| 引用本文:于秀凤1，田立军2.循经针刺对偏头痛的即刻疗效及其机制探讨[J].世界中医药,2019,(06):. |
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| 循经针刺对偏头痛的即刻疗效及其机制探讨 |
| Discussion on Immediate Effect of Meridian Acupuncture on Migraine and its Mechanism |
| 投稿时间：2018-04-28 |
| DOI：10.3969/j.issn.1673-7202.2019.06.050 |
| 中文关键词: 循经针刺 偏头痛 即刻疗效 机制 降钙素基因相关肽 血浆内皮素 酶联免疫吸附剂测定 五羟色胺 |
| English Keywords:Acupuncture along meridians Migraine Immediate effect Mechanism Calcitonin gene-related peptide Plasma endothelin Enzyme-linked immunosorbent assay Five hydroxytryptamine |
| 基金项目:天津市应用基础与前沿技术研究计划青年项目(2015-98) |
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| 中文摘要: |
| 目的：观察循经针刺治疗偏头痛患者的即可疗效，并通过检测降钙素基因相关肽（CGRP）、血浆内皮素（ET）和五羟色胺（5-HT）的表达情况探讨其机制。方法：选取2017年2月至2018年2月天津中医药大学附属武清中医院收治的偏头痛患者85例作为研究对象，根据随机数字表法将患者分为观察组（n＝43）和对照组（n＝40），排除不良反应的5例，2组均为40例，观察组予以循经针刺法针刺少阳经的角孙、风池、外关、阳陵泉和丘墟穴，对照组予以非经非穴治疗。于治疗前及治疗后05、1、2和4 h进行偏头痛积分和VAS（视觉模拟量表评分）评估；采用放射免疫法检测降钙素基因相关肽（CGRP）和血浆内皮素（ET），利用ELISA（酶联免疫吸附剂测定）检测五羟色胺（5-HT），观察2组患者治疗前和治疗后4 h的表达情况，探讨循经针刺的疗效机制。记录研究过程中存在的不良反应。结果：1）观察组循经针刺对偏头痛的临床有效率是9000%，对照组是6750%，观察组的临床有效率优于对照组，2组比较差异有统计学意义（P<005）。2）2组治疗后05、1、2和4 h的偏头痛积分和VAS评分均较治疗前下降（P<005），仅治疗后2 h及治疗后4 h的偏头痛积分和VAS评分较对照组低（P<005）。3）2组治疗前CGRP和ET的表达差异无统计学意义（P>005）；与治疗前比较，2组治疗4 h后均可下调CGRP和ET的表达水平（P<005）；观察组治疗后CGRP和ET的下调水平优于对照组（P<005）。4）2组治疗前5-HT的表达无比较，差异统计学异议（P>005）；与治疗前比较，2组治疗4 h后均上调5-HT的表达水平（P<005），其中观察组优于对照组（P<005）。5）研究过程中5例患者出现不良反应，其中观察组出现3例（晕针2例+局部出血1例），对照组2例（晕针1例+局部出血1例）。晕针患者平卧取针后即可恢复，局部出血则以局部按压进行止血处理。整个研究过程中均未出现严重不良反应。结论：循经针刺治疗偏头痛患者的即刻疗效于治疗后05 h症状开始缓解，于治疗后4 h疗效最佳，其即刻疗效可能与上调CGRP和5-HT表达水平和下调ET表达水平有关。 |
| English Summary: |
| To observe the therapeutic effects of meridian acupuncture on patients with migraine，and to investigate the mechanism of the expression of calcitonin gene related peptide(CGRP)，plasma endothelin(ET)and five serotonin(5-HT).Methods:From February 2017 to February 2018，85 cases of migraine patients were diagnosed in the outpatient department of Neurology Department of Tianjin University of Chinese Medicine Affiliated Wuqing Traditional Chinese Hospital were selected and randomly divided into 43 cases in the observation group and 40 cases in the control group according to the random digital table method.After excluding the 5 cases of adverse reactions，the 2 groups had 40 cases in each.The observation group was given acupuncture at Jiaosun(SJ20)，Fengchi(GB20)，Waiguan(SJ5)，Yanglingquan(GB34)and Qiuxu(GB40)along shaoyang meridian，and the control group was given non-acupoint or non-meridian acupuncture therapy.The migraine scores and VAS(visual analog scale)were evaluated before and 05 h，1 h，2 h and 4 h after treatment.Radioimmunoassay was used to detect calcitonin gene related peptide(CGRP)and plasma endothelin(ET)and the five hydroxyserine(5-HT)was detected by using ELISA(enzyme-linked immunosorbent assay).The expression was observed before and 4 h after treatment.The mechanism of acupuncture along meridians was discussed.Finally，the adverse reactions during the study were recorded.Results:1)The clinical effective rate of acupuncture on migraine was 90% in the observation group and 6750% in the control group.The clinical efficiency of the observation group was better than that of the control group.The difference was statistically significant(P<005)after the chi square test.2)The scores of migraine and VAS of 05 h，1 h，2 h and 4 h were decreased than those before treatment(P<005).The migraine score and VAS score of 2 h and 4 h were lower than those in the control group after treatment(P<005).3)There was no significant difference in the expression of CGRP and ET before treatment in the two groups(P>005).Compared with before treatment，the expression level of CGRP and ET after the treatment of 4 h decreased in the 2 groups(P<005)，and the lower levels of CGRP and ET after treatment in the observation group were better than those of the control group(P<005).4)There was no significant difference in the expression of 5-HT before treatment in the 2 groups(P>005).Compared with before treatment，the expression level of 5-HT was up-regulated in the 2 groups after the treatment of 4 h(P<005)，and the observation group was superior to the control group(P<005).5)In the course of the study，5 patients had adverse reactions，of which there were 3 cases in the observation group(1 case of needle sickness，and 2 cases of local bleeding)，and 2 cases in the control group(1 case of needle sickness and 1 case of local bleeding).The patient with needle sickness can recover when withdrawing the needle lying on the back.Local bleeding was processed with local press for stopping bleeding.No serious adverse reactions occurred during the whole study.Conclusion:The immediate effect of meridian acupuncture on migraine is relieving the symptoms after 05 h's treatment，and the effect is best after treatment of 4 h.The immediate effect may be related to the up-regulation of CGRP and 5-HT expression and the down-regulation of ET expression. |
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