有烟艾灸与无烟艾灸治疗肛门瘙痒症的临床效果对比及艾烟生成物的止痒效应研究

Clinical Efficacy of Smoking versus Smokeless Moxibustion and the Role of Products of Mugwort Somke in Antipruritic Effect in Treating Anal Pruritus

背景近年来,关于艾烟生成物、光辐射效应、温热效应中何者为艾灸治疗起效的关键因素已成为艾灸研究领域颇具争议的问题之一,但目前关于艾烟生成物是否参与艾灸治疗止痒效应的分析研究较少见。目的对比有烟艾灸与无烟艾灸治疗肛门瘙痒症的临床效果,并探讨艾烟生成物的止痒效应。方法选取2017年6月—2019年6月浙江中医药大学附属第一医院肛肠外科门诊收治的肛门瘙痒症患者62例,采用随机数字表法分为无烟艾灸治疗组30例和有烟艾灸治疗组32例。两组患者均采用温和灸长强穴治疗,其中无烟艾灸治疗组患者选用无烟艾条,有烟艾灸治疗组患者选用有烟艾条;以2周为1个疗程,两组患者均连续治疗2个疗程。比较两组患者治疗前后瘙痒程度、瘙痒频率,采用皮肤病生活质量指数(DLQI)评价两组患者治疗前及治疗2、4周后生活质量,记录两组患者对艾灸治疗的耐受情况及治疗期间不适/并发症发生情况。结果两组患者治疗后视觉模拟评分量表(VAS)/数字等级评定量表(NRS)比值及瘙痒频率均低于治疗前,且有烟艾灸治疗组患者VAS/NRS比值及瘙痒频率均低于无烟艾灸治疗组(P<0.05)。组间因素与时间因素在DLQI总分上存在交互作用(P<0.05);组间因素和时间因素在DLQI总分上主效应显著(P<0.05)。两组患者治疗2、4周后DLQI总分均低于治疗前,且治疗4周后DLQI总分低于治疗2周后(P<0.05);有烟艾灸治疗组患者治疗2、4周后DLQI总分均低于无烟艾灸治疗组(P<0.05)。两组患者均能耐受艾灸治疗,治疗期间均未出现明显不适/并发症。结论有烟艾灸治疗在降低肛门瘙痒症患者瘙痒程度、瘙痒频率及改善生活质量方面的效果均优于无烟艾烟治疗,而艾烟生成物是艾灸治疗发挥止痒效应的关键因素之一。

Background It is one of the disputed questions that which is the critical factor for the action of moxibustion therapy in products of mugwort smoke,photoradiation effect and warm-heat effect in recent years.However,there are few reports about the role of products of mugwort smoke in antipruritic effect of moxibustion therapy so far.Objective To explore the clinical efficacy of smoking versus smokeless moxibustion,and the role of products of mugwort smoke in antipruritic effect in treating anal pruritus.Methods From June 2017 to June 2019,62 patients with anal pruritus admitted to Department of Anus and Intestine Surgery,the First Affiliated Hospital of Zhejiang Chinese Medical University,were selected and divided into groups A(n=30)and B(n=32)by a table of random numbers.Patients in the two groups received warming moxibustion of Point GV1(Changqiang),thereinto patients in group A used smokeless moxa stick,while those in group B used smoking moxa stick.Both groups were treated for 2 consecutive courses(2 weeks as a course).Intergroup comparisons were performed regarding pre-and post-treatment pruritus degree,pruritus frequency,qualtiy of life evaluated by the Dermatology Life Quality Index(DLQI)before treatment and at the end of one and two courses of treatment,and tolerance to moxibustion and incidence of discomfort/complications during treatment.Results Post-treatment Visual Analogue Scale(VAS)/Numeric Rating Scale(NRS)ratio and pruritus frequency in both groups were significantly lower than those before treatment,and they were more significantly lower in group B(P<0.05).There was significant interaction on total score of DLQI between treatment method and time(P<0.05).Main effects of treatment method and time were both significant on total score of DLQI(P<0.05).In both groups,each of the total score of DLQI measured after treatment was lower than the baseline score(P<0.05),and the second measured score was lower than the first measured(P<0.05).Each of the total score of DLQI measured after treatment in group B was lower than that of group A(P<0.05).Patients in the two groups were tolerant to moxibustion therapy,and no one occurred any discomfort/complications.Conclusion Smoking moxibustion has better effect on lowing pruritus degree,reducing pruritus frequency and improving quality of life,and products of mugwort smoke play an important role in the antipruritic effect of moxibustion therapy.