透穴给药辅助治疗热毒壅盛证坏死性淋巴结炎:随机对照研究

Efficacy of medicinal penetration on acupoint as adjunctive therapy on histiocytic necrotizing lymphadenitis of heat-toxin syndrome:a randomized controlled trial

目的:评价透穴给药联合西药治疗热毒壅盛证坏死性淋巴结炎(HNL)患者的临床疗效,探讨治疗本病提高临床疗效的方法。方法:将72例热毒壅盛证HNL患者随机分为观察组和对照组,每组36例。对照组予以泼尼松片口服,每次10 mg,每日3次,连用5 d,5 d后每7天减少5 mg,40 d后停药。观察组在对照组药物治疗基础上加用清热消肿糊穴位贴敷疗法与超声药物透入疗法,取患侧外关、风池及患处阿是穴,每日治疗1次,连续治疗14d。评价两组患者治疗前与治疗7、14、28、40 d后靶淋巴结最大径、视觉模拟评分(VAS)、腋温及症状体征总积分各指标变化;治疗前与治疗14、40 d后白细胞(WBC)、血沉(ESR)、C反应蛋白(CRP)、乳酸脱氢酶(LDH)变化;随访半年观察患者复发情况。结果:(1)治疗14 d,观察组治愈率38.9%(14/36),优于对照组的16.7%(6/36,P<0.01);两组在治疗40 d的治愈率均为100%。(2)两组患者治疗7 d腋温、VAS评分及症状体征总积分,治疗14、28、40d淋巴结最大径、VAS评分、腋温及症状体征总积分均较治疗前明显下降(P<0.01);观察组治疗7dVAS评分、症状体征总积分,治疗14 d淋巴结最大径、VAS评分及症状体征总积分低于对照组(P<0.01)。(3)与治疗前比较,两组患者治疗14、40 d后WBC、CRP、ESR均明显改善(P<0.01),治疗40 d后两组患者LDH均降低(P<0.01);组间差异无统计学意义(P>0.05)。(4)随访时观察组复发率5.6%(2/36),对照组复发率16.7%(6/36),组间差异无统计学意义(P>0.05)。结论:透穴给药辅助西药治疗能有效缓解热毒壅盛证HNL患者不适症状,提高临床治愈率,为缩短西药疗程提供了研究方向。

Objective To evaluate the clinical efficacy of medicinal penetration on acupoint combined with medication for histiocytic necrotizing lymphadenitis(HNL)of heat-toxin syndrome,and to explore the methods of improving the clinical effect.Methods A total of 72 cases with HNL with heat-toxin syndrome were randomly divided into an observation group and a control group,36 cases in each group.The patients in the control group were treated with oral administration of prednisone tablets for 40 days(first 5 days:10 mg,three times a day;since then,reduced by5 mg every 7 days).In the observation group,on the basis of the medication in the control group,the patients were treated with acupoint application and ultrasonic drug penetration therapy,once a day for 14 days.The acupoints of Waiguan(TE 5),Fengchi(GB 20)of affected side and ashi points were selected.The changes of target lymph node swelling,visual analogue score(VAS),axillary temperature and total score of symptoms and signs were evaluated before treatment and 7,14,28 and 40 d into treatment;the changes of white blood cell(WBC),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)and lactic dehydrogenase(LDH)were evaluated on 14 d and 40 d into treatment;the patients were followed-up for half a year.Results①Fourteen days into treatment,the clinical cured rate in the observation group was 38.9%(14/36),which was superior to 16.7%(6/36)in the control group(P<0.01);the clinical cured rates were both 100%in the two groups on 40 d into treatment.②The VAS score,axillary temperature and the total score 7 d into treatment,as well as node swelling,VAS score,axillary temperature and the total score 14,28 and 40 d into treatment in the two groups were significantly improved(P<0.01);the total score and VAS score of 7 d into treatment,target lymph node swelling,VAS score and total score of 14 d into treatment in the observation group were significantly improved than those in the control group(P<0.01).③Compared before treatment,WBC,CRP,ESR in the two groups were significantly improved 14 d and 40 d into treatment(P<0.01),and LDH in the two groups were decreased 40 d into treatment(P<0.01),but there was no significant difference between the two groups(P>0.05).④The recurrence rate in the observation group was 5.6%(2/36),which was similar to 16.7%(6/36)in the control group(P>0.05).Conclusion The medicinal penetration on acupoint as adjunctive treatment could effectively relieve the discomfort symptoms of HNL patients with syndrome of heat and toxin,improve the clinical cured rate,and provide the research direction for shortening the course of medication.