苍龟探穴法针刺阿是穴治疗乳腺癌芳香化酶抑制剂所致肌肉骨关节疼痛的临床效果
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摘要
目的探讨苍龟探穴法针刺阿是穴治疗乳腺癌芳香化酶抑制剂所致肌肉骨关节疼痛的临床效果。方法将广州中医药大学第一附属医院乳腺科2016年7月～2017年9月收治的72例因服用芳香化酶抑制剂导致肌肉骨关节疼痛的乳腺癌患者随机分为对照组(36例)和观察组(36例)。对照组给予口服西药治疗,观察组在对照组的基础上给予苍龟探穴法针刺阿是穴治疗,两组均治疗3个疗程。比较两组患者的临床疗效、视觉模拟评分(VAS)、日常生活活动能力量表(BI)评分及腰椎骨密度(BMD)变化,检测血清细胞因子γ干扰素(IFN-γ)、白细胞介素-4(IL-4)和雌二醇(E2)水平,并观察不良反应发生情况。结果①观察组总有效率明显高于对照组(P <0.05)。②两组患者治疗后VAS评分明显低于治疗前(P <0.01),且观察组VAS评分明显低于对照组(P <0.01)。③两组患者治疗后BI评分及BMD值均明显高于治疗前(P <0.05),且观察组BI评分及BMD值均明显高于对照组(P <0.05)。④与治疗前比较,两组患者治疗后IFN-γ水平显著降低,IL-4水平显著升高(P <0.01),E2水平无明显变化(P> 0.05);与对照组比较,观察组IFN-γ水平显著降低,IL-4水平显著升高(P <0.01),但两组患者血清E2水平比较差异无统计学意义(P> 0.05)。⑤两组患者在治疗过程中均未发生不良反应。结论苍龟探穴法针刺阿是穴可有效改善乳腺癌患者因使用芳香化酶抑制剂引起的肌肉骨关节疼痛,并可显著提高患者生活能力,且安全可行,值得临床推广使用。
Objective To explore the clinical effect of Canggui Tanxue acupuncture at ashi point in the treatment of muscle, bone and joint pain induced by aromatase inhibitor of breast cancer. Methods Seventy-two breast cancer patients with muscle, bone and joint pain because of taking aromatase inhibitor admitted to Galactophore Department of the First Affiliated Hospital of Guangzhou University of Chinese Medicine from July 2016 to September 2017 were randomly divided into control group(36 cases) and observation group(36 cases). The control group was treated with oral Western medicine, based on the control group, the observation group was given Canggui Tanxue acupuncture at ashi point. Both groups were treated for 3 courses. The clinical effect, the scores of visual analogue scale(VAS), Barthel index(BI) and the changes of lumbar spine bone mineral density(BMD) were compared between two groups. The levels of serum cytokine interferon-γ(IFN-γ), interleukin-4(IL-4), estradiol(E2) were detected and the occurrence of adverse reactions was observed. Results(1)The total effective rate of the observation group was significantly higher than the control group(P < 0.05).(2)After treatment, the VAS scores of the two groups were significantly lower than those before treatment(P < 0.01), and the observation group was significantly lower than the control group(P < 0.01).(3)After treatment, the BI score and BMD values of lumbar spine in the two groups were significantly higher than those before treatment(P < 0.05), which of the observation group were significantly higher than the control group(P < 0.05).(4)Compared with before treatment, the levels of IFN-γ were decreased significantly, the levels of IL-4 were increased signifi-cantly in the two groups after treatment(P < 0.01),while the levels of E2 did not change significantly(P >0.05); compared with the control group, the levels of IFN-γ were significantly decreased and the levels of IL-4 were significantly increased in the observation group(P < 0.01), but there was no significant difference in serum E2 levels between the two groups(P > 0.05).(5)There were no adverse reactions in both groups during the course of treatment.Conclusion Canggui Tanxue acupuncture at ashi point can effectively improve the muscle, bone and joint pain caused by appliaction of aromatase inhibitor in breast cancer patients, and can significantly enhance the living ability of patients, which is safe, feasible, and worthy of clinical promotion and application.
Objective To explore the clinical effect of Canggui Tanxue acupuncture at ashi point in the treatment of muscle, bone and joint pain induced by aromatase inhibitor of breast cancer. Methods Seventy-two breast cancer patients with muscle, bone and joint pain because of taking aromatase inhibitor admitted to Galactophore Department of the First Affiliated Hospital of Guangzhou University of Chinese Medicine from July 2016 to September 2017 were randomly divided into control group(36 cases) and observation group(36 cases). The control group was treated with oral Western medicine, based on the control group, the observation group was given Canggui Tanxue acupuncture at ashi point. Both groups were treated for 3 courses. The clinical effect, the scores of visual analogue scale(VAS), Barthel index(BI) and the changes of lumbar spine bone mineral density(BMD) were compared between two groups. The levels of serum cytokine interferon-γ(IFN-γ), interleukin-4(IL-4), estradiol(E2) were detected and the occurrence of adverse reactions was observed. Results(1)The total effective rate of the observation group was significantly higher than the control group(P < 0.05).(2)After treatment, the VAS scores of the two groups were significantly lower than those before treatment(P < 0.01), and the observation group was significantly lower than the control group(P < 0.01).(3)After treatment, the BI score and BMD values of lumbar spine in the two groups were significantly higher than those before treatment(P < 0.05), which of the observation group were significantly higher than the control group(P < 0.05).(4)Compared with before treatment, the levels of IFN-γ were decreased significantly, the levels of IL-4 were increased signifi-cantly in the two groups after treatment(P < 0.01),while the levels of E2 did not change significantly(P >0.05); compared with the control group, the levels of IFN-γ were significantly decreased and the levels of IL-4 were significantly increased in the observation group(P < 0.01), but there was no significant difference in serum E2 levels between the two groups(P > 0.05).(5)There were no adverse reactions in both groups during the course of treatment.Conclusion Canggui Tanxue acupuncture at ashi point can effectively improve the muscle, bone and joint pain caused by appliaction of aromatase inhibitor in breast cancer patients, and can significantly enhance the living ability of patients, which is safe, feasible, and worthy of clinical promotion and application.
引文
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[18]文翠菊,孙红娟,于新颖.芳香化酶抑制剂致乳腺癌患者骨关节疼痛及生活质量调查[J].中华现代护理杂志,2016,22(31):4448-4452.
[19]彭楠,于明薇,王笑民.芳香化酶抑制剂相关骨关节症状的研究进展[J].中国肿瘤临床,2015,42(21):1067-1070.
[20]钟莹.补肾强筋胶囊治疗乳腺癌AIMSS的临床研究[D].广州:广州中医药大学,2017.
[21]王天宝,吴玮,孙其斌,等.针刺"根三穴"配合微调手法治疗神经根型颈椎病疗效观察[J].西部中医药,2018,31(1):112-114.
[22]李超然,李甜,殷玉莲,等.补肾中药防治乳腺癌AIs引起的骨关节疼痛疗效观察[J].上海中医药杂志,2017,51(1):80-82,89.
[23]吕品,提桂香,王丽昀,等.针刺八荒穴治疗偏头痛急性发作期的临床研究[J].中国医药导报,2017,14(22):105-108.
[24]Castel LD,Hartmann KE,Mayer IA,et al.Time course of arthralgia among women initiating aromatase inhibitor therapy and apostmenopausal comparison group in a prospective cohort[J].Cancer,2013,119(13):2375-2382.
[25]张福侠,李彦龙,逯俭,等.根结穴针刺治疗腰椎间盘突出症40例[J].西部中医药,2017,30(2):94-95.
[26]滕迎春,于冬冬,关伟强,等.冉氏“益气通经”指针结合阿是穴苍龟探穴法治疗慢性非特异性下腰痛[J].针灸临床杂志,2013,29(11):4-6.
[2]Odermatt R,Wolfer A,Zaman K.Endocrine therapy in breast cancer:efficacy and adverse events[J].Revue medicale Suisse,2013,9(387):1090-1094.
[3]沈追孟.唑来膦酸对骨质疏松症的疗效及其对骨代谢指标的影响[J].中国生化药物杂志,2016,36(4):74-76.
[4]Bradley CJ,Dahman B,Jagsi R,et al.Prescription drug coverage:implications for hormonal therapy adherence in women diagnosed with breast cancer[J].Breast Cancer Res Treat,2015,154(2):417-422.
[5]Halsey EJ,Xing M,Stockley RC.Acupuncture for joint symptoms related to aromatase inhibitor therapy in postmenopausal women with early-stage breast cancer:a narrative review[J]Acupunct Med,2015,33(3):188-195.
[6]马芊,高昆.“苍龟探穴”针法治疗筋骨痛的理论与实践探讨[J].环球中医药,2017,10(2):182-1857.
[7]黄潇.苍龟探穴针法的理论基础与临床应用的文献研究[D].南宁:广西中医药大学,2015.
[8]覃佐爱,吴清明,尹程琳,等.蜂针阿是穴治疗急性腰扭伤临床疗效观察[J].中医药通报,2018,17(1):38-40.
[9]杨元庆,张智龙,李思,等.电针阿是穴治疗下腰痛临床观察[J].天津中医药,2017,34(5):315-319.
[10]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:178.
[11]马文杰,张仲柏,高堃,等.核糖核酸Ⅱ用于阿那曲唑治疗乳腺癌所致骨关节症状的临床观察[J].临床肿瘤学杂志,2017,22(1):26-30.
[12]邓享强,张赛赛,黄心熳,等.滞动针治疗第三腰椎横突综合征的研究进展[J].湖南中医杂志,2017,33(4):185-187.
[13]Redzovic A,Dintinjana RD,Nacinovic AD.Indicators of cellularand developmental disorders in multiple primary cancers[J].Coll Antropol,2016,40(1):59-62.
[14]袁博,胡金辉,周亮,等.补肾活血汤对乳腺癌患者芳香化酶抑制剂治疗后骨量减少的影响[J].中医药导报,2016,22(21):42-44.
[15]鹿晓君.双黄益骨方对芳香化酶抑制剂致乳腺癌患者骨量丢失骨代谢的影响[J].现代中西医结合杂志,2016,25(32):3604-3606.
[16]Mao JJ,Xie SX,Farrar JT,et al.A randomised trial of electro-acupuncture for arthralgia related to aromatase inhibitor use[J].Eur J Cancer,2014,50(2):267-276.
[17]梁荣华.补肾健脾方防治乳腺癌内分泌治疗后骨质疏松的机理研究[D].广州:广州中医药大学,2015.
[18]文翠菊,孙红娟,于新颖.芳香化酶抑制剂致乳腺癌患者骨关节疼痛及生活质量调查[J].中华现代护理杂志,2016,22(31):4448-4452.
[19]彭楠,于明薇,王笑民.芳香化酶抑制剂相关骨关节症状的研究进展[J].中国肿瘤临床,2015,42(21):1067-1070.
[20]钟莹.补肾强筋胶囊治疗乳腺癌AIMSS的临床研究[D].广州:广州中医药大学,2017.
[21]王天宝,吴玮,孙其斌,等.针刺"根三穴"配合微调手法治疗神经根型颈椎病疗效观察[J].西部中医药,2018,31(1):112-114.
[22]李超然,李甜,殷玉莲,等.补肾中药防治乳腺癌AIs引起的骨关节疼痛疗效观察[J].上海中医药杂志,2017,51(1):80-82,89.
[23]吕品,提桂香,王丽昀,等.针刺八荒穴治疗偏头痛急性发作期的临床研究[J].中国医药导报,2017,14(22):105-108.
[24]Castel LD,Hartmann KE,Mayer IA,et al.Time course of arthralgia among women initiating aromatase inhibitor therapy and apostmenopausal comparison group in a prospective cohort[J].Cancer,2013,119(13):2375-2382.
[25]张福侠,李彦龙,逯俭,等.根结穴针刺治疗腰椎间盘突出症40例[J].西部中医药,2017,30(2):94-95.
[26]滕迎春,于冬冬,关伟强,等.冉氏“益气通经”指针结合阿是穴苍龟探穴法治疗慢性非特异性下腰痛[J].针灸临床杂志,2013,29(11):4-6.