本文選題：低頻電針 + 單純性肥胖癥��； 參考：《河北醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:本課題通過采用低頻電針對男、女兩組脾虛濕盛型單純性肥胖癥患者的治療,觀察其治療前后體重、體重指數(shù)(BMI)、體脂百分率(F%)、腰圍、臀圍、腰臀圍比值以及血糖(Glu)、膽固醇(TC)、甘油三酯(TG)、高密度脂蛋白膽固醇(HDL)、低密度脂蛋白膽固醇(LDL)、胰島素(Ins)、胰島素抵抗(Ins-Ab)、瘦素(Leptin)、脂聯(lián)素(ADPN)、神經(jīng)肽Y(NPY)等指標(biāo)變化,并進(jìn)行比較分析。探討低頻電針對男、女單純性肥胖癥減肥效應(yīng)的差異性及可能的作用機(jī)制,以期為臨床應(yīng)用低頻電針針對性治療男、女單純性肥胖癥提供科學(xué)依據(jù)。方法:本研究納入的80例單純性肥胖癥患者,均來自于2014年3月~2015年10月期間河北中醫(yī)學(xué)院門診部和河北省中醫(yī)藥研究院醫(yī)院門診。所有患者均嚴(yán)格按照診斷標(biāo)準(zhǔn)、納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn)進(jìn)行選擇,其中女性組43例,男性組37例。兩組治療方法相同。取穴:陰陵泉(雙)、三陰交(雙)、足三里(雙)、豐隆(雙)、曲池(雙)、天樞(雙)、中脘、水分、氣海、關(guān)元和脂肪堆積部位阿是穴2~4穴。操作:患者取仰臥位,針具使用φ0.30~0.34×40~75mm毫針。肢體選單側(cè)2~3對穴,兩側(cè)穴交替使用。穴位常規(guī)消毒,直刺進(jìn)針,得氣后,連接華佗牌SDZ-II型電針儀;腹部穴采用透刺方法,穴位常規(guī)消毒后,中脘透水分、氣海透關(guān)元、脂肪堆積處穴位透刺(直刺得氣后,將針尖提至脂肪堆積處,再沿脂肪堆積處向下透刺),然后連接電針儀。肢體及腹部穴均采用連續(xù)波,頻率為20Hz,留針30min,1次/d,10次為1療程,療程間休息2天,連續(xù)治療2個(gè)療程。治療結(jié)束后隨訪3個(gè)月。兩組患者治療前后均由專人測量統(tǒng)計(jì)身高、體重、腰圍、臀圍、腰臀比值和體脂百分率(F%)等指標(biāo),同時(shí)檢測血糖(Glu)、膽固醇(TC)、甘油三酯(TG)、高密度脂蛋白膽固醇(HDL)、低密度脂蛋白膽固醇(LDL)、胰島素(Ins)、胰島素抵抗(Ins-Ab)、瘦素(Leptin)、脂聯(lián)素(ADPN)、神經(jīng)肽Y(NPY)等指標(biāo)的含量。并將兩組治療前后各項(xiàng)觀察指標(biāo)的數(shù)據(jù)應(yīng)用SPSS13.0軟件進(jìn)行統(tǒng)計(jì)分析。結(jié)果:1一般資料比較:通過對兩組治療前年齡、病程、肥胖程度等資料均衡,差異均無統(tǒng)計(jì)學(xué)意義(P0.05),具有可比性。2男性組和女性組療效的比較:男性組顯效率為32.43%,總有效率為97.29%;女性組顯效率為11.62%,總有效率為86.04%。經(jīng)χ2檢驗(yàn),兩組顯效率比較,男性組優(yōu)于女性組(P0.05);而總有效率比較,雖差異無統(tǒng)計(jì)學(xué)意義(P0.05),但男性組總有效率明顯高于女性組。兩組總體療效比較,經(jīng)Wilcoxon秩和檢驗(yàn),差異有統(tǒng)計(jì)學(xué)意義(P0.05),男性組優(yōu)于女性組。3男性組和女性組治療前后形體指標(biāo)的比較:治療前兩組患者體重、BMI、胸圍、腰圍、臀圍、腰臀比以及F%均明顯高于正常組,差異有統(tǒng)計(jì)學(xué)意義(P0.01)。男性組和女性組患者治療前以BMI為肥胖程度參數(shù)均衡性比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。治療后組內(nèi)比較:兩組患者體重、BMI、胸圍、腰圍、臀圍、腰臀比以及F%較治療前均明顯降低,差異有統(tǒng)計(jì)學(xué)意義(P0.01)。治療后組間比較:男性組體重、BMI較女性組降低明顯,差異均有統(tǒng)計(jì)學(xué)意義(P0.01);女性組F%、腰圍、臀圍較男性組降低明顯,差異均有統(tǒng)計(jì)學(xué)意義(P0.01);兩組胸圍及腰臀比值的比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。治療后與正常組比較:男性組體重、BMI、胸圍、腰圍、臀圍、腰臀比、F%較正常組差異均有統(tǒng)計(jì)學(xué)意義(P0.01);女性組體重、BMI、胸圍、腰圍、臀圍、F%、較正常組差異均有統(tǒng)計(jì)學(xué)意義(P0.01);腰臀比較正常組差異無統(tǒng)計(jì)學(xué)意義(P0.05)。4男性組和女性組隨訪三個(gè)月和治療前形體指標(biāo)的比較:(1)組內(nèi)比較:隨訪3個(gè)月兩組患者的體重、BMI、胸圍、腰圍、臀圍、腰臀比及F%均明顯低于治療前,差異有統(tǒng)計(jì)學(xué)意義(P0.01)。(2)組間比較:隨訪三個(gè)月,男性組體重、BMI較女性組相應(yīng)隨訪各月的體重、BMI降低明顯,差異有統(tǒng)計(jì)學(xué)意義(P0.01);女性組F%、腰圍、臀圍較男性組相應(yīng)隨訪各月的F%、腰圍、臀圍降低明顯,差異有統(tǒng)計(jì)學(xué)意義(P0.01)。兩組胸圍及腰臀比值的比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05)5男性組和女性組治療前后血脂含量的比較:治療前兩組TC、TG、LDL含量均明顯高于正常組,差異有統(tǒng)計(jì)學(xué)意義(P0.01);HDL的含量明顯低于正常組,差異有統(tǒng)計(jì)學(xué)意義(P0.01)。治療后組內(nèi)比較:兩組患者TC、TG、LDL含量較治療前均明顯降低;HDL的含量較前明顯升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。治療后組間比較:兩組患者TC、TG、HDL、LDL含量比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。治療后與正常組比較:兩組TC、TG、HDL、LDL含量較正常組差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。6男性組和女性組治療前后Glu、Ins、Ins-Ab、ADPN含量比較:治療前兩組患者Glu、Ins、Ins-Ab、ADPN含量均明顯高于正常組,差異均有統(tǒng)計(jì)學(xué)意義(P0.01)。治療后組內(nèi)比較:兩組患者Glu、Ins、Ins-Ab、ADPN的含量較治療前均明顯降低,差異均有統(tǒng)計(jì)學(xué)意義(P0.01或P0.05)。治療后組間比較:男性組Ins、ADPN含量較女性組均明顯降低,差異均有統(tǒng)計(jì)學(xué)意義(P0.01或P0.05);而兩組Glu及Ins-Ab的含量比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。治療后與正常組比較:兩組Glu、ADPN、Ins、Ins-Ab含量較正常組差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。7男性組和女性組治療前后血清Leptin和NPY含量比較:治療前兩組患者血清Leptin和NPY含量均明顯高于正常組,差異均有統(tǒng)計(jì)學(xué)意義(P0.01)。治療后組內(nèi)比較:治療后兩組患者血清Leptin、NPY含量較治療前均明顯降低,差異均有統(tǒng)計(jì)學(xué)意義(P0.01)。治療后組間比較:男性組NPY含量較女性組降低明顯,差異有統(tǒng)計(jì)學(xué)意義(P0.01);女性組血清Leptin含量較男性組降低明顯,差異有統(tǒng)計(jì)學(xué)意義(P0.01)。治療后與正常組比較:兩組血清Leptin、NPY含量較正常組差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。8男性組和女性組患者不良事件率比較:兩組的不良事件率均為0%,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1低頻電針能明顯降低男、女單純性肥胖癥患者的體重、BMI、F%,減少胸圍、腰圍、臀圍及腰臀比值。說明該療法對兩組患者均有很好的減肥作用及明顯的降重瘦身效果,不但近期療效好,而且遠(yuǎn)期療效亦佳,無明顯反彈。2低頻電針可明顯降低男、女單純性肥胖癥患者TC、TG、LDL含量,同時(shí)升高HDL含量。說明低頻電針對兩組單純性肥胖癥患者的脂代謝具有較好的調(diào)節(jié)作用,通過調(diào)節(jié)肥胖患者機(jī)體異常的脂代謝,抑制脂肪合成,促進(jìn)脂肪分解,氧化產(chǎn)熱,消耗多余脂肪,從而達(dá)到減肥消脂之目的。3低頻電針可明顯降低男、女單純性肥胖癥患者血清Glu、Ins、Ins-Ab、ADPN的含量。說明低頻電針對兩組單純性肥胖癥患者血清Glu、Ins、Ins-Ab、ADPN含量具有良好的調(diào)節(jié)作用,可能是通過增加胰島β細(xì)胞的敏感性和分泌功能,糾正肥胖患者體內(nèi)紊亂的脂肪-胰島內(nèi)分泌軸;同時(shí)調(diào)節(jié)Ins-Ab、ADPN的異常水平,有效改善Ins抵抗?fàn)顟B(tài),提高Ins的利用率,調(diào)節(jié)血糖和脂代謝,減少食物攝入,增加能量消耗,從而達(dá)到減肥目的。4低頻電針可明顯降低男、女單純性肥胖癥患者血清Leptin、NPY的含量。說明低頻電針對兩組單純性肥胖癥患者血清Leptin、NPY含量具有良好的調(diào)節(jié)作用,可能是通過改善肥胖患者體內(nèi)紊亂的Leptin-下丘腦NPY軸,促使血清Leptin通過血腦屏障,抑制下丘腦弓狀核和背狀核NPYm RNA表達(dá),減少NPY的分泌,減少食物攝入,增加能量消耗,抑制脂肪形成,從而達(dá)到減肥目的。5低頻電針對單純性肥胖癥的減肥作用,存在有一定的性別差異。其對男性體重、BMI、血清Ins、ADPN、NPY含量的改善作用更加明顯;而女性在F%、腰圍、臀圍、血清Leptin含量的改善方面優(yōu)于男性。但對胸圍、腰臀比值、血清Glu、TC、TG、HDL、LDL、Ins-Ab的變化差異不明顯。這也為臨床應(yīng)用低頻電針針對性治療男、女單純性肥胖癥提供依據(jù)。6該療法臨床應(yīng)用無不良反應(yīng),可避免西藥所引起的副作用,是一種安全有效的治療方法。7本實(shí)驗(yàn)從性別的角度對低頻電針治療單純性肥胖癥進(jìn)行了嘗試性研究,并取得了一定的成果,但由于經(jīng)費(fèi)不足,尚未進(jìn)行深入研究,如高頻電針與低頻電針間,不同波形間,對男、女單純性肥胖癥減肥效應(yīng)的差異性等,有待于今后進(jìn)一步的研究和探討。
[Abstract]:Objective: To observe the weight, body mass index (BMI), body fat percentage (F%), waist circumference, hip circumference, waist to hip circumference and blood glucose (Glu), cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL), low density lipoprotein, and low density fat eggs by the treatment of two groups of men and women with spleen deficiency and humid type of simple obesity. White cholesterol (LDL), insulin (Ins), insulin resistance (Ins-Ab), leptin (Leptin), adiponectin (ADPN), neuropeptide Y (NPY) and so on, and compare and analyze the difference and the possible mechanism of the effect of low frequency electroacupuncture on the weight loss of male and female simple obesity, in order to use low frequency electroacupuncture for the treatment of male and female alone. The scientific basis of sexual obesity was provided. Methods: 80 cases of simple obesity included in this study were from the outpatient department of the Hebei Institute of traditional Chinese medicine (Hebei Institute of traditional Chinese Medicine) and the hospital of the Hebei Institute of traditional Chinese medicine in October March 2014. All patients were selected strictly according to the diagnostic criteria and included in the standard and exclusion criteria, of which 43 cases were in the female group. 37 cases in the male group. The two groups were treated in the same way: Yin Ling spring (double), Sanyinjiao (double), Zusanli (double), Qu chi (double), Tianshu (double), middle Wan, water, Qi sea, Guan Yuanhe fat accumulation site Ashi point 2~4. Operation: patients take the supine position, the needle use of 0.30~0.34 x 40~75mm needle. Extremities selected single side 2~3 pair acupoints alternately. Use. Acupoint routine disinfection, direct puncture needle, after gas, connecting the Hua Tuo brand SDZ-II electroacupuncture instrument; the abdominal cavity through the puncture method, after the routine disinfection of the acupoints, the epigastric water permeates the water, the Qi sea through the point, the fat accumulation point penetration point (after piercing the gas, the needle points to the fat heap place, then down the fat accumulation down pricking), then connected to the electroacupuncture instrument. Continuous wave was used in the limb and abdominal cavity, frequency of 20Hz, needle retention 30min, 1 times /d, 10 times for 1 courses, 2 days of rest during the course of treatment, 2 courses of continuous treatment. After the treatment, the follow-up was 3 months. All the two groups of patients were measured and counted by special persons before and after treatment. The indexes of height, weight, waist, hip, waist hip ratio and body fat percentage (F%) were measured, and blood sugar was detected at the same time (Gl U), cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL), insulin (Ins), insulin resistance (Ins-Ab), leptin (Leptin), adiponectin (ADPN), neuropeptide Y (NPY) and other indicators, and the data of the two groups of observation indicators before and after the application of SPSS13.0 software for statistical analysis. Fruit: 1 general data comparison: through the balance of the age, course of disease and the degree of obesity in the two groups, the difference was not statistically significant (P0.05), with the comparison of the curative effect between the male and female groups of comparable.2: the male group was 32.43%, the total effective rate was 97.29%, the female group was 11.62%, the total effective rate was 86.04%. by chi 2 test, two groups Compared with the female group (P0.05), the male group was more effective than the female group (P0.05), although the difference was not statistically significant (P0.05), but the total effective rate of the male group was significantly higher than that of the female group. The total curative effect of the two groups was compared with the Wilcoxon rank test, the difference was statistically significant (P0.05). The male group was better than the female group.3 male group and the female group before and after treatment. Comparison of the indexes: the weight of the two groups before treatment, BMI, chest circumference, waist circumference, hip circumference, waist hip ratio and F% were significantly higher than those of the normal group. The difference was statistically significant (P0.01). The difference between the male group and the female group was compared with the weight equilibrium of BMI before treatment (P0.05). After treatment, the group was compared with the weight of the two groups, BMI, Chest circumference, waist circumference, hip circumference, waist to hip ratio and F% were significantly lower than before treatment. The difference was statistically significant (P0.01). The weight of the male group was significantly lower than that of the female group (P0.01), and the F%, waist and hip circumference of the female group were significantly lower than those in the male group (P0.01); the two groups of chest circumference and the two groups of chest circumference were statistically significant. The difference in waist hip ratio was not statistically significant (P0.05). Compared with the normal group, the weight of the male group, BMI, chest circumference, hip circumference, waist hip ratio and F% were statistically significant (P0.01). The weight of the female group, BMI, chest circumference, waist circumference, hip circumference, F% were statistically significant (P0.01), and the difference between normal waist and hip group was poor. No statistical significance (P0.05).4 male and female groups were followed up for three months and before the treatment of the physique index: (1) compared to 3 months of two groups of patients' weight, BMI, chest circumference, waist circumference, hip, waist to hip ratio and F% were significantly lower than before, the difference was statistically significant (P0.01). (2) a follow-up of three months, male group weight, BMI Compared with the female group, the BMI decreased significantly, and the difference was statistically significant (P0.01). The F%, waist circumference and hip circumference of the female group were significantly lower than those of the male group, the waist circumference and the hip circumference decreased significantly (P0.01). There was no significant difference between the two groups of chest circumference and waist hip ratio (P0.05) 5 male and female. Comparison of blood lipid content before and after treatment: the content of TC, TG, LDL in the two groups before treatment was significantly higher than that in the normal group, and the difference was statistically significant (P0.01). The content of HDL was significantly lower than that of the normal group (P0.01). The content of TC, TG, LDL in the two groups was significantly lower than that before treatment, and the content of HDL was significantly higher than that before the treatment. The difference was statistically significant (P0.05). There was no significant difference in the content of TC, TG, HDL and LDL in the two groups after treatment (P0.05). Compared with the normal group, there was no significant difference between the two groups of TC, TG, HDL, LDL content compared with the normal group (P0.05). The contents of Glu, Ins, Ins-Ab and ADPN in the first two groups were significantly higher than those in the normal group, and the difference was statistically significant (P0.01). The contents of Glu, Ins, Ins-Ab and ADPN were significantly lower in the two groups than before the treatment. The difference was statistically significant (P0.01 or P0.05). The difference was statistically significant (P0.01 or P0.05), but there was no significant difference in the content of Glu and Ins-Ab in the two groups (P0.05). After treatment, there was no significant difference between the two groups of Glu, ADPN, Ins, Ins-Ab content compared with the normal group (P0.05).7 male and female groups. The levels of serum Leptin and NPY in the first two groups were significantly higher than those in the normal group (P0.01). After treatment, the serum levels of Leptin and NPY in the two groups were significantly lower than those before treatment, and the difference was statistically significant (P0.01). After treatment, the content of NPY in the male group was significantly lower than that in the female group. There was statistical significance (P0.01); the content of serum Leptin in the female group was significantly lower than that in the male group (P0.01). After the treatment, the serum Leptin was compared with the normal group. There was no significant difference between the two groups of serum Leptin and NPY content compared with the normal group (P0.05) the rate of adverse events in the male and female groups of.8 was compared: the rate of adverse events was 0% in the two groups. There is no statistical significance (P0.05). Conclusion: 1 low frequency electroacupuncture can significantly reduce the weight of men and women with simple obesity, BMI, F%, reduce chest circumference, waist circumference, hip circumference and waist hip ratio. It shows that the therapy has a good weight loss effect and obvious weight reduction effect on two groups of patients, not only in the near future, but also in good long-term effect, and no obvious long-term effect. .2 low frequency electroacupuncture can obviously reduce the content of TC, TG, LDL, and increase the content of HDL in men and women with simple obesity. It shows that low frequency electroacupuncture has a good regulating effect on lipid metabolism in two groups of simple obesity patients. It can regulate fat metabolism, inhibit fat synthesis, promote adipose decomposition, oxidize heat production and eliminate heat. .3 low frequency electroacupuncture can significantly reduce the content of serum Glu, Ins, Ins-Ab and ADPN in the serum of men and women with simple obesity, indicating that low frequency electroacupuncture has a good regulatory effect on serum Glu, Ins, Ins-Ab, and ADPN content in two groups of simple obesity patients, which may be by increasing the sensitivity of islet beta cells. Sexual and secretory functions to correct the disorder of fat - islet endocrine axis in obese patients, regulate the abnormal level of Ins-Ab and ADPN, improve the Ins resistance effectively, improve the utilization of Ins, regulate blood glucose and lipid metabolism, reduce food intake, increase energy consumption, and thus achieve the goal of reducing the weight loss of.4. The low frequency electroacupuncture can significantly reduce the purity of men and women. The serum levels of Leptin and NPY in the serum of obese patients showed that low frequency electroacupuncture had a good regulating effect on the serum Leptin and NPY levels in two groups of simple obesity patients. It may be by improving the NPY axis of the hypothalamus in the Leptin- of the obese patients, promoting the serum Leptin through the blood brain barrier and inhibiting the RNA table of the hypothalamus arcuate nucleus and the dorsal nucleus NPYm. To reduce the secretion of NPY, reduce food intake, increase energy consumption, inhibit fat formation, and thus achieve weight loss objective.5 low frequency electroacupuncture on the weight loss of simple obesity, there is a certain gender difference. It is more significant for the male weight, BMI, serum Ins, ADPN, NPY content, while women in F%, waistline, hip circumference, serum Lep The improvement of tin content is better than that of men. However, there is no obvious difference in the changes of chest circumference, waist to hip ratio, serum Glu, TC, TG, HDL, LDL, Ins-Ab. This also provides a basis for the clinical application of low frequency electroacupuncture for male and female simple obesity according to the clinical application of.6, which can avoid side effects caused by western medicine and is a safe and safe method. The effective treatment method.7 is a tentative study on the treatment of simple obesity by low frequency electroacupuncture from the gender perspective, and has achieved certain results. However, due to the lack of funds, there has not been a thorough study, such as the difference between the high frequency electroacupuncture and low frequency electroacupuncture, different waveforms, and the difference in the weight loss effect of male and female obesity. Further research and discussion in the future.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R246.1

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