督三针配合手足挛三针治疗早中期帕金森病肌强直的随机对照试验

Du(督)Three Needles Combined with Hand&Foot Luan(挛)Three Needles in the Treatment of Myotonia During Early-Mid Stage Parkinson's Disease:A Randomized Controlled Trial

目的观察督三针配合手足挛三针治疗早中期帕金森病肌强直的临床疗效和安全性,并探讨可能的效应机制。方法将120例早中期帕金森病肌强直患者随机分为试验组和对照组各60例。试验组在维持原有抗帕金森病药物剂量的基础上用督三针(大椎、筋缩、命门),上肢肌强直者配合手挛三针(极泉、尺泽、内关),下肢肌强直者配合足挛三针(鼠鼷、阴陵泉、三阴交),进针后行提插平补平泻法。对照组在维持原有抗帕金森药物剂量的基础上给予假针刺。两组均每周治疗4次,共治疗8周。治疗前后进行帕金森病统一评分量表运动症状部分(UPDRSⅢ量表)评分、UPDRSⅢ量表中关于肌强直的评分、10米步行测试、阿什沃思(Ashworth)量表评分,检测血清α-突触核蛋白(α-syn)、脑源性神经营养因子(BDNF)含量,治疗后判定临床疗效及记录不良事件发生情况。结果研究过程中对照组脱落6例,试验组脱落2例,最终纳入分析试验组58例,对照组54例。治疗后试验组患者UPDRSⅢ量表评分、肌强直评分、Ashworth量表评分、10米步行时间较治疗前显著降低,10米步行速度及血清BDNF含量较治疗前提高(P<0.05或P<0.01),而对照组治疗前后各指标差异均无统计学意义(P>0.05);两组患者治疗前后10米步行步幅及血清α-syn含量差异无统计学意义(P>0.05)。试验组临床疗效总有效率(67%)高于对照组(26%,P<0.05)。两组在针刺过程中均未见严重不良事件。结论督三针配合手足挛三针可改善早中期帕金森病肌强直症状和四肢痉挛程度,提高运动功能,其机制可能与促进患者产生内源性BDNF有关。

Objective To explore the clinical effect and safety of Du(督)three needles combined with hand&foot Luan(挛)three needles in the treatment of myotonic symptoms in patients with early-mid stage Parkinson's disease(PD),as well as the the possible mechanism.Methods Totally,120 early-mid stage PD patients with mypto⁃nia were randomized into treatment group(60 cases)and control group(60 cases).Maintaining the dose of the origi⁃nal anti-PD drugs,the treatment group was given Du three needles at Dazhui(DU 14),Jinsuo(DU 8)and Mingmen(DU 4),in combination with hand Luan three needles at Jiquan(HT 1),Chize(LU 5)and Neigua(PC 6)in terms of upper limb myotonia,and foot Luan three needles at Shuxi,Yinlingquan(SP 9)and Sanyinjiao(SP 6)for lower limb myotonia,using lifting and thrusting method,with even supplementation and drainage.The control group was treated with sham acupuncture on the basis of the same dose of the original anti-PD drugs.Both groups were treated four times a week for eight weeks.The United Parkinson's Disease Rating Scale PartⅢ(UPDRSⅢ)motor examina⁃tion score,the myotonia score by UPDRSⅢ,10-meter walk test,and Ashworth scale score were assessed,and serumα-synuclein(α-syn)and brain-derived neurotrophic factor(BDNF)levels were detected before and after treat⁃ment.The clinical effect was defined,and the adverse events during treatment were recorded.Results During the study,six cases in the control group and two cases in the treatment group were dropped out.Finally,58 cases in the treatment group and 54 cases in the control group were included in the analysis.After treatment,the UPDRSⅢmo⁃tor examination score,the myotonia score by UPDRSⅢ,the Ashworth scale score and 10-meter walking time in the treatment group significantly decreased,while the 10-meter walking speed and serum BDNF level significantly in⁃creased(P<0.05 or P<0.01);there was no significant differences in above mentioned outcomes before and after treatment in the control group(P>0.05).For 10-meter walking stride and serumα-syn level,there were no signifi⁃cant differences before and after treatment in both groups(P>0.05).The total effective rate in the treatment group was 67%,significantly higher than 26%in the control group(P<0.05).There were no serious adverse events in both groups during the treatment.Conclusion The application of Du three needles combined with hand&foot Luan three needles can improve the myotonia symptoms,reduce the limb spasm,and improve motor function in early-mid stage PD patients,and the mechanism may be related to promoting the production of endogenous BDNF.