎng)絡(luò)、內(nèi)側(cè)痛覺系統(tǒng)網(wǎng)絡(luò)、高級(jí)中樞網(wǎng)絡(luò)路徑；②具有靶向性的特點(diǎn),如杏仁核和前扣帶回；③具有先驅(qū)于臨床的特點(diǎn)。(4)具體的中樞效應(yīng)路徑或者效應(yīng)模式的明晰化有待更進(jìn)一步的研究。(5)假說“穴位-神經(jīng)信號(hào)調(diào)節(jié)-中樞-社神經(jīng)信號(hào)調(diào)節(jié)-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.
【學(xué)位授予單位】：成都中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R246.81

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