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针刺联合艾灸治疗变应性鼻炎的临床疗效及安全性评价

[Clinical efficacy and safety evaluation of acupuncture combined with moxibustion in treatment of allergic rhinitis].

作者信息

Ma Wei, Zhai Chun-Tao, Shang Hui-Mei, Xu Xiao-Shan, Zheng Tong, Tian Yue-Feng

机构信息

College of Acupuncture-Moxibustion and Tuina, Hunan University of Chinese Medicine, Changsha 410208, China; Preventive Treatment Center, Yulin Hospital of Chinese Medicine, Yulin 719000, Shaanxi Province.

The Third Clinical College, Shanxi University of Chinese Medicine, Taiyuan 030024.

出版信息

Zhen Ci Yan Jiu. 2022 Apr 25;47(4):336-42. doi: 10.13702/j.1000-0607.20210315.

Abstract

OBJECTIVE

To evaluate the clinical efficacy and safety of acupuncture combined with moxibustion on allergic rhinitis.

METHODS

Using the random number table, 80 patients with allergic rhinitis were divided into a medication group and an acupuncture combined with moxibustion (acu-mox) group, 40 cases in each one. In the medication group, ioratadine tables were prescribed for oral administration, one tablet daily for 10 days as 1 session , 3 sessions of treatment were required. In the acupuncture combined with moxibustion group, bilateral Yingxiang (LI20), Yintang (EX-HN3), bilateral Hegu (LI4) and bilateral Shenshu (BL23) were selected as the main points and stimulated with acupuncture and moxibustion; and the acupoint prescription was modified according to symptoms. This combined treatment was given once every day, stimulating for 30 min each time, and 10 treatments made 1 course, for 3 courses of treatment totally. Before and after treatment, the scores for symptoms and physical signs, as well as the score of rhino-conjunctivitis related quality of life scale (R-QOL) were evaluated separately. The sample of the inferior turbinate mucosa tissue was collected and the distribution of eosinophil (EOS) was scored using HE staining and Sheldeny evaluation. Using enzyme-linked immunosorbent assay (ELISA), the contents of serum immunoglobulin E (IgE), retinoic-acid-receptor-related orphan nuclear receptor γt (RORγt), forkhead box protein P3 (Foxp3), interleukin-17 (IL-17), IL-27 and IL-33 were determined. The clinical efficacy was evaluated in the patients with allergic rhinitis of two groups and all the adverse reactions were recorded during treatment.

RESULTS

The scores of symptoms and physical signs as well as the score of R-QOL, and EOS distribution score and the contents of serum IgE, RORγt, IL-17 and IL-33 were all reduced as compared with those before treatment in each group (<0.05), and the contents of serum Foxp3 and IL-27 were increased as compared with those before treatment in each group (<0.05). After treatment, the scores of symptoms and physical signs as well as the score of R-QOL, and the contents of serum IgE, RORγt and IL-33 in the acu-mox group were lower than those in the medication group (<0.05), and the contents of serum Foxp3 and IL-27 were higher than those of the medication group (<0.05). The total effective rate of the acu-mox group was 100.0% (40/40), significantly higher than 82.5% (33/40) in the medication group (<0.05). No ob-vious adverse reaction was found in either group during and after treatment.

CONCLUSION

Acupuncture combined with moxibustion is significantly effective and safe in treatment of allergic rhinitis. Its effect mechanism may be related to the balance modulation of Th1/Th2 and Th17/Treg cells mediated by naive CD4T cells.

摘要

目的

评价针灸结合艾灸治疗变应性鼻炎的临床疗效及安全性。

方法

采用随机数字表法,将80例变应性鼻炎患者分为药物组和针灸结合艾灸(针-灸)组,每组40例。药物组口服氯雷他定片,每日1片,连服10天为1个疗程,共治疗3个疗程。针灸结合艾灸组选取双侧迎香(LI20)、印堂(EX-HN3)、双侧合谷(LI4)和双侧肾俞(BL23)为主穴,行针灸结合艾灸刺激;并根据症状调整穴位处方。该联合治疗每天进行1次,每次刺激30分钟,10次治疗为1个疗程,共治疗3个疗程。治疗前后分别评估症状和体征评分、鼻结膜炎相关生活质量量表(R-QOL)评分。采集下鼻甲黏膜组织样本,采用HE染色和Sheldeny评估对嗜酸性粒细胞(EOS)分布进行评分。采用酶联免疫吸附测定(ELISA)法测定血清免疫球蛋白E(IgE)、维甲酸受体相关孤儿核受体γt(RORγt)、叉头框蛋白P3(Foxp3)、白细胞介素-17(IL-17)、IL-27和IL-33的含量。对两组变应性鼻炎患者的临床疗效进行评估,并记录治疗期间的所有不良反应。

结果

与治疗前比较,每组患者的症状和体征评分、R-QOL评分、EOS分布评分以及血清IgE、RORγt、IL-17和IL-33含量均降低(<0.05),每组患者血清Foxp3和IL-27含量均高于治疗前(<0.05)。治疗后,针-灸组的症状和体征评分、R-QOL评分以及血清IgE、RORγt和IL-33含量均低于药物组(<0.05),血清Foxp3和IL-27含量高于药物组(<0.05)。针-灸组的总有效率为100.0%(40/40),显著高于药物组的82.5%(33/40)(<0.05)。两组在治疗期间及治疗后均未发现明显不良反应。

结论

针灸结合艾灸治疗变应性鼻炎疗效显著且安全。其作用机制可能与初始CD4T细胞介导的Th1/Th2和Th17/Treg细胞平衡调节有关。

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