火针结合桃红四物汤加味外涂治疗老年性皮肤瘙痒症疗效观察

Clinical efficacy of fire acupuncture combined with modified Taohong Siwu Decoction in the treatment of senile skin pruritus

目的探讨应用中医火针联合桃红四物汤加味外涂对老年性皮肤瘙痒症的治疗效果。方法选取2018年1月至2019年1月肇庆医学高等专科学校附属医院收治的120例老年性皮肤瘙痒症患者为研究对象,按照抽签法分为对照组和观察组,每组60例。两组均给予基础护理,对照组采用氯雷他定治疗,观察组则采用火针结合桃红四物汤加味外涂治疗,均治疗4周,比较两组患者的临床疗效,以及治疗前后的瘙痒症状评分、细胞因子[γ-干扰素(IFN-γ)、白介素2(IL-2)、肿瘤坏死因子(TNF-α)、白介素4(IL-4)、白介素6(IL-6)、免疫球蛋白E(IgE)抗体]水平;随访2年,比较两组患者的复发情况。结果治疗前两组患者的各项瘙痒症状评分比较差异均无统计学意义(P>0.05);治疗后,观察组患者的瘙痒症状程度、面积、频率、持续时间、睡眠影响症状评分分别为(1.06±0.08)分、(0.96±0.05)分、(0.86±0.14)分、(0.86±0.23)分、(1.06±0.35)分,明显低于对照组的(1.26±0.06)分、(1.12±0.07)分、(1.23±0.10)分、(1.25±0.22)分、(2.15±0.36)分,差异均有统计学意义(P<0.05);治疗后,两组患者的血清学指标均显著降低,且观察组患者的IFN-γ、TNF-α、IgE抗体水平分别为(5.06±0.13)μg/L、(32.15±2.15)fmol/mL、(0.98±0.32)mg/L,明显低于对照组的(5.36±0.15)μg/L、(40.20±2.26)fmol/mL、(1.10±0.21)mg/L,差异均有统计学意义(P<0.05);治疗后,观察组患者的IL-2、IL-4、IL-6水平分别为(6.85±1.21)μg/L、(5.36±0.96)μg/L、(6.21±0.52)μg/L,明显低于对照组的(7.59±1.26)μg/L、(7.26±0.75)μg/L、(7.06±0.54)μg/L,差异均有统计学意义(P<0.05);观察组患者的治疗总有效率为88.33%,明显高于对照组的68.33%,差异有统计学意义(P<0.05);随访2年,观察组和对照组患者的复发率分别为10.00%、8.33%,差异无统计学意义(P>0.05)。结论老年性皮肤瘙痒症患者应用火针联合桃红四物汤加味外涂的疗法能有效改善患者的瘙痒情况,改善机体炎症水平,临床疗效显著。

Objective To explore the clinical efficacy of fire acupuncture plus Taohong Siwu Decoction in the treatment of senile skin pruritus.Methods A total of 120 patients of senile skin pruritus admitted to the Affiliated Hospi-tal of Zhaoqing Medical College from January 2018 to January 2019 were selected and divided into two groups according to the method of drawing lots,each with 60 patients.Based on basic nursing,the control group was treated with loratadine,and the treatment group received fire acupuncture combined with modified Taohong Siwu Decoction,each for 4 weeks.The scores of itching symptoms and cell factors(interferon-r[IFN-γ],interleukin-2[IL-2],tumor necrosis factor[TNF-α],interleukin 4[IL-4],interleukin 6[IL-6],immunoglobulin E[IgE]antibodies)before and after treatment were compared between the two groups,and the clinical efficacy was evaluated.The patients were followed up for 2 years and the recurrence rate was compared.Results Before treatment,there was no significant difference in the scores of itching symptoms between the two groups(P>0.05);after treatment,the scores of itching symptom degree,area,frequency,dura-tion,and sleep influence in the treatment group were(1.06±0.08)points,(0.96±0.05)points,(0.86±0.14)points,(0.86±0.23)points,(1.06±0.35)points,respectively,which were significantly lower than(1.26±0.06)points,(1.12±0.07)points,(1.23±0.10)points,(1.25±0.22)points,(2.15±0.36)points in the control group(P<0.05).After treatment,the serum index-es of the two groups were significantly decreased,and the levels of IFN-γ,TNF-α,and IgE antibody in the treatment group were(5.06±0.13)μg/L,(32.15±2.15)fmol/mL,(0.98±0.32)mg/L,respectively,which were significantly lower than(5.36±0.15)μg/L,(40.20±2.26)fmol/mL,(1.10±0.21)mg/L in the control group(P<0.05).The levels of IL-2,IL-4,and IL-6 in the treatment group were(6.85±1.21)μg/L,(5.36±0.96)μg/L,and(6.21±0.52)μg/L,respectively,which were significantly lower than(7.59±1.26)μg/L,(7.26±0.75)μg/L,and(7.06±0.54)μg/L in the control group(P<0.05).The effective rate of the treatment group was 88.33%,significantly higher than 68.33%of the control group(P<0.05).After 2 years of follow-up,5 cases recurred in the control group(8.33%)and 6 cases recurred in the treatment group(10.00%),and there was no significant difference between the two groups(P>0.05).Conclusion In the elderly patients with pruritus,the application of fire acupuncture and modified Taohong Siwu Decoction can effectively improve the pruritus of patients,improve the level of inflammation,and results in significant clinical effect.