鼻内针刺治疗持续性中重度变应性鼻炎的临床研究

Clinical Study on Patients with Persistent Moderate and Severe Allergic Rhinitis Treated by Intranasal Acupuncture

目的观察鼻内针刺治疗变应性鼻炎(AR)的疗效,并探究其作用机制。方法将161例中重度AR患者采用随机数字表法分为针刺组(81例)和对照组(80例)。针刺组采用鼻内针刺治疗(经鼻内镜针刺双侧鼻腔内迎香穴),留针20 min,隔天1次;对照组每日口服氯雷他定片联合布地奈德鼻喷剂喷鼻治疗,两组均治疗14天。观察两组患者治疗前后总体症状及鼻部症状视觉模拟量表(VAS)、鼻-结膜炎相关生活质量问卷(RQLQ)评分的变化;采用ELISA法检测治疗前后针刺组患者血清IgE含量及鼻腔分泌物P物质(SP)、血管活性肠肽(VIP)、神经肽Y(NPY)的含量。结果与本组治疗前比较,两组患者VAS和RQLQ总评分均明显下降(P<0.05),针刺组患者血清IgE及鼻腔分泌物SP、VIP含量均明显下降(P<0.05),鼻腔分泌物NPY含量差异无统计学意义(P>0.05)。治疗后两组有效率及VAS、RQLQ总评分差异无统计学意义(P>0.05)。多数患者认为鼻内针刺疼痛程度较轻,可以耐受;且患者出血量不多,易止,未见其他明显不良反应。结论鼻内针刺可明显改善持续性中重度AR患者的鼻部症状,并提高其生活质量,其作用机制可能为通过调控鼻黏膜神经功能,并以神经肽为介质,经神经—免疫网络通调节免疫应答,从而降低神经源性炎症程度以有效改善AR症状。

Objective To observe the clinical efficacy of intranasal acupuncture in treating moderate-severe al-lergic rhinitis(AR)and to explore its effective mechanism.Methods Totally 161 patients with persistent moderate and severe allergic rhinitis were assigned to the acupuncture group(81 cases)and the control group(80 cases)by random number table.Patients in the acupuncture group were treated by intranasal acupuncture[acupuncture at Neiyingxiang points(EX-HN9)in both nasal cavities by nasal endoscope],and the needle was kept for 20 min,once every other day.While those in the control group were orally treated by Loratadine Tablets and Budesonide spray daily.The treatment course was 14 days for all.Before and after the treatment,the clinical symptoms were scored by Visual Analogue Scale(VAS)and Rhinoconjunctivitis Quality of Life Questionnaire(RQLQ)to assess the changes in both groups.The serum IgE,nasal secretions SP,VIP and NPY content in the acupunctuer group were detected by ELISA before and after the treatment.Results Compared with before treatment,the VAS and RQLQ total scores were significantly reduced in two groups(P<0.05),the serum IgE,nasal secretions SP and VIP content in the acupunctuer group were decreased significantly after treatment(P<0.05),and there was no statistical difference in nasal secretions NPY con-tent(P>0.05).There was no statistical difference between the two groups in effective rate,total score of VAS and RQLQ after treatment(P>0.05).Most patients felt mild pain during intranasal acupuncture and the pain could be toler-ated.In addition,the amount of nasal hemorrhage was not much,and easily stopped.There were no other obvious adverse reactions during the experiment.Conclusions Intranasal acupuncture can significantly improve the nasal symp-toms of patients with persistent moderate and severe AR and significantly improve their quality of life.The effective mechanism may be to regulate the nasal mucosal nerve function,and using neuropeptide as medium,to adjust the immune response through the neural-immune network pathway,in order to reduce the degree of neurogenic inflammation and then effectively improve AR symptoms.