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五行针灸对慢性疲劳综合征患者临床症状及脑代谢、免疫球蛋白水平的影响

Effects of five-element acupuncture on clinical symptoms,brain metabolism and immunoglobulin levels in patients with chronic fatigue syndrome

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目的 评价五行针灸对慢性疲劳综合征患者临床症状及脑代谢、免疫球蛋白水平的影响.方法 随机对照试验研究.选择2021年1月—2022年1月本院94例慢性疲劳综合征患者,按随机数字表法分为2组,每组47例.常规西医组给予西医常规疗法,五行针灸组在常规西医组基础上给予五行针灸治疗.2组均连续治疗4周.分别于治疗前后采用ELISA法检测血清γ-干扰素(IFN-γ)、皮质酮(CORT)、IL-2、5-羟色胺(5-HT)水平;采用流式细胞仪检测自然杀伤细胞(NK)、CD4+、CD8+、IgG、IgM水平;采用全身超导型MRI扫描仪扫描海马区的T2 Flair、T2WI、T1WI序列,获得N-乙酰天冬氨酸(NAA)、肌酸(Cr)、胆碱(Cho)的波谱曲线及峰下面积,计算峰下面积比值Cho/Cr、NAA/Cr;采用疲劳量表-14(FS-14)、疲劳严重程度量表(FSS)评估患者疲劳状态,抑郁-焦虑-压力量表中文简版(DASS-21)、贝克焦虑量表(BAI)评估患者焦虑状态,90项症状清单量表(SCL-90)、躯体和心理健康报告评分(SPHERE)评估患者生活质量;评价临床疗效.结果 治疗后,五行针灸组IgG、CD4+、NK水平高于常规西医组(t值分别为4.76、3.65、6.42,P<0.01),IgM、CD8+水平低于常规西医组(t值分别为7.30、4.79,P<0.01);IFN-γ、IL-2、5-HT水平高于常规西医组(t 值分别为 7.60、4.05、2.79,P<0.01),CORT 水平低于常规西医组(t=6.72,P<0.01);左侧海马区 NAA/Cr[(1.10±0.04)比(1.05±0.03),t=6.86]、右侧海马区NAA/Cr[(1.18±0.02)比(1.21±0.03),t=8.23]水平高于常规西医组(P<0.01),左侧海马区 Cho/Cr[(1.08±0.04)比(1.03±0.03),t=5.70]、右侧海马区 Cho/Cr[(1.17±0.02)比(1.20±0.03),t=5.71]水平低于常规西医组(P<0.01).治疗后,五行针灸组躯体疲劳、脑力疲劳、FSS评分低于常规西医组(i值分别为 8.08、9.08、7.07,P<0.01);DASS-21、BAI、SCL-90、SPHERE评分低于常规西医组(t值分别为3.63、5.77、8.74、5.92,P<0.0i).五行针灸组总有效率为95.74%(45/47)、常规西医组为82.98%(39/47),2组比较差异无统计学意义(x2=2.80,P=0.094).结论 五行针灸可改善慢性疲劳综合征患者T淋巴细胞表达,提高免疫球蛋白、NK水平,降低CORT水平,调节左右侧海马区NAA代谢,改善患者临床症状及负性情绪,提高临床疗效及生活质量.
Objective To evaluate the effect of five-element acupuncture on clinical symptoms,brain metabolism and immunoglobulin level in patients with chronic fatigue syndrome.Methods It was a randomized controlled trial.A total of 94 patients with chronic fatigue syndrome in our hospital from January 2021 to January 2022 were selected and divided into two groups according to the random number table method,with 47 in each group.The conventional western medicine group was treated with conventional western medicine,and the five-element acupuncture group was treated with five-element acupuncture on the basis of the conventional western medicine group.Both groups were treated for 4 weeks.Before and after treatment,the serum levels of interferon-y(IFN-γ),corticosterone(CORT),IL-2 and 5-hydroxytryptamine(5-HT)were detected by ELISA;the levels of natural killer(NK)cells,CD4+,CD8*,IgG and IgM were detected by flow cytometry;the whole body superconducting MRI scanner was used to scan T2 Flair,T2WI and TlWI.sequences of the hippocampus,and the spectral curves and the areas under the peak of N-acetylaspartic acid(NAA),creatine(Cr)and choline(Cho)were obtained,and the ratios of Cho/Cr and NAA/Cr were calculated.the fatigue Scale-14(FS-14)and Fatigue Severity Scale(FSS)were used to evaluate the fatigue state of the patients,and the Depression-Anxiety-Stress Scale-21(DASS-21)and Beck Anxiety Inventory(BAI)were used to evaluate the anxiety state of the patients.Symptom Checklist 90(SCL-90)and Somatic and Mental Health Report Score(SPHERE)were used to evaluate the quality of life of patients.And the clinical efficacy was evaluated.Results After treatment,the levels of IgG,CD4*and NK in the five-element acupuncture group were significantly higher than those in the conventional western medicine group(tvalues were 4.76,3.65,6.42,respectively,P<0.01),and the level of IgM,CD8*was significantly lower than that in the conventional western medicine group(t values were 7.30,4.79,P<0.01);the levels of IFN-y,IL-2 and 5-HT in the observation group were significantly higher than those in the conventional western medicine group(tvalues were 7.60,4.05,2.79,respectively,respectively,P<0.01),and the level of CORT was significantly lower than that in the conventional western medicine group(t=6.72,P<0.01);the NAA/Cr levels in the left[(1.10±0.04)vs.(1.05±0.03),t=6.86]and right[(1.18±0.02)vs.(1.21±0.03),t=8.23]hippocampus of the experimental group were significantly higher than those in the conventional western medicine group(P<0.01),and the Cho/Cr levels in the left[(1.08±0.04)vs.(1.03±0.03),t=5.70]and right[(1.17± 0.02)vs.(1.20±0.03),t=5.71]hippocampus of the experimental group were significantly lower than those of the conventional western medicine group(P<0.01).After treatment,the scores of physical fatigue,mental fatigue and FSS in the five-element acupuncture group were significantly lower than those in the conventional western medicine group(t values were 8.08,9.08 and 7.07,respectively,P<0.01).The scores of DASS-21,BAI,SCL-90 and SPHERE in the conventional western medicine group were significantly lower than those in the conventional western medicine group(t values were 3.63,5.77,8.74,5.92,respectively,P<0.01).The total effective rate was 95.74%(45/47)in the five-element acupuncture group and 82.98%(39/47)in the conventional western medicine group,and there was no significant difference between the two groups(x2=2.80,P=0.094).Conclusion Five-elements acupuncture can improve the expression of T lymphocytes,increase the levels of immunoglobulin and NK,reduce the level of CORT,regulate the brain metabolism of NAA in the left and right hippocampus,improve the clinical symptoms and negative emotions,and improve the clinical efficacy and quality of life in patients with chronic fatigue syndrome.

Fatigue syndrome,chronicAcupuncture moxibustion therapyFive phasesimmunoglobulinserotoninbrain metabolism in hippocampusT lymphocyte subsets

杨欢、郭慧、米勇、鲍毅梅

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新疆维吾尔自治区中医医院针灸科,乌鲁木齐 830000

疲劳综合征,慢性 针灸疗法 五行 免疫球蛋白 5-羟色胺 海马区脑代谢 T淋巴细胞亚群

新疆维吾尔自治区自然科学基金面上项目新疆维吾尔自治区"适宜技术推广-乡村振兴"项目新疆维吾尔自治区"适宜技术推广-乡村振兴"项目

2021D01C225SYTG-201947SYTG-202147

2024

国际中医中药杂志
中华医学会,中国中医科学院中医药信息研究所

国际中医中药杂志

CSTPCD
影响因子:0.411
ISSN:1673-4246
年,卷(期):2024.46(1)
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