祛风化痰通络止痉法联合西药治疗急性期特发性面神经麻痹临床研究

Clinical Study on Qufeng Huatan Tongluo Zhijing Method Combined with Western Medicine for Idiopathic Facial Paralysis at Acute Stage

目的:观察祛风化痰、通络止痉法联合西药治疗急性期特发性面神经麻痹(IFP)风寒袭络证的疗效及对面神经传导功能及相关细胞因子的影响。方法:选择急性期IFP风寒袭络证患者110例作为研究对象,根据入院顺序随机分为观察组和对照组,每组55例。对照组给予抗病毒药物、糖皮质激素及神经营养剂治疗,观察组在对照组基础上给予祛风化痰、通络止痉法针刺及中药内服。比较2组面神经功能、面神经传导功能及血清胶质细胞源性神经营养因子(GDNF)、神经生长因子(NGF)水平。评价2组临床疗效,记录不良反应情况。结果:治疗后,2组眼裂闭合、口角偏斜评分均下降(P<0.05),观察组眼裂闭合、口角偏斜评分均低于对照组(P<0.05);2组额肌、眼轮匝肌、口轮匝肌M波潜伏期均降低(P<0.05),观察组额肌、眼轮匝肌、口轮匝肌M波潜伏期均低于对照组(P<0.05);2组血清GDNF、NGF水平均提高(P<0.05),观察组血清GDNF、NGF水平均高于对照组(P<0.05);2组中医证候积分均降低(P<0.05),观察组中医证候积分低于对照组(P<0.05)。观察组总有效率为89.09%,显著高于对照组的72.73%(P<0.05)。观察组(9.09%)与对照组(0)不良反应发生率比较,差异有统计学意义(P<0.05)。结论:祛风化痰、通络止痉法联合西药治疗急性期IFP风寒袭络证能显著提升治疗效果,改善中医证候,促进面神经功能恢复,可能与增强GDNF、NGF等生长因子表达有关。

Objective: To observe the curative effect of Qufeng Huatan and Tongluo Zhijing method combined with western medicine for idiopathic facial paralysis(IFP) with wind-cold assailing the collaterals syndrome at acute stage,and its effect on conduction function of facial nerve and related cytokines. Methods: A total of 110 cases of IFP patients with wind-cold assailing the collaterals syndrome at acute stage were selected as the study subjects,and were divided into the observation group and the control group according to the order of admission,55 cases in each group. The control group was given antiviral medicine, glucocorticoid and nerve nutritional agents, and the observation group was additionally given acupuncture with Qufeng Huatan and Tongluo Zhijing method as well as oral administration of Chinese medicine based on the treatment of the control group. The facial nerve function,conduction function of facial nerve,and the levels of glial cell linederived neurotrophic factor(GDNF) and nerve growth factor(NGF) in serum were compared between the two groups. The clinical effect was evaluated. The incidence of adverse reactions was recorded. Results: After treatment, the scores of lagophthalmos and deviation of angle of mouth in the two groups were decreased(P<0.05), and the two scores in the observation group were lower than those in the control group(P<0.05). After treatment,M-wave latency of frontal muscle,orbicularis oculi muscle and orbicularis oris muscle in the two groups was decreased(P<0.05),and the M-wave latency in the observation group was lower than that in the control group(P<0.05). After treatment,the levels of GDNF and NGF in serum in the two groups were increased(P<0.05),and the two levels in the observation group were higher than those in the control group(P<0.05). After treatment, the Chinese medicine syndrome scores in the two groups were decreased(P<0.05),and the scores in the observation group were lower than those in the control group(P<0.05). The total effective rate was 89.09% in the observation group,significantly higher than that of 72.73% in the control group(P<0.05). The incidence of adverse reactions was 9.09% in the observation group,0 in the control group,and there was significant difference being found in the comparison of the incidence of adverse reactions between the two groups(P<0.05). Conclusion:For IFP patients with wind-cold assailing the collaterals syndrome at acute stage,the therapy of Qufeng Huatan and Tongluo Zhijing method combined with western medicine can significantly improve curative effect and Chinese medicine syndrome,and promote the recovery of facial nerve function. Its mechanism may be related to its enhancement to the expression of GDNF,NGF and other growth factors.