针刺对慢性酒精中毒性周围神经病患者神经功能及心理的影响

Effects of Acupuncture on Neurofunction and Neuropsychological Factors of Chronic Alcoholic Peripheral Neuropathy Patients

目的观察针刺疗法对慢性酒精中毒性周围神经病(chronic alcoholic peripheral neuropathy,CAPN)患者神经功能及心理的影响。方法采用随机数字表法将120例CAPN患者分为针刺治疗A组、针刺治疗B组及普通治疗组,每组40例。3组均给予常规药物治疗。在此基础上,针刺治疗A组取穴脾俞、胃俞、血海、阴陵泉、足三里、阳陵泉、解溪、悬钟、陷谷、太溪、曲池、外关、合谷等治疗,针刺治疗B组在针刺治疗A组方案基础上加选四神聪、印堂、内关、太冲、三阴交、太阳治疗。每日1次,14日为1个疗程,治疗2个疗程。后隔日针刺1次,治疗14次,共4周。连续治疗8周。观察治疗前后下肢神经损害量表(Neuropathy Impairment Score in the Lower Limbs,NIS-LL)、神经系统症状评分(Neurological Severity Score,NSS)评分、汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)及汉密尔顿焦虑量表(Hamilton Anxiety Scale,HAMA)评分并检测运动神经传导速度(motor nerve conduction velocity,MCV)及感觉神经传导速度(sensory nerve conduction velocity,SCV)变化。结果与本组治疗前比较,治疗8周后,3组NIS-LL、NSS评分均明显降低(P<0.05)。与普通治疗组比较,针刺治疗A、B组治疗后NIS-LL、NSS评分均降低(P<0.05),且针刺治疗B组评分下降更明显(P<0.05);与本组治疗前比较,治疗8周后,针刺治疗A组、针刺治疗B组正中神经、尺神经、腓总神经、胫神经MCV、SCV均增加(P<0.05);普通治疗组正中神经MCV,腓总神经、胫神经MCV、SCV增加(P<0.05);与普通治疗组比较,针刺治疗A组及B组治疗后正中神经SCV、尺神经、腓总神经及胫神经MCV、SCV明显增加(P<0.05),针刺治疗B组尺神经MCV、腓总神经及胫神经MCV、SCV增加较针刺治疗A组更明显(P<0.05);与本组治疗前比较,治疗8周后,针刺治疗A组及B组HAMD、HAMA评分明显降低,普通治疗组HAMD评分亦明显降低(均P<0.05),针刺治疗B组HAMD、HAMA评分降低水平较针刺治疗A组更明显(P<0.05)。结论针刺治疗可显著改善CAPN患者的神经功能,加选四神聪、印堂、太冲、三阴交、太阳诸穴对其合并的焦虑及抑郁有改善作用。

Objective To observe the effects of acupuncture on neurofunction and neuropsychological factors of chronic alcoholic peripheral neuropathy（ CAPN） patients. Methods Totally 120 CAPN patients were assigned to the common treatment group,acupuncture group A,and acupuncture group B according to random digit table,40 in each group. All patients recieved conventional drug therapy. Besides,patients in the acupuncture group A were additionally needled at Pishu（ BL20）,Weishu（ BL21）,Xuehai（ SP10）,Yinlingquan（ SP9）,Zusanli（ ST36）,Yanglingquan（ GB34）,Jiexi（ ST41）,Xuanzhong（ GB39）,Xiangu（ ST43）,Taixi（ KI3）,Quchi（ LI11）,Waiguan（ SJ5）,Hegu（ LI4）,and so on. On these bases patients in the acupuncture group B were needled at Sishencong（ EX-HN1）,Yintang（ EX-HN3）,Neiguan（ PC6）,Taichong（ LR3）,Sanyinjiao（ SP6）,and Taiyang（ EX-HN5）. Acupuncture was performed once a day,14 times as a course; and then once on every other day,14 times in total for 4 weeks. All treatment lasted for 8 successive weeks. Neuropathy Impairment Score in the Lower Limbs（ NIS-LL）,Neurological Severity Score（ NSS）,Hamilton Depression Scale（ HAMD）,and Hamilton Anxiety Scale（ HAMA） were assessed,motor nerve conduction velocity（ MCV） and sensory nerve conduction velocity（ SCV） were detected before and after treatment. Results After 8 weeks of treatment the scores of NIS-LL and NSS significantly decreased in the 3 groups,with statistical difference as compared with before treatment（P〈0. 05）. Scores of NIS-LL and NSS decreased more in acupuncture groups A and B than in the common treatment group（P〈0. 05）,and more obvious in acupuncture group B（P〈0. 05）. Compared with the same group before treatment,MCV and SCV of median nerve,ulnar nerve,common peroneal nerve and tibial nerve increased in acupuncture treatment group A and B after 8-week treatment（P〈0. 05）. MCV of median nerve,MCV and SCV of common peroneal nerve and tibial nerve significantly increased in the common treatment group（P〈0. 05）. Compared with the common treatment group,SCV of median nerve,MCV and SCV of ulnar nerve,common peroneal nerve and tibial nerve obviously increased in acupuncture treatment groups A and B after treatment（P〈0. 05）. MCV of ulnar nerve,MCV and SCV of common peroneal nerve and tibial nerve obviously increased more in acupuncture treatment group A than in acupuncture treatment group B（P〈0. 05）. At week 8 after treatment scores of HAMD and HAMA were obviously lowered in acupuncture groups A and B,with statistical difference as compared with before treatment（ P〈0. 05）. The scores of HAMD were also decreased in the common treatment group,as compared with before treatment（P〈0. 05）. At week 8 after treatment scores of HAMD and HAMA were obviously lowered more in acupuncture treatment group B than in acupuncture treatment group A（P〈0. 05）. Conclusion Acupuncture therapy could effectively improve the neurofunction of CAPN patients,and improve complicated anxiety and depression by additionally needling at Sishencong（ EX-HN1）,Yintang（ EX-HN3）,Taichong（ LR3）,Sanyinjiao（ SP6）,and Taiyang（ EX-HN5）.