主客原络配穴针刺联合补中益气汤治疗阻塞性睡眠呼吸暂停低通气综合征的临床研究

Clinical study of acupuncture of Zhukeyuanluo principle combined with Buzhong Yiqi Decoction for the patients with obstructive sleep apnea hypopnea syndrome

目的评价主客原络配穴针刺联合补中益气汤治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效。方法随机对照试验研究。选择2017年1月-2022年1月本院104例OSAHS患者作为观察对象,按随机数字表法分为2组,每组52例。中药组在西医常规治疗基础上服用补中益气汤加减治疗,针药组在中药组基础上结合主客原络配穴针刺治疗。2组均连续治疗2个月。采用Epworth嗜睡量表、斯坦福嗜睡自评量表(SSS)评估嗜睡程度;采用ELISA法检测血清TNF-α、IL-6、IL-8水平,血细胞自动分析仪检测血红蛋白、RBC、平均红细胞容积水平;采用多导睡眠监测仪监测呼吸暂停低通气指数(AHI)、呼吸暂停指数(AI)、低通气指数(HI)、动脉血氧饱和度(SaO_(2)),评价临床疗效。结果针药组总有效率为94.2%(49/52)、中药组为82.7%(43/52),2组比较差异有统计学意义(χ^(2)=6.73,P=0.035)。治疗后,针药组Epworth嗜睡量表、SSS评分低于中药组(t值分别为-8.19、-5.48,P<0.01);AHI[(15.64±2.81)次/h比(19.82±3.05)次/h,t=-7.27]、HI[(5.53±1.28)次/h比(7.37±1.34)次/h,t=-7.16]、AI[(8.13±1.95)次/h比(10.98±2.26)次/h,t=-6.89]低于中药组(P<0.01),SaO_(2)[(92.77±2.91)%比(89.53±2.44)%,t=6.15]高于中药组(P<0.01);血清TNF-α、IL-6、IL-8水平低于中药组(t值分别为-2.62、-3.14、-6.58,P<0.01);血红蛋白、RBC、平均红细胞容积水平低于中药组(t值分别为-2.11、-2.92、-2.48,P<0.05或P<0.01)。结论主客原络配穴针刺联合补中益气汤可降低OSAHS患者血清炎症因子水平,升高SaO_(2),降低AHI、HI、AI及嗜睡程度,提高临床疗效。

Objective To evaluate the effect of acupuncture of Zhukeyuanluo principle and Buzhong Yiqi Decoction on obstructive sleep apnea hypopnea syndrome(OSAHS).Methods Randomized controlled trial.A total of 104 patients with OSAHS in our hospital from January 2017 to January 2022 who met the inclusion criteria were divided into 2 groups according to random number table method,with 52 patients in each group.The Traditional Chinese Medicine(TCM)group was treated with Buzhong Yiqi Decoction on the basis of conventional western medicine treatment,and the acupuncture and medicine group was treated with the combination of primary and primary collaterals and acupoints.Both groups were treated continuously for 2 months.Epworth Lethargy Scale and Stanford Self-Rated Lethargy Scale(SSS)were used to assess the degree of lethargy.The serum levels of TNF-α,IL-6 and IL-8 were detected by ELISA.The hemoglobin,RBC and mean RBC volume levels were detected by automatic blood cell analyzer.apnea hypopnea index(AHI),apnea index(AI),hypopnea index(HI)and arterial oxygen saturation(SaO_(2))were monitored by polysomnographic sleep monitor to evaluate the clinical effect.Results The total effective rate was 94.2%(49/52)in the acupuncture group and 82.7%(43/52)in the TCM group,and there was significant difference between the two groups(χ^(2)=6.73,P=0.035).After treatment,the Epworth Lethargy Scale and SSS scores in the acupuncture and medicine group were significantly lower than those in the TCM group(t=-8.19 and-5.48,respectively,P<0.01);AHI[(15.64±2.81)times/h vs.(19.82±3.05)times/h,t=-7.27],HI[(5.53±1.28)times/h vs.(7.37±1.34)times/h,t=-7.16],AI[(8.13±1.95)times/h vs.(10.98±2.26)times/h,t=-6.89]in the acupuncture and medicine group were significantly lower than those in the TCM group(P<0.01),SaO_(2)[(92.77±2.91)%vs.(89.53±2.44)%,t=6.15]in the acupuncture and medicine group was significantly higher than that of the TCM group(P<0.01).The levels of TNF-α,IL-6 and IL-8 in serum in the acupuncture and medicine group were significantly lower than those in the TCM group(t=-2.62,-3.14 and-6.58,P<0.01).The levels of hemoglobin,RBC and mean red blood cell volume were in the acupuncture and medicine group were significantly lower than those in the TCM group(t=-2.11,-2.92,-2.48,P<0.05 or P<0.01).Conclusion The acupuncture of Zhukeyuanluo principle combined with Buzhong Yiqi Decoction can reduce the serum inflammatory cytokines level in OSAHS patients,increase SaO_(2),reduce AHI,HI,AI and lethargy degree,and improve clinical effects.