基于玄府理论的刺络拔罐结合耳穴贴压治疗慢性自发性荨麻疹:随机对照研究

Chronic spontaneous urticaria treated with bloodletting therapy and auricular point sticking on the base of xuanfu theory: a randomized controlled trial

目的:比较基于玄府理论的刺络拔罐结合耳穴贴压与盐酸左西替利嗪口服溶液治疗慢性自发性荨麻疹(CSU)的临床疗效及对复发率的影响。方法:将86例CSU患者随机分为观察组(43例,脱落1例)和对照组(43例,脱落3例)。观察组采用刺络拔罐(穴取大椎、肺俞、膈俞、脾俞)结合耳穴贴压(穴取肺、肾、神门、心等)治疗,隔日治疗1次;对照组予盐酸左西替利嗪口服溶液治疗,每次10 mL,每日1次,两组均治疗4周。比较两组患者治疗前后7日荨麻疹活动度评分(UAS7)、皮肤病生活质量指数(DLQI)量表评分和血清免疫球蛋白E(IgE)、白细胞介素4(IL-4)、γ干扰素(IFN-γ)水平;评定两组患者临床疗效,并于治疗结束后4、8、12周随访复发率。结果:治疗后,两组患者UAS7、DLQI量表评分及血清IgE、IL-4水平均较治疗前降低(P<0.05),血清IFN-γ水平均较治疗前升高(P<0.05)。观察组总有效率为83.3%(35/42),对照组总有效率为85.0%(34/40),两组临床疗效比较差异无统计学意义(P>0.05)。治疗结束后8、12周,观察组患者复发率分别为21.1%(4/19)、26.3%(5/19),均低于对照组患者的55.0%(11/20)、65.0%(13/20,P<0.05)。结论:基于玄府理论的刺络拔罐结合耳穴贴压能改善CSU患者临床症状和血清IgE、IL-4、IFN-γ水平,提高患者生活质量,其临床疗效与盐酸左西替利嗪口服溶液相当,然而刺络拔罐结合耳穴贴压复发率较低,远期疗效更优。

Objective To compare the clinical therapeutic effect and the impacts on recurrence rate on chronic spontaneous urticaria(CSU) between the combined treatment of bloodletting therapy and auricular point sticking on the base of xuanfu theory and the oral solution of levocetirizine hydrochloride. Methods A total of 86 patients with CSU were randomized into an observation group(43 cases, 1 case dropped off) and a control group(43 cases, 3 cases dropped off). In the observation group, bloodletting therapy at Dazhui(GV 14), Feishu(BL 13), Geshu(BL 17) and Pishu(BL 20) was combined with auricular point sticking at lung(CO14), kidney(CO10), shenmen(TF4) and heart(CO15), etc. This combined treatment was given once every two days. In the control group, the oral solution of levocetirizine hydrochloride was prescribed, 10 mL each time, once daily. The treatment lasted for 4 weeks in the two groups. Before and after treatment,urticaria activity score 7(UAS7), the score of dermatology life quality index(DLQI) and the levels of serum immune globulin E(IgE), interleukin 4(IL-4) and interferon γ(IFN-γ) were compared in the patients between the two groups.The clinical therapeutic effect was evaluated in patients of the two groups and the recurrence rate was followed up 4, 8 and 12 weeks after treatment separately. Results After treatment, the scores of UAS7 and DLQI, as well as the levels of serum IgE and IL-4 were all reduced as compared with those before treatment in the two groups(P<0.05), and the level of serum IFN-γ was increased(P<0.05). The total effective rate was 83.3%(35/42) in the observation group and was 85.0%(34/40) in the control group. There was no statistical significance for the difference in the clinical therapeutic effect between the two groups(P>0.05). Eight and 12 weeks after treatment, the recurrence rates were 21.1%(4/19) and 26.3%(5/19) in the observation group, lower than 55.0%(11/20) and 65.0%(13/20) in the control group, respectively(P<0.05). Conclusion The combined therapy of bloodletting and auricular point sticking on the base of xuanfu theory relieves the clinical symptoms, regulates the levels of serum IgE, IL-4 and IFN-γ and improves the quality of life in the patients with CSU. The clinical therapeutic effect of this combined treatment is similar to the oral solution of levocetirizine hydrochloride. But, the recurrence rate of the combined treatment of bloodletting and auricular point sticking is lower and its long-term curative effect is better.