针刺内关对急性左心衰患者临床疗效和血清炎症因子的影响

Effect of Acupuncture at Neiguan(PC6)on Clinical Efficacy and Eerum Inflammatory Factors in Patients with Acute Left Heart Failure

目的探讨针刺内关对急性左心衰患者的疗效及相关作用机制。方法收集我院2017年至2019年年间本院收治的80例急性左心衰患者,采用随机数字表法将患者按照入院时间随机分为对照组(n=36,西医常规疗法)和试验组(n=44,西医常规疗法联合针刺双侧内关穴治疗)。针刺治疗方案为2次/日,每次20分钟,连续治疗7天。观察两组患者干预后在临床指标(症状缓解率、NYHA心功能评级提升率、住院死亡率)、心肌损伤指标(血浆利钠肽(BNP)、肌钙蛋白)及血清炎症因子指标(白细胞介素-6(IL-6)、肿瘤坏死因子(TNF-α)、血清C反应蛋白(CRP))的变化。结果(1)干预后,试验组的症状缓解率、NYHA心功能评级改善率明显高于对照组(P<0.05);试验组患者的住院死亡率低于对照组,但无统计学差异(P>0.05)。(2)干预后,试验组BNP的下降水平明显高于对照组(P<0.05),且肌钙蛋白水平低于对照组,但无统计学差异(P>0.05)。(3)治疗后,试验组血清IL-6和CRP的表达明显低于对照组(P<0.05),但两组间TNF-α的含量无统计学差异。结论(1)在常规西医治疗的基础上给予针刺内关穴治疗可以改善急性左心衰患者的症状和心功能。(2)针刺可有效的降低患者血清心肌损伤相关标志物和炎性细胞因子的水平,这可能是针刺治疗急性左心衰的作用机制之一。

Objective To explore the curative effect and related mechanism of acupuncture at Neiguan(PC6)on acute left heart failure and mechanism.Methods 80 patients with acute left heart failure from 2017 to 2019 in our hospital were randomly divided into control group(n=36,conventional therapy of western Medicine)and experimental group(n=44,cConventional therapies in western medicine combined with acupuncture at bilateral Neiguan(PC6)).Two groups of patients were treated with the same western medicine treatment plan.On this basis,the experimental group added acupuncture at Neiguan(PC6),twice a day,treatment for 7 days.The changes of clinical indicators(symptom relief rate,mortality rate,NYHA heart function rating),myocardial injury index(plasma natriuretic peptide(BNP),troponin)and serum inflammatory factors(interleukin-6(IL-6),tumor necrosis factor(TNF-α),serum c-reactive protein(CRP))were compared between the two groups after intervention.Results(1)After the intervention,the symptom relief rate,NYHA heart function rating improvement rate in the experimental group were significantly higher than those in the control group(P<0.05).The mortality rate in the experimental group were lower than that in the control group,but with no significantly difference(P>0.05).(2)After the intervention,the serum level of BNP was more lower in the experimental group(P<0.05),but there was no difference between two groups in troponin(P>0.05).(3)After treatment,the patients serum IL-6 and the expression of CRP were significantly lower than the control group(P<0.05),but the content of TNF-αbetween the two groups had no statistical differences(P>0.05).Conclusion(1)Acupuncture at Neiguan(PC6)on the basis of traditional western medicine can improve the symptoms and cardiac function of patients with acute left heart failure.(2)Acupuncture can effectively reduce the levels of serum myocardial injury related markers and inflammatory cytokines in patients,which may be one of the mechanisms of acupuncture in the treatment of acute left heart failure.