目的:观察热敏灸联合针刺治疗寒湿型颈肩部肌筋膜疼痛综合征的临床疗效.方法:将94例颈肩部肌筋膜疼痛综合征患者按照随机数字表法分为热敏灸联合针刺组和针刺组,每组47例.热敏灸联合针刺组给予热敏灸联合针刺治疗,针刺组给予针刺治疗.治疗前后检测两组患者β-内啡肽(β-endorphin,β-EP)、P物质(substance P,SP)、6-酮前列腺素E1α(6-keto-prostaglandin E1α,6-keto-PGE1α)、5-羟色胺(5-hydroxytryptamine,5-HT)、白细胞介素-1β(interleukin-1β,IL-1β)、环氧化酶-2(cyclooxygenase-2,COX-2)、肿瘤坏死因子-α(tumour necrosis factor-α,TNF-α)、25-羟基维生素D[25-dihydroxy vitamin D,25(OH)D]含量,检测筋膜厚度、组织弹性图评分、杨氏模量值、平均振幅值及平均频率斜率,观察患者疼痛视觉模拟评分(visual analogue scale,VAS)、颈部功能障碍指数(neck disability index,NDI)、生活质量综合评定问卷(generic quality of life inventory 74,GQOLI-7)变化情况及临床疗效.结果:热敏灸联合针刺组治疗后IL-1β、COX-2、TNF-α含量低于针刺组,25(OH)D含量高于针刺组,差异有统计学意义(P＜0.05);热敏灸联合针刺组治疗后6-keto-PGE1α、SP、5-HT含量低于针刺组,β-EP含量高于针刺组,差异有统计学意义(P＜0.05);热敏灸联合针刺组筋膜厚度、组织弹性图评分、杨氏模量值低于针刺组,差异有统计学意义(P＜0.05);热敏灸联合针刺组治疗后平均振幅值、平均频率斜率高于针刺组,差异有统计学意义(P＜0.05);热敏灸联合针刺组治疗后NDI评分、VAS评分低于针刺组,GQOLI-74评分高于针刺组,差异有统计学意义(P＜0.05);热敏灸联合针刺组有效率为95.74％,针刺组有效率为82.98％,热敏灸联合针刺组有效率显著高于针刺组,差异有统计学意义(P＜0.05).结论:热敏灸联合针刺治疗寒湿型颈肩部肌筋膜疼痛综合征,可抑制患者炎性因子含量,降低疼痛介质指标,改善患者组织弹性、肌肉活动能力和疲劳程度,提高患者临床疗效及生活质量.
Clinical Study on the Treatment of Neck and Shoulder Myofascial Pain Syndrome of Cold Dampness Type with Heat-Sensitive Moxibustion Combined with Acupuncture
Objective:To observe the clinical efficacy of heat-sensitive moxibustion combined with acupuncture on neck and shoulder myofascial pain syndrome of cold dampness type.Methods:A total of 94 patients with neck and shoulder myofascial pain syndrome were divided into the heat-sensitive moxibustion combined acupuncture group and the acupuncture group according to the random number ta-ble method,with 47 cases in each group.The heat-sensitive moxibustion combined with acupuncture group was given heat-sensitive mox-ibustion combined with acupuncture treatment,while the acupuncture group was given acupuncture treatment.Then β-endorphin(β-EP),substance P(SP),6-keto-prostaglandin E1α(6-keto-PGE1α)were detected in two groups before and after treatment.6-keto-PGE1α),5-hydroxytryptamine(5-HT),interleukin-1β(IL-1β),cyclooxygenase-2(COX-2),tumour necrosis factor-α(TNF-α),25-dihydroxy vitamin D[25(OH)D]content were measured.Fascia thickness,tissue elastogram score,Young's modulus value,average amplitude value and average frequency slope were also measured.Visual analogue scale(VAS),neck disability index(NDI),generic quality of life inventory 74(GQOLI-7)and clinical efficacy were observed.Results:After treatment,the contents of IL-1β,COX-2 and TNF-α in the heat-sensitive moxibustion combined acupuncture group were lower than those in the acupuncture group,while the content of25(OH)D was higher than that in the acupuncture group,and all the differences were statistically significant(P＜0.05).The con-tents of 6-keto-PGE1α,SP and 5-HT in the heat-sensitive moxibustion combined with acupuncture group were lower than those in the acupuncture group,while the content of β-EP was higher than that in acupuncture group,and all the differences were statistically signifi-cant(P＜0.05).The fascia thickness,tissue elasticity chart score and Young's modulus of the heat-sensitive moxibustion combined with acupuncture group were lower than those of the acupuncture group,and all the differences were statistically significant(P＜0.05).The average amplitude and average frequency slope of the heat-sensitive moxibustion combined with the acupuncture group were higher than those of acupuncture group,and all the differences were statistically significant(P＜0.05).The NDI score and VAS score of the heat-sensitive moxibustion combined with acupuncture group were lower than those of the acupuncture group,while GQOLI-74 score was higher than that of the acupuncture group,and all the differences were statistically significant(P＜0.05).The effective rate of the heat-sensitive moxibustion combined with acupuncture group was 95.74％,and that of the acupuncture group was 82.98％.The effective rate of the heat-sensitive moxibustion combined with acupuncture group was significantly higher than that of acupuncture group,and the difference was statistically significant(P＜0.05).Conclusion:Heat-sensitive moxibustion combined with acupuncture in the treatment of cold-damp neck and shoulder myofascial pain syndrome can inhibit the contents of inflammatory factors,reduce the in-dex of pain mediators,improve the tissue elasticity,muscle activity and fatigue degree of patients,and improve the clinical efficacy and quality of life.
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