基于析因设计的天灸疗法防治虚寒型哮喘优化研究

Clinical Study on Vesiculation Moxibustion in Preventing and Treating Asthma Due to Cold Deficiency

目的探寻天灸疗法防治虚寒型哮喘的最佳穴位组合及药物配伍。方法将554例虚寒型支气管哮喘患者随机分为A组(虚寒药+虚寒穴组)138例、B组(虚寒药+常规穴组)138例、C组(常规药+虚寒穴组)139例和D组(常规药+常规穴组)139例,以哮喘临床症状评分、哮喘控制测试表(ACT)和哮喘生存质量评定表(AQLQ)为观察指标,进行两因素(穴位、药物)和两水平(常规、虚寒)的2×2析因设计研究。结果 A组总有效率为96.4%,B组为93.5%,C组为94.2%,D组为83.5%,4组患者组间疗效经秩和检验,差异具有统计学意义(P<0.01)。A组总有效率与B组、C组和D组比较,差异均具有统计学意义(P<0.05)。B组和C组总有效率与D组比较,差异均具有统计学意义(P<0.05)。4组患者治疗后各项临床症状评分与同组治疗前比较,差异均具有统计学意义(P<0.01)。A组治疗后各项临床症状评分与B组、C组和D组比较,差异均具有统计学意义(P<0.05)。B组和C组治疗后各项临床症状评分与D组比较,差异均具有统计学意义(P<0.05)。B组治疗后各项临床症状评分与C组比较,差异无统计学意义(P>0.05)。4组患者治疗后ACT评分及AQLQ各项评分与同组治疗前比较,差异均具有统计学意义(P<0.01)。A组治疗后ACT评分及AQLQ各项评分与B组、C组和D组比较,差异均具有统计学意义(P<0.01)。B组治疗后ACT评分及AQLQ各项评分与D组比较,差异具有统计学意义(P<0.05)。结论天灸疗法防治虚寒型哮喘患者总有效率以虚寒药+虚寒穴组最高,药物和穴位两者具有交互作用,虚寒穴位配合虚寒药物可减轻患者的临床症状,控制哮喘发作,并提高患者生存质量。

Objective To explore the optimal acupoint and medicine compatibility in vesiculation moxibustion for asthma due to cold deficiency. Method Totally 554 patients with bronchial asthma due to cold deficiency were randomized into group A （medicines plus acupoints for cold deficiency） （n= 138）, group B （medicines for cold deficiency plus conventional acupoints） （n= 138）, group C （conventional medicines plus acupoints for cold deficiency） （n=139）, and group D （conventional medicines plus conventional acupoints） （n=139）. The asthma symptom score, asthma control test （ACT）, and Asthma Quality of Life Questionnaire （AQLQ） were adopted as the observation indexes, to conduct a two-factor （acupoint, medicine） two-level （conventional, cold-deficiency） 2x2 factorial design. Result The total effective rate was 96.4% in group A, versus 93.5% in group B, 94.2% in group C, and 83.5% in group D, and the differences among the four groups were statistically significant according to rank-sum test （P〈0.01）. The total effective rate of group A was significantly different from that of group B, C, and D （P〈0.05）. The total effective rates of group B and group C were significantly different from that of group D （P〈0.05）. After treatment, the four groups all achieved significant changes in symptom scores （P〈0.01）. Group A was markedly different from group B, C, and D in comparing the symptom score after treatment （P〈0.05）. The symptom scores in group B and C were significantly different from that in group D after treatment （P〈0.05）. There was no significant difference in comparing the symptom score between group B and C after treatment （P〉0.05）. The four groups all achieved significant changes in ACT and AQLQ scores after treatment （P〈0.01）. Group A was significantly different from group B, C and D in comparing the ACT and AQLQ scores after treatment （P〈0.01）. Group B was significantly different from group D in comparing the ACT and AQLQ scores after treatment （P〈0.05）. Conclusion With medicines and acupoints for cold deficiency, vesiculation moxibustion produces the highest total effective rate in preventing and treating asthma due to cold deficiency. The medicines and acupoints work interactively to reduce the asthma symptoms, control the attack, and improve the quality of life.