电针五脏背俞穴对慢性疲劳综合征疲劳状态及皮层兴奋性的影响

Effect of electroacupuncture at back-shu points of five zang on fatigue status and cortical excitability in chronic fatigue syndrome

目的:观察电针五脏背俞穴对慢性疲劳综合征(CFS)患者疲劳状态、生活质量及运动皮层兴奋性的影响,探讨电针治疗CFS的作用机制。方法:将72例CFS患者随机分为电针组(36例,脱落4例)及假电针组(36例,脱落3例)。电针组采用电针治疗,穴取肝俞、心俞、脾俞、肺俞、肾俞,予连续波,频率2 Hz;假电针组采用假电针治疗,于非穴点(五脏背俞穴水平向外旁开1.5~2.0cm)浅刺,连接电针但不通电。两组均每次针刺20 min,隔天1次,2周为一疗程,共治疗3个疗程。观察两组治疗前后疲劳量表-14(FS-14)、健康调查简表(SF-36)评分,并检测两组患者运动皮层兴奋性[静息运动阈值(RMT)、运动诱发电位的波幅(MEP-A)和潜伏期(MEP-L)]。结果:治疗后,电针组FS-14躯体疲劳、精神疲劳维度评分及总分与运动皮层RMT均较治疗前降低(P<0.01),假电针组FS-14躯体疲劳维度评分及总分较治疗前降低(P<0.05);电针组FS-14各维度评分及总分、运动皮层RMT均低于假电针组(P<0.01,P<0.05)。治疗后,电针组SF-36各维度评分及总分、运动皮层MEP-A较治疗前升高(P<0.01),且电针组均高于假电针组(P<0.01,P<0.05)。结论:电针五脏背俞穴可改善CFS患者疲劳状态,提高患者生活质量,可能与提高大脑运动皮层兴奋性有关。

Objective To observe the effect of electroacupuncture(EA)at back-shu points of five zang on fatigue status,quality of life and motor cortical excitability in patients with chronic fatigue syndrome(CFS),so as to explore the possible mechanism of EA for CFS.Methods A total of 72 patients with CFS were randomized into an EA group(36 cases,4 cases dropped off)and a sham EA group(36 cases,3 cases dropped off).In the EA group,EA at Ganshu(BL 18),Xinshu(BL 15),Pishu(BL 20),Feishu(BL 13)and Shenshu(BL 23)was adopted,with continuous wave,2 Hz in frequency.In the sham EA group,sham EA at non-acupoints(1.5-2.0 cm lateral to back-shu points of five zang)was applied,with shallow needling,and no current was connected.The treatment in the both groups was 20 min each time,once every other day,2 weeks as one course,3 courses were required.Before and after treatment,the scores of fatigue scale-14(FS-14)and the MOS 36-item short form health survey(SF-36)were observed,and cortical excitability(the resting motor threshold[RMT],amplitude of motor-evoked potential[MEP-A]and latency of motor-evoked potential[MEP-L])was detected in the two groups.Results After treatment,the physical fatigue score,mental fatigue score and total score of FS-14,as well as RMT of motor cortex in the EA group were decreased compared with those before treatment(P<0.01),the physical fatigue score and total score of FS-14 in the sham EA group were decreased compared with those before treatment(P<0.05);each item score and total score of FS-14 and RMT of motor cortex in the EA group were lower than those in the sham EA group(P<0.01,P<0.05).After treatment,each item score and total score of SF-36and MEP-A of motor cortex in the EA group were increased compared with those before treatment(P<0.01),which were higher than those in the sham EA group(P<0.01,P<0.05).Conclusion EA at back-shu points of five zang can effectively improve the fatigue status and quality of life in patients with CFS,its mechanism may be related to the up-regulating excitability of cerebral motor cortex.