经皮神经穴位电刺激对COPD稳定期患者临床疗效、肺功能及急性加重风险的影响

Effect of transcutaneous electrical nerve point stimulation on clinical outcome, lung function and risk of acute exacerbation in patients with stable COPD

目的:探究经皮神经穴位电刺激对慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)稳定期患者临床疗效、肺功能及急性加重风险的影响。方法:选取2021年12月~2022年12月来我院就诊的COPD稳定期患者126例作为研究对象,进行前瞻性、单盲、随机、安慰剂对照研究试验,采取随机数字表法分为经穴治疗组33例、非经非穴组32例、假针组29、对照组31例。观察并比较四组治疗前后肺功能(FVC%、FEV 1 %、FEV 1 /FVC)、呼吸困难问卷(modified Medical Research Council,mMRC)评分、慢阻肺评估测试评分(COPD Assessment Test,CAT)、炎性因子水平(CRP、IL-6、TNF-ɑ、IL-8)、6min步行距离(6minute walking distance,6MWD)、急性加重风险(COPD中重度急性加重次数和住院次数)情况。结果:治疗后,四组FEV 1 /FVC、FVC%、FEV 1 %均升高,经穴治疗组均高于其他三组,差异有统计学意义( P <0.05)。治疗后,四组mMRC评分均下降,经穴治疗组均低于其他三组,差异有统计学意义( P <0.05)。治疗后,四组6MWD均延长、CAT评分均降低,经穴治疗组6MWD均长于其他三组、CAT评分均低于其他三组,差异有统计学意义( P <0.05)。治疗前6个月、治疗后6个月和治疗后6~12个月比较:四组COPD中重度急性加重次数和住院次数均下降,经穴治疗组均低于其他三组,差异有统计学意义( P <0.05)。治疗后,四组CRP、IL-6、TNF-ɑ和IL-8水平均下降,且经穴治疗组各指标水平均低于其他三组,差异有统计学意义( P <0.05)。四组不良反应发生率比较,差异无统计学意义( P >0.05)。结论:acu-TENS治疗可以明显改善COPD稳定期患者肺功能和呼吸困难程度,并下调患者体内炎性因子水平,同时降低COPD稳定期患者发生急性加重的风险,临床疗效尚可。

Objective: To investigate the effects of transcutaneous electrical nerve point stimulation on clinical outcomes, lung function and risk of acute exacerbation in patients with chronic obstructive pulmonary disease(COPD) in the stable phase. Methods: A total of 126patients with stable COPD who came to our hospital from December 2021to December 2022were selected as study subjects for a prospective, single-blind, randomised, placebo-controlled research trial, which was divided into 33cases in the meridian-point treatment group, 32cases in the non-meridian-non-acupuncture group, 29cases in the sham-needle group, and 31cases in the control group by adopting the random number table method. Lung function(FVC%, FEV 1 %, FEV 1 /FVC), modified Medical Research Council(mMRC) dyspnoea questionnaire score, COPD Assessment Test(CAT) score, inflammatory factor levels(CRP, IL-6, TNF-ɑ, IL-8), 6minute walking distance(6MWD), and acute exacerbation risk(number of moderate-to-severe acute exacerbations of COPD and number of hospitalisations) status. Results: After treatment, FEV 1 /FVC, FVC%, and FEV 1 % increased in all four groups, and the transcaval therapy group was higher than the other three groups, and the difference was statistically significant( P <0.05). After treatment, the mMRC scores of all four groups decreased, and the meridian therapy group was lower than the other three groups, and the difference was statistically significant( P <0.05).After treatment, 6MWD was prolonged and CAT scores were reduced in all four groups, and 6MWD was longer and CAT scores were lower in the meridian therapy group than in the other three groups, and the difference was statistically significant( P <0.05).Comparison of 6months before treatment, 6months after treatment and 6~12months after treatment: the number of moderate-to-severe acute exacerbations of COPD and the number of hospitalisations decreased in the four groups, and the meridian therapy group was lower than the other three groups, and the difference was statistically significant( P <0.05).After treatment, the levels of CRP, IL-6, TNF-ɑ and IL-8decreased in the four groups, and the levels of each index in the meridian therapy group were lower than those in the other three groups, and the difference was statistically significant( P <0.05). Comparing the incidence of adverse reactions among the four groups, the difference was not statistically significant( P >0.05). Conclusion: acu-TENS treatment can significantly improve lung function and dyspnoea in patients with stable COPD, and down-regulate the level of inflammatory factors in patients, as well as reduce the risk of acute exacerbation in patients with stable COPD, with fair clinical efficacy.