Curative effect of fire acupuncture combined with acupuncture in the treatment of lower leg plaque psoriasis
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摘要:
目的 观察火针配合针刺治疗小腿斑块状银屑病的疗效及患者治疗前后血管内皮抑制素(ES)、血管抑制素(AS)水平的变化。 方法 选择2019年5月—2020年4月嘉兴市第一医院收治的105例小腿斑块状银屑病患者，采用随机数字表法分为常规治疗组、火针组及联合治疗组，每组35例。常规治疗组采用局部涂擦哈西奈德乳膏联合窄谱中波紫外线(NB-UVB)照射治疗，火针组采用火针配合针刺治疗，联合治疗组同时采用上述2组的治疗方案，3组疗程均为8周。通过银屑病皮损面积和严重程度指数(PASI)评分评价疗效，并检测治疗前及治疗4、8周血清ES、AS水平。 结果 治疗8周3组PASI评分均较治疗前下降(均P＜0.05)，治疗8周常规治疗组与火针组PASI评分比较差异无统计学意义(P>0.05)，联合治疗组PASI评分低于常规治疗组与火针组(均P＜0.05)。常规治疗组总有效率(54.29%)与火针组(60.00%)比较差异无统计学意义(P>0.05)，联合治疗组总有效率(85.71%)高于常规治疗组与火针组(均P＜0.05)。3组治疗后血清ES、AS水平均随时间推移呈上升趋势(均P＜0.05)，治疗4周联合治疗组血清ES水平高于常规治疗组与火针组(均P＜0.05)，治疗8周联合治疗组血清AS水平高于常规治疗组与火针组(均P＜0.05)。 结论 火针配合针刺治疗小腿斑块状银屑病疗效与常规治疗相当，联合治疗可提高疗效，其作用机制可能与升高ES、AS水平，抑制血管新生有关。 Abstract:Objective To observe the clinical efficacy of fire acupuncture combined with acupuncture in the treatment of lower leg plaque psoriasis and the changes of endostatin (ES) and angiostatin (AS) levels before and after treatment. Methods A total of 105 patients with lower leg plaque psoriasis treated in the First Hospital of Jiaxing from May 2019 to April 2020 were selected and randomly divided into the conventional treatment group, fire acupuncture group and combined treatment group, with 35 cases in each group. The conventional treatment group was treated with external application of halcinonide cream combined with NB-UVB irradiation, the fire acupuncture group was treated with fire acupuncture combined with acupuncture, and the combined treatment group was treated with the above-mentioned treatments simultaneously. All the three groups were treated for 8 weeks. The clinical efficacy was evaluated by PASI score, and the serum levels of ES and AS were detected before treatment and 4 and 8 weeks after treatment. Results The PASI scores of the three groups decreased after 8 weeks of treatment (all P < 0.05). After treatment, no significant difference in PASI score was found between the conventional treatment group and fire acupuncture group (P>0.05), but the PASI score of the combined treatment group was lower than that of the conventional treatment group and the fire acupuncture group (all P < 0.05). In addition, no significant difference in the total effective rate was found between the conventional treatment group (54.29%) and fire acupuncture group (60.00%, P>0.05). The total effective rate of the combined treatment group (85.71%) was higher than that of the conventional treatment group and fire acupuncture group (all P < 0.05). The serum levels of ES and AS in the three groups increased with time (all P < 0.05). The serum ES level of the combined treatment group was higher than that of the conventional treatment group and fire acupuncture group after 4 weeks of treatment (all P < 0.05), and the serum AS level of the combined treatment group after 8 weeks of treatment was higher than that of the conventional treatment group and fire acupuncture group (all P < 0.05). Conclusion The curative effect of fire acupuncture combined with acupuncture in the treatment of lower leg plaque psoriasis is similar to that of conventional treatment. Combined treatment can improve the curative effect, and its mechanism may be related to the increase of ES and AS levels and the inhibition of angiogenesis. -
Key words:
- Plaque psoriasis /
- Lower leg /
- Fire acupuncture /
- Acupuncture /
- Endostatin /
- Angiostatin
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表 1 3组银屑病患者一般资料比较
组别 例数 性别[例(%)] 年龄
(x±s，岁)病程
(x±s，年)男性 女性 常规治疗组 35 19(54.29) 16(45.71) 43.80±6.56 8.43±3.69 火针组 35 17(48.57) 18(51.43) 41.77±7.73 8.06±2.95 联合治疗组 35 21(60.00) 14(40.00) 40.57±7.88 7.74±2.85 统计量 0.921a 1.697b 0.406b P值 0.631 0.188 0.667 注：a为χ2值，b为F值。 
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表 2 3组银屑病患者治疗前后PASI评分比较[M(P25，P75)，分]
组别 例数 治疗前 治疗8周 Z值 P值 常规治疗组 35 4.0(3.2，6.0) 2.0(0.8，2.6) -5.167 < 0.001 火针组 35 3.6(3.2，5.6) 1.6(0.8，2.4) -5.167 < 0.001 联合治疗组 35 4.0(3.2，5.6) 0.8(0.0，1.6)ab -5.168 < 0.001 χ2值 0.249 10.835 P值 0.883 0.004 注：与常规治疗组比较，aP＜0.05；与火针组比较，bP＜0.05。
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表 3 3组银屑病患者临床疗效比较[例(%)]
组别 例数 痊愈 显效 有效 无效 总有效 常规治疗组 35 6(17.14) 13(37.14) 10(28.57) 6(17.14) 19(54.29) 火针组 35 8(22.86) 13(37.14) 11(31.43) 3(8.57) 21(60.00) 联合治疗组 35 16(45.71) 14(40.00) 5(14.29) 0(0) 30(85.71)ab 注：3组总有效率比较，χ2=8.829, P=0.012；与常规治疗组比较，aP＜0.017；与火针组比较，bP＜0.017。
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表 4 3组银屑病患者治疗前后血清ES水平比较(x±s，ng/mL)
组别 例数 治疗前 治疗4周 治疗8周 常规治疗组 35 233.41±39.03 268.61±41.67a 317.85±57.92ab 火针组 35 224.37±37.92 264.13±45.42a 323.87±50.51ab 联合治疗组 35 241.54±49.06 294.26±48.35a 379.30±64.83ab F值 1.442 4.522 11.919 P值 0.241 0.013 < 0.001 注：F组间=5.524，P组间=0.005；F时间=2198.210，P时间 < 0.001；F交互=49.302，P交互 < 0.001。组内比较，与治疗前比较，aP＜0.05，与治疗4周比较，bP＜0.05。
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表 5 3组银屑病患者治疗前后血清AS水平比较(x±s，ng/mL)
组别 例数 治疗前 治疗4周 治疗8周 常规治疗组 35 17.73±4.23 20.00±4.65a 23.90±5.34ab 火针组 35 16.47±3.93 21.23±3.87a 24.12±4.71ab 联合治疗组 35 17.26±3.37 22.47±5.01a 28.56±6.69ab F值 0.947 2.579 7.583 P值 0.391 0.081 0.001 注：F组间=2.615，P组间=0.078；F时间=1047.539，P时间 < 0.001；F交互=40.346，P交互 < 0.001。组内比较，与治疗前比较，aP＜0.05，与治疗4周比较，bP＜0.05。
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