穴位埋线法治疗糖尿病周围神经病变随机对照研究
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摘要
目的:观察评价穴位埋线法治疗糖尿病周围神经病变(DPN)的临床疗效。方法:将符合诊断标准的60例DPN患者随机分为穴位埋线治疗组和普通针刺对照组各30例,两组均进行糖尿病基础治疗。治疗组选取双侧三阴交、足三里、外关、血海等穴位埋线,对照组选取与治疗组相同的穴位进行普通针刺治疗。观察两组患者治疗前后密歇根糖尿病周围神经病筛查表(MNSI)总积分、正中神经运动纤维传导速度(MNCV)和腓总神经感觉神经纤维传导速度(SNCV)的改变。结果:治疗后两组MNSI积分均较前降低(均P<0.05),且治疗组MNSI积分降低幅度优于对照组(P<0.05);治疗后两组MNCV、SNCV均较前提高(均P<0.05)。治疗后两组对比,治疗组MNCV和SNCV均优于普通针刺组(均P<0.05)。穴位埋线治疗组的总有效率优于普通针刺组(86.7%vs 63.3%,P<0.05)。结论:穴位埋线与普通针刺对DPN的治疗均有良好疗效,相较于普通针刺方法,穴位埋线治疗DPN疗效确切,作用柔和持久、不良反应少、弥补了单纯普通针刺穴位治疗作用时间短、治疗次数多、患者依从性差的缺陷。适合DPN的防治和长期应用,值得临床推广。
Objective:To observe the clinical curative effect of diabetic peripheral neuropathy(DPN)with catgut-embedding therapy. Methods:Sixty DPN patients were randomly divided into a catgutembedding therapy group and an acupuncture group. 30 cases in each group. Patients in the two groups received basic treatment to control blood sugar within a safe range. On this basis,patients in the catgutembedding therapy group were treated with catgut-embedding at"Sanyinjiao(SP 6)""Zusanli(ST 36)""Waiguan(SJ 5)""Xuehai(SP 10)"points,the treatment was given once a week,2 weeks for a course of treatment. Patients in another group were treated with ordinary acupuncture treatment. To observe two groups before and after treatment in patients with diabetic peripheral neuropathy screening MNSI total scores,and MNCV,SNCV changes. Results:After treatment the MNSI score of peripheral neuropathy was significantly reduced in the two group(all P<0.05),which was more significant in the catgut-embedding therapy group(P<0.05). After treatment,the sensory nerve conduction velocity(SNCV)and motor nerve conduction velocity(MNCV)of median nerve and common peroncal nerve were significantly increased in the two groups(all P<0.05). Compared between two groups after treatment,catgut-embedding therapy group were superior to the ordinary acupuncture group(P<0.05). Conclusion:Catgut-embedding therapy and the ordinary acupuncture treatment both have satisfied effects for distal symmetric multiple peripheral neuropathy,and catgut-embedding therapy is superior to medication on improving clinical sins of sensory disorder,reflection disturbance and muscle weakness nerve conduction and clinical curative effect,is suitable for the prevention and control of DPN,and long-term application,catgut-embedding therapy is worth to clinical promotion.
Objective:To observe the clinical curative effect of diabetic peripheral neuropathy(DPN)with catgut-embedding therapy. Methods:Sixty DPN patients were randomly divided into a catgutembedding therapy group and an acupuncture group. 30 cases in each group. Patients in the two groups received basic treatment to control blood sugar within a safe range. On this basis,patients in the catgutembedding therapy group were treated with catgut-embedding at"Sanyinjiao(SP 6)""Zusanli(ST 36)""Waiguan(SJ 5)""Xuehai(SP 10)"points,the treatment was given once a week,2 weeks for a course of treatment. Patients in another group were treated with ordinary acupuncture treatment. To observe two groups before and after treatment in patients with diabetic peripheral neuropathy screening MNSI total scores,and MNCV,SNCV changes. Results:After treatment the MNSI score of peripheral neuropathy was significantly reduced in the two group(all P<0.05),which was more significant in the catgut-embedding therapy group(P<0.05). After treatment,the sensory nerve conduction velocity(SNCV)and motor nerve conduction velocity(MNCV)of median nerve and common peroncal nerve were significantly increased in the two groups(all P<0.05). Compared between two groups after treatment,catgut-embedding therapy group were superior to the ordinary acupuncture group(P<0.05). Conclusion:Catgut-embedding therapy and the ordinary acupuncture treatment both have satisfied effects for distal symmetric multiple peripheral neuropathy,and catgut-embedding therapy is superior to medication on improving clinical sins of sensory disorder,reflection disturbance and muscle weakness nerve conduction and clinical curative effect,is suitable for the prevention and control of DPN,and long-term application,catgut-embedding therapy is worth to clinical promotion.
引文
[1]Ziegler D.Treatment of diabetic neuropathy and neuropathic pain:how far have we come[J].Diabetes Care,2008,Suppl 2:S255-261.
[2]Schreiber AK,Nones CF,Reis RC,et al.Diabetic neumpathic pain:Physiopathology and treatment[J].World Diabetes,2015,15(3):432-434.
[3]肖爽,程金莲,易京红.针灸治疗糖尿病周围神经病变临床研究现状[J].世界中西医结合杂志,2015(5):737-740.
[4]范丽红,舒仪琼.糖尿病周围神经病变的中西医治疗进展[J].中医药临床杂志,2013(8):738-740.
[5]于建军,孙忠人,闵冬梅,等.近10年针灸治疗糖尿病周围神经病变的临床研究概况[J].针灸临床杂志,2011(4):64-67.
[6]陈永斌,陈仁年,李玉兰.穴位埋线为主干预2型糖尿病早期肾病[J].中国针灸,2012(5):390-394.
[7]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中国糖尿病杂志,2014,22(8):2-42.
[8]庞国明,闫镛,朱璞,等.糖尿病周围神经病变中医诊疗规范初稿[J].中华中医药杂志,2010(2):260-264.
[9]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:233-237.
[10]路玫,李昆珊,王佳丽.针刺治疗糖尿病患者肢体远端对称性多发性周围神经病变:随机对照研究[J].中国针灸,2016(5):481-484.
[11]刘乡.针灸温阳疗法治疗糖尿病周围神经病变患者32例临床观察[J].中医杂志,2011(20):1745-1747.
[12]范华英,陈姣,杨明晓,等.针刺治疗糖尿病周围神经病变的研究进展[J].湖南中医杂志,2016(5):197-200.
[13]陈丽,梁凤霞,陈瑞,等.“标本配穴”针灸结合甲钴胺治疗糖尿病周围神经病变的临床对照研究[J].中国中西医结合消化杂志,2014(4):178-181.
[14]费爱华,蔡圣朝,陈颖,等.针刺对糖尿病周围神经病变疗效及hs-CRP的影响[J].上海针灸杂志,2011,30(2):99-100.
[15]张选平,贾春生,王建岭,等.穴位埋线疗法的优势病种及应用规律[J].中国针灸,2012(10):947-951.
[16]布的尔坡,张兴明.穴位埋线疗法的治疗原理与临床应用价值[J].西部医学,2009,21(5):852-854.
[17]金泽,任英杰,李峰,等.针刺配合穴位埋线治疗糖尿病周围神经病32例[J].针灸临床杂志,2014(2):20-21.
[18]边心会,张宏.穴位埋线对衰老模型大鼠慢性应激下海马神经元结构的影响[J].针刺研究,2014(1):35-39.
[19]罗雄,凌湘力.穴位埋线对糖尿病大鼠血浆内皮素、血清一氧化氮的影响[J].甘肃中医,2007(3):46-47.
[2]Schreiber AK,Nones CF,Reis RC,et al.Diabetic neumpathic pain:Physiopathology and treatment[J].World Diabetes,2015,15(3):432-434.
[3]肖爽,程金莲,易京红.针灸治疗糖尿病周围神经病变临床研究现状[J].世界中西医结合杂志,2015(5):737-740.
[4]范丽红,舒仪琼.糖尿病周围神经病变的中西医治疗进展[J].中医药临床杂志,2013(8):738-740.
[5]于建军,孙忠人,闵冬梅,等.近10年针灸治疗糖尿病周围神经病变的临床研究概况[J].针灸临床杂志,2011(4):64-67.
[6]陈永斌,陈仁年,李玉兰.穴位埋线为主干预2型糖尿病早期肾病[J].中国针灸,2012(5):390-394.
[7]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中国糖尿病杂志,2014,22(8):2-42.
[8]庞国明,闫镛,朱璞,等.糖尿病周围神经病变中医诊疗规范初稿[J].中华中医药杂志,2010(2):260-264.
[9]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:233-237.
[10]路玫,李昆珊,王佳丽.针刺治疗糖尿病患者肢体远端对称性多发性周围神经病变:随机对照研究[J].中国针灸,2016(5):481-484.
[11]刘乡.针灸温阳疗法治疗糖尿病周围神经病变患者32例临床观察[J].中医杂志,2011(20):1745-1747.
[12]范华英,陈姣,杨明晓,等.针刺治疗糖尿病周围神经病变的研究进展[J].湖南中医杂志,2016(5):197-200.
[13]陈丽,梁凤霞,陈瑞,等.“标本配穴”针灸结合甲钴胺治疗糖尿病周围神经病变的临床对照研究[J].中国中西医结合消化杂志,2014(4):178-181.
[14]费爱华,蔡圣朝,陈颖,等.针刺对糖尿病周围神经病变疗效及hs-CRP的影响[J].上海针灸杂志,2011,30(2):99-100.
[15]张选平,贾春生,王建岭,等.穴位埋线疗法的优势病种及应用规律[J].中国针灸,2012(10):947-951.
[16]布的尔坡,张兴明.穴位埋线疗法的治疗原理与临床应用价值[J].西部医学,2009,21(5):852-854.
[17]金泽,任英杰,李峰,等.针刺配合穴位埋线治疗糖尿病周围神经病32例[J].针灸临床杂志,2014(2):20-21.
[18]边心会,张宏.穴位埋线对衰老模型大鼠慢性应激下海马神经元结构的影响[J].针刺研究,2014(1):35-39.
[19]罗雄,凌湘力.穴位埋线对糖尿病大鼠血浆内皮素、血清一氧化氮的影响[J].甘肃中医,2007(3):46-47.