本文選題：溫針灸 + 肺氣虛寒證��； 參考：《成都中醫(yī)藥大學(xué)》2016年博士論文

【摘要】：目的：變應(yīng)性鼻炎(Allergic Rihnitis,AR)是特異性機(jī)體接觸致敏原后由IgE介導(dǎo)的鼻黏膜高反應(yīng)性疾病,具有反復(fù)發(fā)作、難治愈的特點(diǎn)。近年來AR發(fā)病率呈明顯增加趨勢,嚴(yán)重影響了人們的工作效率和生活質(zhì)量,已成為一個全球性多發(fā)疾病。導(dǎo)師張勤修認(rèn)為AR發(fā)病主要是以肺衛(wèi)不固為本,外感風(fēng)寒邪氣為標(biāo),臨床以肺氣虛寒型常見,宜以溫肺散寒、益氣固表為治法。針灸治療變應(yīng)性鼻炎歷史悠久,具有獨(dú)特的優(yōu)勢,受到越來越多的關(guān)注。本研究旨在評價溫針灸治療肺氣虛寒型持續(xù)性變應(yīng)性鼻炎的臨床療效和安全性,探討溫針灸治療變應(yīng)性鼻炎的作用機(jī)制,為溫針灸治療變應(yīng)性鼻炎的臨床廣泛應(yīng)用提供科學(xué)依據(jù)。方法：本研究采用隨機(jī)、對照的臨床試驗(yàn)方法,通過計算機(jī)產(chǎn)生的隨機(jī)數(shù)字表,將符合納入標(biāo)準(zhǔn)的60名肺氣虛寒型持續(xù)性AR患者分為A組(溫針灸組)、B組(針刺組)和C組(針刺加艾灸組)。三組均采用相同的取穴方法,5次為一個療程,連續(xù)治療2個療程,療程之間間隔1周,共10次,分別于治療后4周和8周進(jìn)行短期隨訪。以視覺模擬評分量表(visual analogue scale,VAS)積分及鼻眼結(jié)膜相關(guān)生活質(zhì)量問卷調(diào)查量表(Rhinocoujunctivitis Quality of Life Questionaire,RQLQ)(中文版自測版本)作為主要的主觀療效評價指標(biāo),以鼻內(nèi)鏡檢查鼻甲腫脹程度,血清特異性IgE和IL-10和IL-4實(shí)驗(yàn)室檢測指標(biāo)作為客觀評價指標(biāo)。在治療前、治療結(jié)束、隨訪期間進(jìn)行VAS、RQLQ評分,治療前后進(jìn)行鼻內(nèi)鏡、血清特異性IgE和IL-10和IL-4檢查,比較溫針灸組、單純針刺組、針刺加灸法組在主要、次要療效觀察指標(biāo)之間數(shù)據(jù)差異,評價溫針灸、單純針刺、針刺加灸法治療AR的安全性和有效性。治療期間記錄患者的合并用藥和不良反應(yīng)發(fā)生的情況。結(jié)果：1.三組受試者的人口學(xué)特征和病史病情等基線資料具有可比性。2.VAS量表評分結(jié)果顯示：總體癥狀評分方面：組間比較,三組患者在治療后、第1次隨訪、第2次隨訪差異均有統(tǒng)計學(xué)意義(P0.05)。組內(nèi)比較：三組在治療前vs治療結(jié)束、治療前vs隨訪結(jié)束方面,差異均具有統(tǒng)計學(xué)意義(P0.05)。典型過敏癥狀評分方面：組間比較：溫針組與針刺組、針刺加艾灸相比較,在鼻癢、噴嚏、清水涕、鼻塞四個方面,治療后、兩次隨訪期間評分差異均具有統(tǒng)計學(xué)意義(P0.05)。組內(nèi)比較：三組各典型癥狀在治療前vs治療結(jié)束、治療前vs隨訪結(jié)束,差異均具有統(tǒng)計學(xué)意義(P0.05)。3.RQLQ問卷調(diào)查表比較結(jié)果：組間比較：治療前各組數(shù)據(jù)比較均無顯著性差異,治療后,溫針組與針刺加艾灸組無顯著性差異,余均有統(tǒng)計學(xué)意義；第一次隨訪,溫針組與針刺加艾灸組無顯著性差異外,余均有統(tǒng)計學(xué)意義：第二次隨訪,溫針組分別與針刺組和針刺加艾灸組之間比較P均0.05,差異具有統(tǒng)計學(xué)意義。組內(nèi)比較：溫針組治療前vs治療結(jié)束、治療前vs隨訪結(jié)束比較數(shù)據(jù)P0.05,提示RQLQ值在不同時間點(diǎn)比較時,數(shù)據(jù)呈現(xiàn)下降趨勢,表明差異具有統(tǒng)計學(xué)意義。針刺組與針刺加艾灸組,治療前與治療結(jié)束、第二次隨訪結(jié)束,兩次比較數(shù)據(jù)均呈現(xiàn)顯著性差異,表明差異均具有統(tǒng)計學(xué)意義。4.下鼻甲腫脹程度(鼻內(nèi)鏡檢查)比較結(jié)果顯示：組間比較：治療前后鼻甲腫脹程度評分均未呈現(xiàn)顯著性差異。組內(nèi)比較：各組治療前vs治療結(jié)束P值均0.05,表明各組內(nèi)治療前后差異具有統(tǒng)計學(xué)意義。5.中醫(yī)證候積分比較結(jié)果：三組受試者治療后、第1次隨訪、第2次隨訪中醫(yī)癥候客觀量化評分不完全相同(P0.05),差異具有統(tǒng)計學(xué)意義。組間比較：溫針組與針刺組、針刺加艾灸組相比較,治療后、第1次隨訪、第2次隨訪P0.05,差異均有統(tǒng)計學(xué)意義。組內(nèi)比較：各組在治療前vs治療結(jié)束、治療前vs隨訪結(jié)束P0.05,差異均有統(tǒng)計學(xué)意義。6.實(shí)驗(yàn)室檢查指標(biāo)比較結(jié)果： (1)血清特異性IgE比較結(jié)果：組間比較：溫針組vs針刺組治療后差異無統(tǒng)計學(xué)意義(P0.05),溫針組VS針刺加艾灸組差異有統(tǒng)計學(xué)意義(P0.05)。在組內(nèi)對比方面,治療前后SIgE除艾灸組外,溫針組與針刺組治療前后SIgE差異均有統(tǒng)計學(xué)意義(P0.05)。(2)IL-4比較結(jié)果：組間比較：治療后溫針組VS針刺組差異無統(tǒng)計學(xué)意義(P0.05),溫針組VS針刺加艾灸組差異有統(tǒng)計學(xué)意義(P0.05)。組內(nèi)比較：溫針組差異均有統(tǒng)計學(xué)意義(P0.05),針刺組、針刺加艾灸組治療前后的差異無統(tǒng)計學(xué)意義。(3)IL-10比較結(jié)果：組內(nèi)比較和組間比較治療前后均未出現(xiàn)顯著性差異。7.在治療期間,三組受試者均未發(fā)生嚴(yán)重不良反應(yīng)結(jié)論：1.溫針灸、針刺和針刺加艾灸均有助于改善變應(yīng)性鼻炎患者的癥狀和病情(VAS評分)及相關(guān)的生活質(zhì)量(RQLQ評分)。與針刺和艾灸相比較,溫針灸組患者的癥狀(VAS評分)及相關(guān)的生活質(zhì)量(RQLQ評分)以及體征的改善較針刺組和針刺加艾灸組更加顯著,在改善患者病情和各項癥狀和生活質(zhì)量方面具有明顯優(yōu)勢,差異具有統(tǒng)計學(xué)意義。2.溫針灸、針刺和針刺加艾灸均有助于改善肺氣虛寒型持續(xù)性變應(yīng)性鼻炎患者的主要過敏癥狀和全身癥狀,但就數(shù)據(jù)下降趨勢而言,溫針灸較其它兩組更具有明顯的優(yōu)勢,且隨訪期的控制性更好。3.溫針組與針刺組和針刺加艾灸組比較而言,可以明顯降低患者外周血清中的SIgE和IL-4的含量水平,究其機(jī)制,可能是通過對不同細(xì)胞因子的調(diào)節(jié),間接調(diào)控Thl/Th2平衡,減輕AR患者鼻腔變態(tài)反應(yīng)性炎癥。4.溫針灸治療及隨訪期間未出現(xiàn)不良反應(yīng)和嚴(yán)重不良事件,表明其治療肺氣虛寒型AR的安全性較好。
[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.
【學(xué)位授予單位】：成都中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R246.81

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