针刺对治疗患者面部痤疮、血清IGF-1、DHEA及改善其抑郁焦虑状态的研究
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摘要
1研究目的
目前国内外对痤疮、抑郁、焦虑的研究甚多,但曾未见透过针刺治疗面部痤疮来观察患者心里抑郁、焦虑状态改变的研究。本研究的目的为观察针灸刺血疗法对患者面部痤疮、心理临床症状及血清IGF—1,DHEA激素的影响；通过检测探讨其激素对痤疮皮损、患者心理状态的影响；并对可能出现的不良事件做出讨论。
2研究方法
2.1研究对象及分组
按患者纳入的先后顺序,将痤疮患者随机分配到治疗组和对照组。根据临床研究最小样本量,计划每组纳入30例病人,两组共60例,考虑20%脱失率,每组纳入36例患者,总计72例。
2.2治疗方法：
治疗组：
1.针刺疗法：(1)针刺穴位：针刺选穴曲池、百会、中渚、足三里、三阴交、太冲、太溪(体针穴位全部直刺平补平泻)面部皮损阿是穴(针尖扎入痤疮病灶处根底部为度,不做刺激手法),肺胃蕴热者加合谷、内庭；脾胃湿热者加中脘、内庭、天枢；痰瘀热结者加血海、内庭、和丰隆,留针20-25分钟。(2)刺血拔罐：针刺结束后,随之施行走罐疗法,由上往下,在双侧膀胱经,督脉上走罐各3次。再于背部大椎、双侧肺俞、膈俞穴点刺放血,3-5毫升(3)耳尖放血：耳尖消毒后,将耳廓对折,用一次性采血针一次性采血针行耳尖穴放血,每次12-15滴。(4)局部操作：痤疮局部消毒,以三棱针挑刺面部病灶处,将丘疹、囊肿,结节,粉刺挑破,挑出脂肪栓,再行脸部快速闪罐。
2.在针刺疗法的基础上给予饮食指导与控制,注意面部清洁方法。嘱咐病患禁食辛辣、油腻、生冷食物,调节睡眠起居时间,多喝水,多吃水果蔬菜,保持心情放松。
对照组：除了不施加针刺疗法及其他任何治疗之外,与治疗组同样进行饮食指导与控制,注意面部清洁方法；嘱咐病患禁食辛辣、油腻、生冷食物,调节睡眠起居时间,多喝水,多吃水果蔬菜,保持心情放松。
2.3观察指标和方法：
所有患者在治疗前及治疗6周后分别填写观察表格,纪录皮疹的性质及数目,如痤疮大小,丘疹,脓包,结节等；填写痤疮皮损严重度评分表,中医症状自评量表,痤疮抑郁自评量表,状态焦虑自评量表,体质焦虑自评量表。同时电话追踪日常生活起居正常,和患者保持联络,纪录出现的不良反应。用酶联免疫吸附试验(enzyme-linked immunosorbent assay, ELISA)测量治疗前后血清胰岛素生成因子-1(IGF-1)与血清脱氢表雄酮(DHEA)水平。2.5临床疗效评价：
参照1997年10月中华医学会美学与美容分会皮肤美容学组制定的《寻常痤疮严重程度分级和疗效判定标准》进行疗效评价。根据治疗前后痤疮患者皮损的数目来计算疗效指数；根据中医症状自评分数来做疗效评价。根据治疗前后的痤疮抑郁自评量表,状态焦虑自评量表及体质焦虑自评量表分数来观察痤疮患者心理状态的改变。
3.试验结果
3.1皮损疗效分析
3.1.1组内比较
在治疗6周后,治疗组皮损总有效率为74.91%,对照组总有效率为23.56%。3.1.2组间比较
经6周治疗观察,治疗组痤疮压痛分数降低0.67±0.09；瘙痒分数降低0.20±0.01；潮红分数降低1.044±0.02；囊肿分数降低0.55±±0.01；结节分数降低0.69±0.01。对照组痤疮压痛分数降低0.20±0.05；瘙痒分数降低0.01±0.04；潮红分数降低0.03±0.01；囊肿分数降低0.044±0.01；结节分数降低0.03±±0.01.治疗组在压痛感,皮肤瘙痒,潮红程度,囊肿数目,结节数目等方面的评分分数较对照组均显著降低,P<0.05,有统计学意义。
3.2中医症状量表评分分析
3.2.1组内比较
治疗组：治疗前中医症状量表总分为52.89±1.98,治疗后为42.95±1.53；治疗组治疗结束后中医症状总分与治疗前比较,P<0.05,差异显著,有统计学意义。对照组：治疗前中医症状总分为51.36±1.60,治疗后49.42±1.56,治疗后与治疗前比较P>0.05,差异不显著,无统计学意义。
3.2.1组间比较
治疗观察6周后,治疗组中医症状总分降低9.94±1.98；对照组中医症状总分降低1.94±1.60。经治疗,治疗组中医症状总分降低分值与对照组相比P<0.05,差异显著,有统计学意义,治疗组中医症状改善情况较明显。
3.3痤疮抑郁自评量表评分分析
3.3.1组内比较
治疗组：治疗前患者抑郁自评量表评分为48.27±1.60,治疗后为42.84±1.40,治疗后抑郁自评评分与治疗前比较,P<0.05,差异显著,有统计学意义；对照组：治疗前总分为46.83±1.30,治疗后为44.15±1.32,治疗后与治疗前比较P>05,差异不显著,无统计学意义。
3.3.2组间比较
治疗结束后,治疗组痤疮患者抑郁自评量表评分下降5.43±0.19；对照组下降2.6±0.02。经治疗,治疗组与对照组相比P<0.05,差异显著,有统计学意义,治疗组抑郁情况改善较对照组明显。
3.4状态焦虑自评量表评分分析
3.4.1组内比较
治疗组：治疗前患者状态焦虑自评量表评分为47.40±2.07,治疗后为41.14±1.63,治疗后状态焦虑自评量表评分与治疗前比较,P<0.05,差异显著,有统计学意义；对照组：治疗前总分为48.46±1.65,治疗后为48.36±1.84,治疗后与治疗前比较P>0.05,差异不显著,无统计学意义。
3.4.2组间比较
治疗结束后,治疗组痤疮患者状态焦虑自评量表评分下降5.36±0.42；对照组下降0.10±0.22。经治疗,治疗组与对照组相比P<0.05,差异显著,有统计学意义,治疗组状态焦虑情况改善较对照组明显。
3.5特质焦虑自评量表评分分析
3.5.1组内比较
治疗组：治疗前患者特质焦虑自评量表评分为47.00±1.57,治疗后为40.65±1.37,治疗后特质焦虑自评量表评分与治疗前比较,P<0.05,差异显著,有统计学意义；对照组：治疗前总分为47.86±1.68,治疗后为45.54±1.59,治疗后与治疗前比较尸>0.05,差异不显著,无统计学意义。
3.5.2组间比较
治疗结束后,治疗组痤疮患者特质焦虑自评量表评分下降6.35±0.20;对照组下降0.10±0.09。经治疗,治疗组与对照组相比P<0.05,差异显著,有统计学意义,治疗组特质焦虑情况改善较对照组明显。
3.6血清IGF-1变化分析
3.6.1组内比较
治疗组：治疗前患者血清IGF-1浓度为312.66±8.71ug/ml,治疗后为269.38±7.70ug/ml,治疗后血清IGF-1浓度与治疗前比较,P<0.01,差异显著,有统计学意义；对照组：治疗前总分为332.30±6.75ug/ml,治疗后为326.93±6.25ug/ml,治疗后与治疗前比较P>0.05,差异不显著,无统计学意义。
3.6.2组间比较
治疗结束后,治疗组痤疮患者血清IGF-1浓度下降43.28±1.01；对照组下降5.37±0.37。经治疗,治疗组与对照组相比P<0.05,差异显著,有统计学意义,治疗组血清IGF-1浓度下降较对照组明显。
3.7血清DHEA分析
3.7.1组内比较
治疗组：治疗前患者血清DHEA浓度为34.22±2.87ug/ml,治疗后为32.73±2.67ug/ml,治疗后血清DHEA浓度与治疗前比较,P<0.01,差异显著,有统计学意义；对照组：治疗前总分为30.97±3.54ug/ml,治疗后为30.42±3.46ug/ml,治疗后与治疗前比较P>0.05,差异不显著,无统计学意义。
3.7.2组间比较
治疗结束后,治疗组痤疮患者血清DHEA浓度下降3.06±1.11：对照组下降0.55±0.43。经治疗,治疗组与对照组相比P<0.05,差异显著,有统计学意义,治疗组血清DHEA浓度下降较对照组明显。
3.8血清IGF-1、DHEA与痤疮患者抑郁焦虑相关性分析
治疗前IGF-1浓度与痤疮皮损数相关系数为0.513(P<0.05),为正相关关系。状态焦虑自评分与痤疮皮损数相关系数为0.363(P<0.05),为正相关关系。IGF-1与痤疮皮损数量以外的其他指标没有相关性,DHEA与所有其他指标没有相关性。
4结论
1针刺疗法对各种寻常性痤疮皮损均有安全良好的治疗作用。
2针刺对痤疮所引起的并发症状如瘙痒,压痛,潮热,等症状有良好的改善作用。
3针刺可能通过降低血清IGF-1, DHEA水平,改善了痤疮患者皮损严重度、临床抑郁、焦虑状态。
1Purpose
To observe the therapeutic effect of acupuncture treatment on the clinical presentation of psychological behavior and blood serum hormone levels; to discuss the physiological mechanism of target hormones in relation to acne genesis and psychological influences; to observe and evaluate the safety protocols of the acupuncture treatment in this study.
2METHODS
2.1Subject and Grouping:All patients are randomly selected into Treatment and Control Group. According to Chinese Medicine differential disgnosis, patients are sub divided into FeiWei Yunre Group, Piwei Shire Group and Tanyu Rejie Group. The total number of test subjects is62, of which32are in Treatment group, and30are in Control group.
2.2Therapeutic Method:
Treatment Group:
1) Acupuncture treatment for20-25mins. Moderate stimulation bilaterally on LI11, DU20, SJ3, ST36, SP6, LI3, KI3, in addition, facial ASHI points with no manipulation. Feiwei Yunre Group add LI4, ST44; Piwei Shire group add REN12, ST44, ST25; Tanyu Rejie group add ST44, ST40, SP10.2) All treatments followed blood letting cupping, running sups on bladder and Du channel then puncture DU14, BL13, BL17, with cupping to release stagnant blood.3) Blood letting from ErJian,3-5drops.4) Using a sterile syringe needle and clean out the plugs in facial pustules, cysts, on acne affected areas. Dietary advice is given to include more vegetable and fruit, avoid oily, spicy food and raw meat. Exercise and maintain a relaxed attitude.
2) Control Group:Dietary advice is given to include more vegetable and fruit, avoid oily, spicy food and raw meat. Exercise and maintain a relaxed attitude.
2.3OBSERVATION METHOD
All test subjects will fill out TCM Diagnostic Evaluation Questionnaire, SDS questionnaire, SAI-TAI Anxiety Index, Quality of Life Questionnaire before and after the treatment period. Using enzyme-linked immunosorbent assay to evaluate the serum level of IGF-1, DHE A pre and post trial.
2.4Evaluation of Clinical Curative Effect
According to the standard set forth for Acne Vulgaris by the China Dermatological Medical Association for evaluation, sing the number of skin lesions to calculate improvement percentage; compare and contrast the scores obtained in the TCM Diagnostic Evaluation Questionnaire, SDS questionnaire, SAI-TAI Anxiety Index,
Quality of Life Questionnaire, and blood serum level of IGF-1and DHEA.
2.5Safety Protocol
Compare with initial test period, observe any subsequent side effects or adverse effects, if any. Make recommendations and evaluations on the treatment methodology.
3Result
3.1Skin Lesion Analysis
3.1.1. Groups Result
After6weeks of treatment, treatment group lesion improved by74.91%, control group23.56%。
3.1.2Group Comparison
After6weeks, treatment group improvements are as follows:Pain level0.67±0.09; Itchiness0.20±0.01; Rednessl.04±0.02; Cysts0.55±0.01; Pustules0.69±0.01; for Control Group:Pain level0.20±0.05, Itchiness0.01±0.04; redness0.03±0.01; cysts0.04±0.01; pustules0.03±0.01. All categories have improved in the Treatment group with P<0.05, carrying statistical significance.
3.2Traditional Chinese Medicine Symptom Questionnaire
3.2.1Group Result
Treatment Group result was52.89±1.98, after6weeks42.95±1.53; Treatment group result t analysis,P<0.05, significant statistical value。 Control Group:Initial score51.36±1.60, after6weeks is49.42±1.56, after t analysis, P>0.05, no statistical significance
3.2.1Group Comparison
After6weeks of treatment, Treatment group score lowered by9.94±1.980; control group score lowered by1.94±1.6. Treatment group improvemt significantly greater than control group.
3.3Zung Self Rating Depression Scare (SDS)
3.3.1Group Result
Treatment Group::Initial SDS score was48.27±1.60, after6weeks42.84±1.40, after t-score analysis, P<0.05, has statistical significance; Control group:initial score was46.83±1.30, after6weeks44.15±1.32, P>0.05, no statistical significance
3.3.2Group Comparison
After6weeks, treatment group score dropped by5.43±0.19; control group2.68±0.02。Chi Analysis P<0.05, statistically significant, treatment group result is better than control group.
3.4State Anxiety Index
3.4.1Group Result
Treatment group score was47.40±2.07, after treatment41.14±1.63, after t-score analysis, P<0.05, has statistical significance; Control group:initial score was48.46±1.65, after treatment48.36±1.84, P>0.05, no statistical significance
3.4.2Group Comparison
After6weeks, treatment group score dropped by5.36±0.42; Control group by0.10±0.22。 Chi Analysis P<0.05, statistically significant, treatment group result is better than control group.
3.5Trait Anxiety Index Analysis
3.5.1Group Result
Treatment group score was47.00±1.57, after treatment40.65±1.37, after t-score analysis, P<0.05, has statistical significance; Control group:initial score was47.86±1.68, after treatment45.54±1.59, P>0.05, no statistical significance
3.5.2Group Comparison
After6weeks, treatment group score dropped by6.35±0.20; Control group by0.10±0.09。 Chi Analysis P<0.05, statistically significant, treatment group result is better than control group.
3.6Blood Serum IGF-1Analysis
3.6.1Group Result
Treatment group IGF-1level was312.66±8.71ug/ml, after6weeks,269.38±7.70ug/ml, after t-score analysis, P<0.05, has statistical significance; Control group:initial serum level was332.30±6.753ug/ml, after6weeks326.93±6.25ug/ml, after t analysis, P>0.05, no statistical significance.
3.6.2Group Comparison
After6weeks, treatment group IGF-1Level dropped by43.28±1.01; control group by5.37±0.37。 Chi Analysis P<0.05, statistically significant, treatment group result is better than control group.
3.7Blood Serum DHEA Analysis
3.7.1Group Result
Treatment group DHEA level was34.22±2.87ug/ml, after6weeks,32.73±2.67, after t-score analysis, P<0.05, has statistical significance; Control group:initial serum level was30.97±3.54ug/ml, after6weeks30.42±3.46ug/ml, after t analysis, P>0.05, no statistical significance
3.7.2Group Comparison
After6weeks, treatment group DHEA Level dropped by3.06±1.11; control group by0.55±0.43。 Chi Analysis P<0.05, statistically significant, treatment group result is better than control group.
3.8Correlation analysis for IGF-1, DHEA to Depression and Anxiety Scores
Correlation coefficient of IGF-1to acne lesion count is0.513(P<0.05), Positively correlated。 State Anxiety and Acne lesion count correlation coefficient0.363(P<0.05=positively correlated.
IGF-1has not been found to have statistical correlation to any other markers in this study. DHEA has not been found to have correlation to any of the markets in this study.
4Conclusion
1Acupuncture treatment is effect against various type of Acne vulgaris.
2Acupuncture treatment is effective against acne comorbidities like itchiness, pain, redness and cysts.
3Acupuncture treatment improved the scores of SDS, SAI, TAI.
4Acupuncture treatment can lower blood serum IGF-1, DHEA to improve the negative psychological effect of Acne patients.
5Acupuncture is a safe and effective method in treating acne vulgaris while improving depressive and anxious behaviors of the patients.
目前国内外对痤疮、抑郁、焦虑的研究甚多,但曾未见透过针刺治疗面部痤疮来观察患者心里抑郁、焦虑状态改变的研究。本研究的目的为观察针灸刺血疗法对患者面部痤疮、心理临床症状及血清IGF—1,DHEA激素的影响；通过检测探讨其激素对痤疮皮损、患者心理状态的影响；并对可能出现的不良事件做出讨论。
2研究方法
2.1研究对象及分组
按患者纳入的先后顺序,将痤疮患者随机分配到治疗组和对照组。根据临床研究最小样本量,计划每组纳入30例病人,两组共60例,考虑20%脱失率,每组纳入36例患者,总计72例。
2.2治疗方法：
治疗组：
1.针刺疗法：(1)针刺穴位：针刺选穴曲池、百会、中渚、足三里、三阴交、太冲、太溪(体针穴位全部直刺平补平泻)面部皮损阿是穴(针尖扎入痤疮病灶处根底部为度,不做刺激手法),肺胃蕴热者加合谷、内庭；脾胃湿热者加中脘、内庭、天枢；痰瘀热结者加血海、内庭、和丰隆,留针20-25分钟。(2)刺血拔罐：针刺结束后,随之施行走罐疗法,由上往下,在双侧膀胱经,督脉上走罐各3次。再于背部大椎、双侧肺俞、膈俞穴点刺放血,3-5毫升(3)耳尖放血：耳尖消毒后,将耳廓对折,用一次性采血针一次性采血针行耳尖穴放血,每次12-15滴。(4)局部操作：痤疮局部消毒,以三棱针挑刺面部病灶处,将丘疹、囊肿,结节,粉刺挑破,挑出脂肪栓,再行脸部快速闪罐。
2.在针刺疗法的基础上给予饮食指导与控制,注意面部清洁方法。嘱咐病患禁食辛辣、油腻、生冷食物,调节睡眠起居时间,多喝水,多吃水果蔬菜,保持心情放松。
对照组：除了不施加针刺疗法及其他任何治疗之外,与治疗组同样进行饮食指导与控制,注意面部清洁方法；嘱咐病患禁食辛辣、油腻、生冷食物,调节睡眠起居时间,多喝水,多吃水果蔬菜,保持心情放松。
2.3观察指标和方法：
所有患者在治疗前及治疗6周后分别填写观察表格,纪录皮疹的性质及数目,如痤疮大小,丘疹,脓包,结节等；填写痤疮皮损严重度评分表,中医症状自评量表,痤疮抑郁自评量表,状态焦虑自评量表,体质焦虑自评量表。同时电话追踪日常生活起居正常,和患者保持联络,纪录出现的不良反应。用酶联免疫吸附试验(enzyme-linked immunosorbent assay, ELISA)测量治疗前后血清胰岛素生成因子-1(IGF-1)与血清脱氢表雄酮(DHEA)水平。2.5临床疗效评价：
参照1997年10月中华医学会美学与美容分会皮肤美容学组制定的《寻常痤疮严重程度分级和疗效判定标准》进行疗效评价。根据治疗前后痤疮患者皮损的数目来计算疗效指数；根据中医症状自评分数来做疗效评价。根据治疗前后的痤疮抑郁自评量表,状态焦虑自评量表及体质焦虑自评量表分数来观察痤疮患者心理状态的改变。
3.试验结果
3.1皮损疗效分析
3.1.1组内比较
在治疗6周后,治疗组皮损总有效率为74.91%,对照组总有效率为23.56%。3.1.2组间比较
经6周治疗观察,治疗组痤疮压痛分数降低0.67±0.09；瘙痒分数降低0.20±0.01；潮红分数降低1.044±0.02；囊肿分数降低0.55±±0.01；结节分数降低0.69±0.01。对照组痤疮压痛分数降低0.20±0.05；瘙痒分数降低0.01±0.04；潮红分数降低0.03±0.01；囊肿分数降低0.044±0.01；结节分数降低0.03±±0.01.治疗组在压痛感,皮肤瘙痒,潮红程度,囊肿数目,结节数目等方面的评分分数较对照组均显著降低,P<0.05,有统计学意义。
3.2中医症状量表评分分析
3.2.1组内比较
治疗组：治疗前中医症状量表总分为52.89±1.98,治疗后为42.95±1.53；治疗组治疗结束后中医症状总分与治疗前比较,P<0.05,差异显著,有统计学意义。对照组：治疗前中医症状总分为51.36±1.60,治疗后49.42±1.56,治疗后与治疗前比较P>0.05,差异不显著,无统计学意义。
3.2.1组间比较
治疗观察6周后,治疗组中医症状总分降低9.94±1.98；对照组中医症状总分降低1.94±1.60。经治疗,治疗组中医症状总分降低分值与对照组相比P<0.05,差异显著,有统计学意义,治疗组中医症状改善情况较明显。
3.3痤疮抑郁自评量表评分分析
3.3.1组内比较
治疗组：治疗前患者抑郁自评量表评分为48.27±1.60,治疗后为42.84±1.40,治疗后抑郁自评评分与治疗前比较,P<0.05,差异显著,有统计学意义；对照组：治疗前总分为46.83±1.30,治疗后为44.15±1.32,治疗后与治疗前比较P>05,差异不显著,无统计学意义。
3.3.2组间比较
治疗结束后,治疗组痤疮患者抑郁自评量表评分下降5.43±0.19；对照组下降2.6±0.02。经治疗,治疗组与对照组相比P<0.05,差异显著,有统计学意义,治疗组抑郁情况改善较对照组明显。
3.4状态焦虑自评量表评分分析
3.4.1组内比较
治疗组：治疗前患者状态焦虑自评量表评分为47.40±2.07,治疗后为41.14±1.63,治疗后状态焦虑自评量表评分与治疗前比较,P<0.05,差异显著,有统计学意义；对照组：治疗前总分为48.46±1.65,治疗后为48.36±1.84,治疗后与治疗前比较P>0.05,差异不显著,无统计学意义。
3.4.2组间比较
治疗结束后,治疗组痤疮患者状态焦虑自评量表评分下降5.36±0.42；对照组下降0.10±0.22。经治疗,治疗组与对照组相比P<0.05,差异显著,有统计学意义,治疗组状态焦虑情况改善较对照组明显。
3.5特质焦虑自评量表评分分析
3.5.1组内比较
治疗组：治疗前患者特质焦虑自评量表评分为47.00±1.57,治疗后为40.65±1.37,治疗后特质焦虑自评量表评分与治疗前比较,P<0.05,差异显著,有统计学意义；对照组：治疗前总分为47.86±1.68,治疗后为45.54±1.59,治疗后与治疗前比较尸>0.05,差异不显著,无统计学意义。
3.5.2组间比较
治疗结束后,治疗组痤疮患者特质焦虑自评量表评分下降6.35±0.20;对照组下降0.10±0.09。经治疗,治疗组与对照组相比P<0.05,差异显著,有统计学意义,治疗组特质焦虑情况改善较对照组明显。
3.6血清IGF-1变化分析
3.6.1组内比较
治疗组：治疗前患者血清IGF-1浓度为312.66±8.71ug/ml,治疗后为269.38±7.70ug/ml,治疗后血清IGF-1浓度与治疗前比较,P<0.01,差异显著,有统计学意义；对照组：治疗前总分为332.30±6.75ug/ml,治疗后为326.93±6.25ug/ml,治疗后与治疗前比较P>0.05,差异不显著,无统计学意义。
3.6.2组间比较
治疗结束后,治疗组痤疮患者血清IGF-1浓度下降43.28±1.01；对照组下降5.37±0.37。经治疗,治疗组与对照组相比P<0.05,差异显著,有统计学意义,治疗组血清IGF-1浓度下降较对照组明显。
3.7血清DHEA分析
3.7.1组内比较
治疗组：治疗前患者血清DHEA浓度为34.22±2.87ug/ml,治疗后为32.73±2.67ug/ml,治疗后血清DHEA浓度与治疗前比较,P<0.01,差异显著,有统计学意义；对照组：治疗前总分为30.97±3.54ug/ml,治疗后为30.42±3.46ug/ml,治疗后与治疗前比较P>0.05,差异不显著,无统计学意义。
3.7.2组间比较
治疗结束后,治疗组痤疮患者血清DHEA浓度下降3.06±1.11：对照组下降0.55±0.43。经治疗,治疗组与对照组相比P<0.05,差异显著,有统计学意义,治疗组血清DHEA浓度下降较对照组明显。
3.8血清IGF-1、DHEA与痤疮患者抑郁焦虑相关性分析
治疗前IGF-1浓度与痤疮皮损数相关系数为0.513(P<0.05),为正相关关系。状态焦虑自评分与痤疮皮损数相关系数为0.363(P<0.05),为正相关关系。IGF-1与痤疮皮损数量以外的其他指标没有相关性,DHEA与所有其他指标没有相关性。
4结论
1针刺疗法对各种寻常性痤疮皮损均有安全良好的治疗作用。
2针刺对痤疮所引起的并发症状如瘙痒,压痛,潮热,等症状有良好的改善作用。
3针刺可能通过降低血清IGF-1, DHEA水平,改善了痤疮患者皮损严重度、临床抑郁、焦虑状态。
1Purpose
To observe the therapeutic effect of acupuncture treatment on the clinical presentation of psychological behavior and blood serum hormone levels; to discuss the physiological mechanism of target hormones in relation to acne genesis and psychological influences; to observe and evaluate the safety protocols of the acupuncture treatment in this study.
2METHODS
2.1Subject and Grouping:All patients are randomly selected into Treatment and Control Group. According to Chinese Medicine differential disgnosis, patients are sub divided into FeiWei Yunre Group, Piwei Shire Group and Tanyu Rejie Group. The total number of test subjects is62, of which32are in Treatment group, and30are in Control group.
2.2Therapeutic Method:
Treatment Group:
1) Acupuncture treatment for20-25mins. Moderate stimulation bilaterally on LI11, DU20, SJ3, ST36, SP6, LI3, KI3, in addition, facial ASHI points with no manipulation. Feiwei Yunre Group add LI4, ST44; Piwei Shire group add REN12, ST44, ST25; Tanyu Rejie group add ST44, ST40, SP10.2) All treatments followed blood letting cupping, running sups on bladder and Du channel then puncture DU14, BL13, BL17, with cupping to release stagnant blood.3) Blood letting from ErJian,3-5drops.4) Using a sterile syringe needle and clean out the plugs in facial pustules, cysts, on acne affected areas. Dietary advice is given to include more vegetable and fruit, avoid oily, spicy food and raw meat. Exercise and maintain a relaxed attitude.
2) Control Group:Dietary advice is given to include more vegetable and fruit, avoid oily, spicy food and raw meat. Exercise and maintain a relaxed attitude.
2.3OBSERVATION METHOD
All test subjects will fill out TCM Diagnostic Evaluation Questionnaire, SDS questionnaire, SAI-TAI Anxiety Index, Quality of Life Questionnaire before and after the treatment period. Using enzyme-linked immunosorbent assay to evaluate the serum level of IGF-1, DHE A pre and post trial.
2.4Evaluation of Clinical Curative Effect
According to the standard set forth for Acne Vulgaris by the China Dermatological Medical Association for evaluation, sing the number of skin lesions to calculate improvement percentage; compare and contrast the scores obtained in the TCM Diagnostic Evaluation Questionnaire, SDS questionnaire, SAI-TAI Anxiety Index,
Quality of Life Questionnaire, and blood serum level of IGF-1and DHEA.
2.5Safety Protocol
Compare with initial test period, observe any subsequent side effects or adverse effects, if any. Make recommendations and evaluations on the treatment methodology.
3Result
3.1Skin Lesion Analysis
3.1.1. Groups Result
After6weeks of treatment, treatment group lesion improved by74.91%, control group23.56%。
3.1.2Group Comparison
After6weeks, treatment group improvements are as follows:Pain level0.67±0.09; Itchiness0.20±0.01; Rednessl.04±0.02; Cysts0.55±0.01; Pustules0.69±0.01; for Control Group:Pain level0.20±0.05, Itchiness0.01±0.04; redness0.03±0.01; cysts0.04±0.01; pustules0.03±0.01. All categories have improved in the Treatment group with P<0.05, carrying statistical significance.
3.2Traditional Chinese Medicine Symptom Questionnaire
3.2.1Group Result
Treatment Group result was52.89±1.98, after6weeks42.95±1.53; Treatment group result t analysis,P<0.05, significant statistical value。 Control Group:Initial score51.36±1.60, after6weeks is49.42±1.56, after t analysis, P>0.05, no statistical significance
3.2.1Group Comparison
After6weeks of treatment, Treatment group score lowered by9.94±1.980; control group score lowered by1.94±1.6. Treatment group improvemt significantly greater than control group.
3.3Zung Self Rating Depression Scare (SDS)
3.3.1Group Result
Treatment Group::Initial SDS score was48.27±1.60, after6weeks42.84±1.40, after t-score analysis, P<0.05, has statistical significance; Control group:initial score was46.83±1.30, after6weeks44.15±1.32, P>0.05, no statistical significance
3.3.2Group Comparison
After6weeks, treatment group score dropped by5.43±0.19; control group2.68±0.02。Chi Analysis P<0.05, statistically significant, treatment group result is better than control group.
3.4State Anxiety Index
3.4.1Group Result
Treatment group score was47.40±2.07, after treatment41.14±1.63, after t-score analysis, P<0.05, has statistical significance; Control group:initial score was48.46±1.65, after treatment48.36±1.84, P>0.05, no statistical significance
3.4.2Group Comparison
After6weeks, treatment group score dropped by5.36±0.42; Control group by0.10±0.22。 Chi Analysis P<0.05, statistically significant, treatment group result is better than control group.
3.5Trait Anxiety Index Analysis
3.5.1Group Result
Treatment group score was47.00±1.57, after treatment40.65±1.37, after t-score analysis, P<0.05, has statistical significance; Control group:initial score was47.86±1.68, after treatment45.54±1.59, P>0.05, no statistical significance
3.5.2Group Comparison
After6weeks, treatment group score dropped by6.35±0.20; Control group by0.10±0.09。 Chi Analysis P<0.05, statistically significant, treatment group result is better than control group.
3.6Blood Serum IGF-1Analysis
3.6.1Group Result
Treatment group IGF-1level was312.66±8.71ug/ml, after6weeks,269.38±7.70ug/ml, after t-score analysis, P<0.05, has statistical significance; Control group:initial serum level was332.30±6.753ug/ml, after6weeks326.93±6.25ug/ml, after t analysis, P>0.05, no statistical significance.
3.6.2Group Comparison
After6weeks, treatment group IGF-1Level dropped by43.28±1.01; control group by5.37±0.37。 Chi Analysis P<0.05, statistically significant, treatment group result is better than control group.
3.7Blood Serum DHEA Analysis
3.7.1Group Result
Treatment group DHEA level was34.22±2.87ug/ml, after6weeks,32.73±2.67, after t-score analysis, P<0.05, has statistical significance; Control group:initial serum level was30.97±3.54ug/ml, after6weeks30.42±3.46ug/ml, after t analysis, P>0.05, no statistical significance
3.7.2Group Comparison
After6weeks, treatment group DHEA Level dropped by3.06±1.11; control group by0.55±0.43。 Chi Analysis P<0.05, statistically significant, treatment group result is better than control group.
3.8Correlation analysis for IGF-1, DHEA to Depression and Anxiety Scores
Correlation coefficient of IGF-1to acne lesion count is0.513(P<0.05), Positively correlated。 State Anxiety and Acne lesion count correlation coefficient0.363(P<0.05=positively correlated.
IGF-1has not been found to have statistical correlation to any other markers in this study. DHEA has not been found to have correlation to any of the markets in this study.
4Conclusion
1Acupuncture treatment is effect against various type of Acne vulgaris.
2Acupuncture treatment is effective against acne comorbidities like itchiness, pain, redness and cysts.
3Acupuncture treatment improved the scores of SDS, SAI, TAI.
4Acupuncture treatment can lower blood serum IGF-1, DHEA to improve the negative psychological effect of Acne patients.
5Acupuncture is a safe and effective method in treating acne vulgaris while improving depressive and anxious behaviors of the patients.
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