“颅底七穴”治疗帕金森病的临床疗效评价研究
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摘要
背景：近年帕金森病(Parkinson's disease,PD)发病率逐年增高,且日益年轻化,成为一个全球性的公共卫生问题。随着对PD认识的不断深入,医学界不断尝试新的治疗药物和方法,但仍未发现任何一种治疗方法可以阻止或减缓PD患者神经变性的进程。药物治疗的副作用及外科、基因等治疗的局限性为中医针灸治疗提供了临床研究的空间。“颅底七穴”由位于颅底的哑门、天柱(双)、风池(双)、完骨(双)组成,是针刺疗法治疗PD的临证经验穴位,可以直达病所。本研究以期客观评价“颅底七穴”治疗PD的临床疗效。
研究目的：通过前瞻性随机对照研究,客观评价“颅底七穴”针法治疗帕金森病的临床疗效。
研究方法：以中国中医科学院望京医院就诊的PD患者为研究对象,将改良Webster评分低于25分的120例轻中度PD患者随机分为针刺治疗组(针刺组)与药物对照组(药物组)。针刺组应用“颅底七穴”针法治疗,药物组采用美多芭口服,两组同期治疗9周,随访半年,期间5次应用改良Webster评分记录其症状变化,随访结束后进行疗效评定,计算其疗效百分比。采用Microsoft Excel工作表及SPSS17.0软件进行数据录入及统计分析,比较组间差异,以判断临床疗效。
结果：本研究共纳入患者120例,6例因未能坚持治疗脱落,脱落剔除率为5.0%。最终用于统计病例114例,男性55例,女性59例；年龄38-87岁,平均64岁；病程24周～23年(1152周),平均278周；治疗前改良Webster评分5～25分,平均15.22分；最后就诊改良Webster评分0-17分,平均7.28分。其中针刺组61例,药物组58例。入选各组病例治疗前积分无明显统计学差异,治疗前两组改良Webster得分均值分别为15.77±3.575和14.58±4.050。经针灸或西药治疗后大多数病例症状均可得到控制,治疗3个疗程后,114例患者前后积分降幅为1～16分,平均6.64分；两组分别降低为6.70±3.805和7.94±4.605,两组比较无显著统计学差异。疗效判断分析结果：针刺组为：17.00-94.7%,平均57.23%,药物组为5.80～100%,平均47.51%,两组比较,p=0.052。针刺组对PD轻中度患者的治疗总有效率为86.89%,而药物组总有效率为75.47%；两组比较具有显著统计学差异,P=0.019。
根据改良Webster评分中涉及的十大症状,对两组患者五次症状评价情况进行分析,入选患者以轻、中度病变为主,针刺组与药物组症状对比轻重程度分布较平均。由第3个治疗疗程结束后和治疗结束后半年进行的第二次随访可见：两组对于震颤、患者步态的改善均有明显疗效。针刺组对于头俯屈、上肢屈曲的异常姿势、患者面容的呆板以及患者的语言功能疗效明显。随访半年期间,针刺组8例症状进展,治疗完毕与随访完毕改良Webster评分均值分别为：8.51和6.70；而药物组21例症状进展,治疗完毕与随访完毕改良Webster评分均值分别为：8.77和8.23；由此可见针灸治疗较西药治疗远期效应更佳。
结论：PD是一种常见于中老年的神经系统变性疾病,“颅底七穴”位于颅底,可以直达病所。穴位分属于督脉、太阳经、少阳经,具有平肝熄风、醒脑强脊的功效。据现代医学研究,PD发病与静息态脑功能网络相关,而“颅底七穴”恰好如网状布于颅底,内应静息态脑功能网络,针刺治疗能够调节该网络系统的功能。此外,PD患者的全脑血流量都有下降,针刺可以增加脑血流量,从而改善脑部的血液循环。
我们通过前瞻性研究证实了“颅底七穴”的临床有效性。该针法通过对颅底网络系统的神经调节和脑部血液循环的改善,可以明显改善帕金森病患者的临床症状,其临床疗效评价优于美多芭常规剂量的应用；对于PD患者震颤、步态的改善与药物组相当,而对于改善PD患者肢体灵活性,改善患者僵直、俯屈姿态以及面容的呆板,言语障碍优于常规左旋多巴类药物的应用；其远期疗效显著,大大提高患者的生活质量。
Background:With the rapid increase in the incidence and the patients becoming younger, Parkinson's disease (PD) is becoming one of the most important global healthy problems. Over the past decades, the treatment of PD has undergone tremendous changes. New drugs and methods have been introduced to improve the symptoms of PD. But till now, no method can stop or slow down the neural defects of PD patients while Traditional Chinese Medicine (TCM) is gaining more and more focus as a form of complementary or alternative treatment."The Seven Acupoints of the Cranial Base"(SACB), which consists of DU15, BL10, GB20and GB12, was used to treat PD for about twenty years. It's valuable to study the clinical curative effect of SACB for PD.
Objective:To observe the clinical curative effect of SACB for PD.
Methods:The study subjects were derived from Wangjing Hospital,120PD subjects were all of mild or middle degree, whose modified Webster Scale (mWS) is lower than25. Subjects were divided into two groups, i.e., acupuncture group and drug group. The former was treated by SACB every two days, while the latter took Madopar250mg tid, after9weeks treatment and a half year follow-up, the symptoms were evaluated by modified Webster scale. The statistical analysis was completed by Microsoft Excel and SPSS17.0.
Results:Among the120subjects,6cases are dropped out, the expulsion rate is5.0%. In the114evaluated cases,55are male and59are female, whose average age is64and average PD history is5years, the mWS is5～25(average15.22) at the beginning and0～17(average7.28) at last. Acupuncture group includes61cases, while the drug group (treated by west medicine) includes58cases. Before the treatment mWS is15.77±3.575and14.58±4.050separately for the two groups. After3periods of treatment, the symptoms of most patients improved, the114cases debased their scales by1～16(average by6.64). The two groups are6.70±3.805and7.94±4.605respectively. The efficiency index is57.23%and47.51%respectively. The total efficiency is respectively86.89%and75.47%.
According to the ten kinds of symptoms showed in the mWS, the PD patients in our study is of mild or middle degree, and they are divided into two groups evenly. After3periods of treatment and a half year follow-up, the patients of both two groups improved their performance of tremor and gait, while in the acupuncture group stiffness, countenance, pronunciation and expression were significantly improved. After a half year follow-up, the mWS of two groups changes to6.70and8.23respectively. Better long-term efficiency of the acupuncture group are found.
Conclusion:SACB consists of seven points locating at Du Meridian, Taiyang Meridian and Shaoyang Meridian separately. They have the function of calming down the liver wind and strengthening the brain and bone. Recent studies show that the neural defects of PD patients are relying on the integrity of the resting-state network. SACB is at the very place of the cranial bottom, echoing with the resting-state network. Besides, the cerebral blood flow declined for PD patients, acupuncture can increase the blood flow significantly.
From the clinical study, the efficiency of SACB for PD is proved. It leads to significant improvements for patients with PD, especially in respect of the flexibility, stiffness, countenance, pronunciation and expression. SACB has better long-term efficiency for PD patients to improve their life quality.
研究目的：通过前瞻性随机对照研究,客观评价“颅底七穴”针法治疗帕金森病的临床疗效。
研究方法：以中国中医科学院望京医院就诊的PD患者为研究对象,将改良Webster评分低于25分的120例轻中度PD患者随机分为针刺治疗组(针刺组)与药物对照组(药物组)。针刺组应用“颅底七穴”针法治疗,药物组采用美多芭口服,两组同期治疗9周,随访半年,期间5次应用改良Webster评分记录其症状变化,随访结束后进行疗效评定,计算其疗效百分比。采用Microsoft Excel工作表及SPSS17.0软件进行数据录入及统计分析,比较组间差异,以判断临床疗效。
结果：本研究共纳入患者120例,6例因未能坚持治疗脱落,脱落剔除率为5.0%。最终用于统计病例114例,男性55例,女性59例；年龄38-87岁,平均64岁；病程24周～23年(1152周),平均278周；治疗前改良Webster评分5～25分,平均15.22分；最后就诊改良Webster评分0-17分,平均7.28分。其中针刺组61例,药物组58例。入选各组病例治疗前积分无明显统计学差异,治疗前两组改良Webster得分均值分别为15.77±3.575和14.58±4.050。经针灸或西药治疗后大多数病例症状均可得到控制,治疗3个疗程后,114例患者前后积分降幅为1～16分,平均6.64分；两组分别降低为6.70±3.805和7.94±4.605,两组比较无显著统计学差异。疗效判断分析结果：针刺组为：17.00-94.7%,平均57.23%,药物组为5.80～100%,平均47.51%,两组比较,p=0.052。针刺组对PD轻中度患者的治疗总有效率为86.89%,而药物组总有效率为75.47%；两组比较具有显著统计学差异,P=0.019。
根据改良Webster评分中涉及的十大症状,对两组患者五次症状评价情况进行分析,入选患者以轻、中度病变为主,针刺组与药物组症状对比轻重程度分布较平均。由第3个治疗疗程结束后和治疗结束后半年进行的第二次随访可见：两组对于震颤、患者步态的改善均有明显疗效。针刺组对于头俯屈、上肢屈曲的异常姿势、患者面容的呆板以及患者的语言功能疗效明显。随访半年期间,针刺组8例症状进展,治疗完毕与随访完毕改良Webster评分均值分别为：8.51和6.70；而药物组21例症状进展,治疗完毕与随访完毕改良Webster评分均值分别为：8.77和8.23；由此可见针灸治疗较西药治疗远期效应更佳。
结论：PD是一种常见于中老年的神经系统变性疾病,“颅底七穴”位于颅底,可以直达病所。穴位分属于督脉、太阳经、少阳经,具有平肝熄风、醒脑强脊的功效。据现代医学研究,PD发病与静息态脑功能网络相关,而“颅底七穴”恰好如网状布于颅底,内应静息态脑功能网络,针刺治疗能够调节该网络系统的功能。此外,PD患者的全脑血流量都有下降,针刺可以增加脑血流量,从而改善脑部的血液循环。
我们通过前瞻性研究证实了“颅底七穴”的临床有效性。该针法通过对颅底网络系统的神经调节和脑部血液循环的改善,可以明显改善帕金森病患者的临床症状,其临床疗效评价优于美多芭常规剂量的应用；对于PD患者震颤、步态的改善与药物组相当,而对于改善PD患者肢体灵活性,改善患者僵直、俯屈姿态以及面容的呆板,言语障碍优于常规左旋多巴类药物的应用；其远期疗效显著,大大提高患者的生活质量。
Background:With the rapid increase in the incidence and the patients becoming younger, Parkinson's disease (PD) is becoming one of the most important global healthy problems. Over the past decades, the treatment of PD has undergone tremendous changes. New drugs and methods have been introduced to improve the symptoms of PD. But till now, no method can stop or slow down the neural defects of PD patients while Traditional Chinese Medicine (TCM) is gaining more and more focus as a form of complementary or alternative treatment."The Seven Acupoints of the Cranial Base"(SACB), which consists of DU15, BL10, GB20and GB12, was used to treat PD for about twenty years. It's valuable to study the clinical curative effect of SACB for PD.
Objective:To observe the clinical curative effect of SACB for PD.
Methods:The study subjects were derived from Wangjing Hospital,120PD subjects were all of mild or middle degree, whose modified Webster Scale (mWS) is lower than25. Subjects were divided into two groups, i.e., acupuncture group and drug group. The former was treated by SACB every two days, while the latter took Madopar250mg tid, after9weeks treatment and a half year follow-up, the symptoms were evaluated by modified Webster scale. The statistical analysis was completed by Microsoft Excel and SPSS17.0.
Results:Among the120subjects,6cases are dropped out, the expulsion rate is5.0%. In the114evaluated cases,55are male and59are female, whose average age is64and average PD history is5years, the mWS is5～25(average15.22) at the beginning and0～17(average7.28) at last. Acupuncture group includes61cases, while the drug group (treated by west medicine) includes58cases. Before the treatment mWS is15.77±3.575and14.58±4.050separately for the two groups. After3periods of treatment, the symptoms of most patients improved, the114cases debased their scales by1～16(average by6.64). The two groups are6.70±3.805and7.94±4.605respectively. The efficiency index is57.23%and47.51%respectively. The total efficiency is respectively86.89%and75.47%.
According to the ten kinds of symptoms showed in the mWS, the PD patients in our study is of mild or middle degree, and they are divided into two groups evenly. After3periods of treatment and a half year follow-up, the patients of both two groups improved their performance of tremor and gait, while in the acupuncture group stiffness, countenance, pronunciation and expression were significantly improved. After a half year follow-up, the mWS of two groups changes to6.70and8.23respectively. Better long-term efficiency of the acupuncture group are found.
Conclusion:SACB consists of seven points locating at Du Meridian, Taiyang Meridian and Shaoyang Meridian separately. They have the function of calming down the liver wind and strengthening the brain and bone. Recent studies show that the neural defects of PD patients are relying on the integrity of the resting-state network. SACB is at the very place of the cranial bottom, echoing with the resting-state network. Besides, the cerebral blood flow declined for PD patients, acupuncture can increase the blood flow significantly.
From the clinical study, the efficiency of SACB for PD is proved. It leads to significant improvements for patients with PD, especially in respect of the flexibility, stiffness, countenance, pronunciation and expression. SACB has better long-term efficiency for PD patients to improve their life quality.
引文
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