基于“脑肾相济”干预治疗慢性疲劳综合征:随机对照研究
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摘要
目的:观察"脑肾相济"理论下针刺对慢性疲劳综合征(CFS)患者疲劳症状、潜在症状和细胞因子的影响,探讨其临床疗效及部分作用机制。方法:将68例患者随机分为观察组与对照组,每组34例。对照组予谷维素和维生素B1口服,合理休息及适当运动,观察组在此基础上予"脑肾相济"理论下针刺治疗,穴取百会、风池、脾俞、肾俞、三阴交、太溪,每日治疗1次,每周治疗5 d、休息2 d。两组均治疗4周。观察两组患者治疗前后疲劳量表-14(FS-14)评分、躯体和心理健康报告(SPHERE)评分及匹兹堡睡眠质量指数(PSQI)评分,采用酶联免疫吸附法(ELISA法)检测治疗前后患者血清白细胞介素-6(IL-6)及干扰素-γ(INF-γ)含量。结果:两组治疗后FS-14评分、SPHERE评分及PSQI评分均较治疗前下降(P<0.05,P<0.01),观察组血清IL-6、INF-γ含量较治疗前下降(均P<0.01);治疗后观察组FS-14评分、SPHERE评分、PSQI评分及血清IL-6、INF-γ含量低于对照组(P<0.05,P<0.01)。结论:基于"脑肾相济"理论下的针刺疗法能缓解CFS患者的疲劳症状及潜在症状,改善睡眠质量,其作用机制可能与降低患者血清IL-6、INF-γ含量有关。
Objective To observe the effects of acupuncture on the fatigue symptoms of chronic fatigue syndrome, the potential symptoms and cytokines on the base of the theory as "interaction of brain and kidney" and explore its clinical therapeutic effects and the potential mechanism. Methods A total of 68 patients were randomized into an observation group and a control group, 34 cases in each one. In the control group, oryzanol and vitamin B1 were prescribed for oral administration and the patients were required to have a proper rest and physical exercise. In the observation group, on the base of the theory as "interaction of brain and kidney", acupuncture was added to Baihui(BL 20), Fengchi(GB 20), Pishu(BL 20), Shenshu(BL 23), Sanyinjiao(SP 6) and Taixi(KI 3). The treatment was given once a day, 5 treatments a week, with 2 days break. The consecutive treatment for 4 weeks was required. Before and after treatment, the score of the fatigue scale-14(FS-14), the score of the somatic and psychological health report(SPHERE) and the score of the Pittsburgh sleep quality index(PSQI) were observed in the patients of the two groups separately. The enzyme-linked immunosorbent assay(ELISA) was adopted to determine the levels of serum interleukin-6(IL-6) and interferon-γ(INF-γ) before and after treatment. Results After treatment, FS-14 scores, SPHERE scores and PSQI scores were all reduced as compared with the scores before treatment in the two groups(P<0.05, P<0.01). After treatment, the levels of IL-6 and INF-γ in the serum in the observation group were reduced as compared with the levels before treatment(both P<0.01). After treatment, the scores of FS-14, SPHERE and PSQI as well as the levels of serum IL-6 and INF-γ in the observation group were all lower than the results in the control group(P<0.05, P<0.01). Conclusion On the base of the theory as "interaction of brain and kidney", acupuncture therapy relieves the fatigue symptoms and the potential symptoms and improves the sleep quality in the patients of chronic fatigue syndrome. The effect mechanism is probably related to the decrease of the levels of IL-6 and INF-γ in serum.
Objective To observe the effects of acupuncture on the fatigue symptoms of chronic fatigue syndrome, the potential symptoms and cytokines on the base of the theory as "interaction of brain and kidney" and explore its clinical therapeutic effects and the potential mechanism. Methods A total of 68 patients were randomized into an observation group and a control group, 34 cases in each one. In the control group, oryzanol and vitamin B1 were prescribed for oral administration and the patients were required to have a proper rest and physical exercise. In the observation group, on the base of the theory as "interaction of brain and kidney", acupuncture was added to Baihui(BL 20), Fengchi(GB 20), Pishu(BL 20), Shenshu(BL 23), Sanyinjiao(SP 6) and Taixi(KI 3). The treatment was given once a day, 5 treatments a week, with 2 days break. The consecutive treatment for 4 weeks was required. Before and after treatment, the score of the fatigue scale-14(FS-14), the score of the somatic and psychological health report(SPHERE) and the score of the Pittsburgh sleep quality index(PSQI) were observed in the patients of the two groups separately. The enzyme-linked immunosorbent assay(ELISA) was adopted to determine the levels of serum interleukin-6(IL-6) and interferon-γ(INF-γ) before and after treatment. Results After treatment, FS-14 scores, SPHERE scores and PSQI scores were all reduced as compared with the scores before treatment in the two groups(P<0.05, P<0.01). After treatment, the levels of IL-6 and INF-γ in the serum in the observation group were reduced as compared with the levels before treatment(both P<0.01). After treatment, the scores of FS-14, SPHERE and PSQI as well as the levels of serum IL-6 and INF-γ in the observation group were all lower than the results in the control group(P<0.05, P<0.01). Conclusion On the base of the theory as "interaction of brain and kidney", acupuncture therapy relieves the fatigue symptoms and the potential symptoms and improves the sleep quality in the patients of chronic fatigue syndrome. The effect mechanism is probably related to the decrease of the levels of IL-6 and INF-γ in serum.
引文
[1]Rajeevan MS, Murray J, Oakley L, et al. Association of chronic fatiguesyndromewithprematuretelomereattrition[J].JTransl Med, 2018, 16(1):44.
[2]BozziniS,AlbergatiA,CapelliE,etal.Cardiovascular characteristics of chronic fatigue syndrome[J]. Biomed Rep, 2018,8(1):26-30.
[3]张宝文,翟恒,苑迅.针灸治疗慢性疲劳综合征临床研究现况[J].辽宁中医药大学学报, 2017, 19(10):178-180.
[4]FukudaK,StrausSE,HickieI,etal.Thechronicfatigue syndrome:a comprehensive approach to its definition and study[J].Ann Intern Med, 1994, 121(12):953-959.
[5]李玉珍,王伟,凌瑞杰,等.疲劳量表-14在汽车装配作业工人中的信度和效度检验[J].工业卫生与职业病,2016,42(5):346-350.
[6]Couvy-DuchesneB,DavenportTA,MartinNG,etal.Validation andpsychometricpropertiesoftheSomaticandPsychological Health Report(SPHERE)in a young Australian-based population sampleusingnon-parametricitemresponsetheory[J].BMC Psychiatry, 2017, 17(1):279.
[7]Mollayeva T, Thurairajah P, Burton K, et al. The Pittsburgh sleep qualityindexasascreeningtool for sleepdysfunction inclinical and non-clinical samples:a systematic review and meta-analysis[J].Sleep Med Rev, 2016, 25(2):52-73.
[8]ShiJ,ShenJ,XieJ,etal.ChronicfatiguesyndromeinChinese middle-schoolstudents[J].Medicine(Baltimore),2018,97(4):e9716.
[9]Martínez-MartínezLA,MoraT,VargasA,etal.Sympathetic nervous system dysfunction in fibromyalgia, chronic fatigue syndrome,irritablebowelsyndrome,andinterstitialcystitis:areviewofcasecontrol studies[J]. J Clin Rheumatol, 2014, 20(3):146-150.
[10]张维,刘志顺,徐海蓉,等.针刺背俞穴治疗慢性疲劳综合征临床研究[J].针刺研究, 2011, 36(6):437-441.
[11]祁元刚,宋守江,窦志强,等.柴胡加龙骨牡蛎汤联合针刺背俞穴治疗慢性疲劳综合征[J].中国针灸, 2017, 37(11):1187-1190.
[12]谭惠娟,罗婷婷,瞿玉竹,等.基于数据挖掘的针灸治疗慢性疲劳综合征腧穴运用规律[J].中国中医基础医学杂志,2017,23(2):242-244.
[13] GottsZM,EllisJG,DearyV,etal.Theassociationbetween daytimenappingandcognitivefunctioninginchronicfatigue syndrome[J]. PLoS One, 2015, 10(1):e0117136.
[14] Munemoto T, Soejima Y, Masuda A, et al. Increase in the regional cerebralbloodflowfollowingWaontherapyinpatientswith chronicfatiguesyndrome:apilotstudy[J].InternMed,2017,56(14):1817-1824.
[15]黄伟,李佳,朱广为.针刺百会、人中穴对急性脑缺血大鼠模型NF-κB/IκB-α的影响[J].中华中医药杂志, 2017, 32(1):298-302.
[16]赵军,兰惠羽.针刺太阳、风池穴对脑缺血再灌注家兔热休克蛋白70及细胞凋亡的影响[J].上海针灸杂志, 2015, 34(11):1122-1125.
[17] ShephardRJ.Cytokineresponsestophysicalactivity,with particularreferencetoIL-6:sources,actions,andclinical implications[J]. Crit Rev Immunol, 2002, 22(3):165-182.
[18] LeonardBE.Theconceptofdepressionasadysfunctionofthe immune system[J]. Curr Immunol Rev, 2010, 6(3):205-212.
[19]熊杉,张如祥,刘良生.针刺配合推拿膀胱经对慢性疲劳综合征患者血清细胞因子的影响[J].湖北中医药大学学报,2015,17(2):39-41.
[2]BozziniS,AlbergatiA,CapelliE,etal.Cardiovascular characteristics of chronic fatigue syndrome[J]. Biomed Rep, 2018,8(1):26-30.
[3]张宝文,翟恒,苑迅.针灸治疗慢性疲劳综合征临床研究现况[J].辽宁中医药大学学报, 2017, 19(10):178-180.
[4]FukudaK,StrausSE,HickieI,etal.Thechronicfatigue syndrome:a comprehensive approach to its definition and study[J].Ann Intern Med, 1994, 121(12):953-959.
[5]李玉珍,王伟,凌瑞杰,等.疲劳量表-14在汽车装配作业工人中的信度和效度检验[J].工业卫生与职业病,2016,42(5):346-350.
[6]Couvy-DuchesneB,DavenportTA,MartinNG,etal.Validation andpsychometricpropertiesoftheSomaticandPsychological Health Report(SPHERE)in a young Australian-based population sampleusingnon-parametricitemresponsetheory[J].BMC Psychiatry, 2017, 17(1):279.
[7]Mollayeva T, Thurairajah P, Burton K, et al. The Pittsburgh sleep qualityindexasascreeningtool for sleepdysfunction inclinical and non-clinical samples:a systematic review and meta-analysis[J].Sleep Med Rev, 2016, 25(2):52-73.
[8]ShiJ,ShenJ,XieJ,etal.ChronicfatiguesyndromeinChinese middle-schoolstudents[J].Medicine(Baltimore),2018,97(4):e9716.
[9]Martínez-MartínezLA,MoraT,VargasA,etal.Sympathetic nervous system dysfunction in fibromyalgia, chronic fatigue syndrome,irritablebowelsyndrome,andinterstitialcystitis:areviewofcasecontrol studies[J]. J Clin Rheumatol, 2014, 20(3):146-150.
[10]张维,刘志顺,徐海蓉,等.针刺背俞穴治疗慢性疲劳综合征临床研究[J].针刺研究, 2011, 36(6):437-441.
[11]祁元刚,宋守江,窦志强,等.柴胡加龙骨牡蛎汤联合针刺背俞穴治疗慢性疲劳综合征[J].中国针灸, 2017, 37(11):1187-1190.
[12]谭惠娟,罗婷婷,瞿玉竹,等.基于数据挖掘的针灸治疗慢性疲劳综合征腧穴运用规律[J].中国中医基础医学杂志,2017,23(2):242-244.
[13] GottsZM,EllisJG,DearyV,etal.Theassociationbetween daytimenappingandcognitivefunctioninginchronicfatigue syndrome[J]. PLoS One, 2015, 10(1):e0117136.
[14] Munemoto T, Soejima Y, Masuda A, et al. Increase in the regional cerebralbloodflowfollowingWaontherapyinpatientswith chronicfatiguesyndrome:apilotstudy[J].InternMed,2017,56(14):1817-1824.
[15]黄伟,李佳,朱广为.针刺百会、人中穴对急性脑缺血大鼠模型NF-κB/IκB-α的影响[J].中华中医药杂志, 2017, 32(1):298-302.
[16]赵军,兰惠羽.针刺太阳、风池穴对脑缺血再灌注家兔热休克蛋白70及细胞凋亡的影响[J].上海针灸杂志, 2015, 34(11):1122-1125.
[17] ShephardRJ.Cytokineresponsestophysicalactivity,with particularreferencetoIL-6:sources,actions,andclinical implications[J]. Crit Rev Immunol, 2002, 22(3):165-182.
[18] LeonardBE.Theconceptofdepressionasadysfunctionofthe immune system[J]. Curr Immunol Rev, 2010, 6(3):205-212.
[19]熊杉,张如祥,刘良生.针刺配合推拿膀胱经对慢性疲劳综合征患者血清细胞因子的影响[J].湖北中医药大学学报,2015,17(2):39-41.
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