针刺迎香穴联合清热通窍汤加减治疗过敏性鼻炎临床研究

Clinical Study on Acupuncture at Yingxiang Point Combined with Modified Qingre Tongqiao Decoction for Allergic Rhinitis

目的:观察针刺迎香穴联合清热通窍汤加减治疗过敏性鼻炎的临床疗效。方法:选择98例过敏性鼻炎患者,按随机数字表法分为参照组与研究组各49例。参照组给予西医基础治疗,研究组在参照组基础上给予针刺迎香穴联合清热通窍汤加减治疗。比较2组治疗前后转化生长因子-β (TGF-β)、白细胞介素-4 (IL-4)、白细胞介素-5 (IL-5)、肿瘤坏死因子-α (TNF-α)、可溶性血管细胞黏附分子-1 (sVCAM-1)、白细胞介素-33 (IL-33)、特异性免疫球蛋白E (IgE)、集落刺激因子(CSF)、嗜酸粒细胞(EOS)、微小R-487b (miR-487b)、水通道蛋白1 (AQP1)、鼻阻力(NR)、鼻黏膜纤毛输送率(MTR)、鼻黏膜纤毛传输时间(MTT)、鼻黏膜纤毛清除速率(MCV)、峰值呼气流速(PEF)、PEF昼夜变异率、第1秒用力呼气容积(FEV1)水平及症状评分、鼻结膜炎生存质量量表(RQLQ)评分,并比较2组临床疗效及不良反应。结果:研究组治疗总有效率95.92%,高于参照组83.67%(P<0.05)。治疗后,2组sVCAM-1、IL-5水平降低(P<0.05),且研究组低于参照组(P<0.05),2组TGF-β、IL-10水平升高(P<0.05),且研究组高于参照组(P<0.05)。治疗后,2组TNF-α、IL-33、AQP1水平降低(P<0.05),且研究组低于参照组(P<0.05),2组miR-487b水平升高(P<0.05),且研究组高于参照组(P<0.05)。治疗后,2组CSF、特应性IgE、EOS水平均降低(P<0.05),且研究组低于参照组(P<0.05)。治疗后,2组MCV、MTR水平升高(P<0.05),且研究组高于参照组(P<0.05),2组NR、MTT水平降低(P<0.05),且研究组低于参照组(P<0.05)。治疗后,2组PEF昼夜变异率降低(P<0.05),且研究组低于参照组(P<0.05),2组FEV1、PEF水平升高(P<0.05),且研究组高于参照组(P<0.05)。治疗后,2组症状、RQLQ评分降低(P<0.05),且研究组低于参照组(P<0.05)。研究组不良反应总发生率低于参照组(P<0.05)。结论:针刺迎香穴联合清热通窍汤加减治疗过敏性鼻炎,可改善患者免疫应答,抑制机体炎症,提升通气及鼻黏膜纤毛功能,缓解患者致敏症状,提升患者临床疗效及生活质量,降低不良反应发生率。

Objective:To observe the clinical effect of acupuncture at Yingxiang point(LI 20) combined with modified Qingre Tongqiao Decoction for allergic rhinitis.Methods:A total of 98 cases of patients with allergic rhinitis were selected and divided into the reference group and the study group according to the random number table method,with 49 cases in each group.The reference group was treated with basic western medicine treatment,and the study group was additionally treated with acupuncture at Yingxiang point(LI 20) combined with modified Qingre Tongqiao Decoction based on the treatment of the reference group.Before and after treatment,the following indexes were compared between the two groups:transforming growth factor-β(TGF-β),interleukin-4(IL-4),interleukin-5(IL-5),tumor necrosis factor-α(TNF-α),soluble vascular cell adhesion molecule-1(sVCAM-1),interleukin-33(IL-33),atopic Immunoglobulin E(IgE),colony stimulating factor(CSF),eosinophils(EOS),micro RNA-487b(miR-487b),aquaporin 1(AQP1),nasal resistance(NR),nasal mucociliary transport rate(MTR),nasal mucociliary transport time(MTT),nasal ciliary clearance velocity(MCV),peak expiratory flow rate(PEF),day-night variability rate(%) of PEF,the levels of forced expiratory volume in one second(FEV1),and the scores of Rhinoconjunctivitis Quality of Life Questionnaire(RQLQ).Clinical effects and adverse reactions were compared between the two groups.Results:The total effective rate was 95.92% in the study group,higher than that of 83.67% in the reference group(P<0.05).After treatment,the levels of sVCAM-1 and IL-5 in the two groups were decreased(P<0.05),and the two levels in the study group were lower than those in the reference group(P<0.05);the levels of TGF-β and IL-10 in the two groups were increased(P<0.05),and the two levels in the study group were higher than those in the reference group(P<0.05).After treatment,the levels of TNF-α,IL-33,and AQP1 in the two groups were decreased(P<0.05),and the three levels in the study group were lower than those in the reference group(P<0.05);the level of miR-487b in the two groups were increased(P<0.05),and the level in the study group was higher than that in the reference group(P<0.05).After treatment,the levels of CSF,atopic IgE,and EOS in the two groups were decreased(P<0.05),and the three levels in the study group were lower than those in the reference group(P<0.05).After treatment,the levels of MCV and MTR in the two groups were increased(P<0.05),and the two levels in the study group were higher than those in the reference group(P<0.05);the levels of NR and MTT in the two groups were decreased(P<0.05),and the two levels in the study group were lower than those in the reference group(P<0.05).After treatment,day-night variability rates of PEF in the two groups were decreased(P<0.05),and the rate in the study group was lower than that in the reference group(P<0.05);the levels of FEV1and PEF in the two groups were increased(P<0.05),and the two levels in the study group were higher than those in the reference group(P<0.05).After treatment,the scores of symptoms and RQLQ in the two groups were decreased(P<0.05),and the above scores in the study group were lower than those in the reference group(P<0.05).The total incidence of adverse reactions in the study group was lower than that in the reference group(P<0.05).Conclusion:Acupuncture at Yingxiang point(LI 20) combined with modified Qingre Tongqiao Decoction for allergic rhinitis can improve the patient's immune response,suppress inflammation,enhance ventilation and nasal mucosal ciliary function,alleviate sensitization symptoms,improve clinical effects and quality of life,and reduce the incidence of adverse reactions.