针刺联合A型肉毒素治疗特发性眼睑痉挛的临床观察  

Clinical Observation on Treatment of Idiopathic Blepharospasm with Acupuncture Combined with Botulinum Toxin Type A

作　　者：杨安 胡怀彬[1] 张志芳[1] 张明明[1] 胡瑛[1] 屈金源 YANG An;HU Huaibin;ZHANG Zhifang;ZHANG Mingming;HU Ying;QU Jinyuan(Eye Hospital,China Academy of Chinese Medical Sciences,Beijing 100040,China)

机构地区：[1]中国中医科学院眼科医院,北京100040

出　　处：《中国中医眼科杂志》2023年第12期1129-1133,1154,共6页China Journal of Chinese Ophthalmology

基　　金：中国中医科学院自主选题研究项目(ZZ11-040)。

摘　　要：目的观察针刺联合A型肉毒杆菌毒素(BTX-A)治疗特发性眼睑痉挛(BES)的临床疗效。方法纳入2022年1月—2023年1月中国中医科学院眼科医院诊治的BES患者60例(120只眼),证属心脾两虚证。随机分为肉毒素组(A组)、针刺组(B组)和肉毒素联合针刺组(C组),每组各20例(40只眼)。A组予BTX-A眼睑注射治疗,B组予针刺治疗,C组予针刺联合BTX-A治疗。3组均观察7个月。分别于治疗前、治疗后7 d和治疗后7个月检测患者的肌肉痉挛等级及例数、起效时间和疗效持续时间并做统计分析。结果(1)痉挛等级:治疗前3组痉挛等级分布总体比较,差异无统计学意义(P>0.05)。治疗后7 d与治疗前比较,A组和C组痉挛等级分布总体均较前降低,差异均有统计学意义(ZA组=47.088,Z_(C组)=45.888,均P=0.000)。治疗后7 d 3组间痉挛等级分布总体比较,差异有统计学意义(Z=28.572,P=0.000)。A组和C组痉挛等级分布总体低于B组,差异均有统计学意义(ZA组=36.212,Z_(C组)=32.938,均P=0.000)。治疗后7个月与治疗前比较,B组和C组痉挛等级分布总体均较前降低,差异均有统计学意义(Z_(B组)=29.450,Z_(C组)=54.162,均P=0.000)。治疗后7个月3组间痉挛等级分布总体比较,差异有统计学意义(Z=38.878,P=0.000)。B组和C组痉挛等级分布总体均低于A组,差异均有统计学意义(Z_(B组)=19.788,P=0.026;Z_(C组)=46.850,P=0.000),C组痉挛等级分布总体低于B组,差异有统计学意义(Z=27.062,P=0.001)。(2)起效时间:3组起效时间比较,差异有统计学意义(Welch F=315.658,P=0.000)。与A组比较,B组起效时间均延后,差异有统计学意义(t=25.348,P=0.000);C组起效时间无明显变化,差异无统计学意义(P>0.05)。与B组比较,C组起效时间提前,差异有统计学意义(t=24.270,P=0.000)。(3)疗效持续时间:3组疗效持续时间比较,差异有统计学意义(Welch F=38.290,P=0.000)。B组和C组疗效持续时间均较A组长,差异均有统计学意义(tB组=3.441,P=0.0OBJECTIVE To observe the clinical efficacy of acupuncture combined with botulinum toxin type A(BTX-A)in the treatment of benign essential blepharospasm(BES).METHODS A total of 60 patients with BES(120 eyes)were January 2023 were included which were diagnosed with spleen and heart deficiency syndrome.They were randomly divided into botulinum toxin group(Group A),acupuncture group(Group B),and botulinum toxin combined with acupuncture group(Group C),with 20 cases in each group(40 eyes).Group A received BTX-A eyelid injection treatment,Group B received acupuncture treatment,and Group C received combined acupuncture and BTX-A treatment.All groups were observed for seven months.Muscle spasm levels,onset time,and duration of efficacy were measured and statistically analyzed before treatment,seven days after treatment,and seven months after treatment.RESULTS(1)Spasm severity:No significant differences in level distribution were observed among the three groups before treatment(P>0.05).Seven days after treatment,both Group A and Group C showed a significant reduction in spasm severity compared to before treatment(ZA=47.088,ZC=45.888,both P=0.000).The spasm severity among the three groups showed significant differences at seven days after treatment(Z=28.572,P=0.000).Spasm severity in Group A and Group C was lower than Group B(ZA=36.212,ZC=32.938,both P=0.000).After seven months,Group B and Group C showed a significant reduction in spasm severity compared to before treatment(ZB=29.450,ZC=54.162,both P=0.000).The level distribution among the three groups at seven months showed significant differences(Z=38.878,P=0.000).Spasm severity in Group B and Group C was lower than Group A(ZB=19.788,P=0.026;ZC=46.850,P=0.000),and Group C was lower than Group B(Z=27.062,P=0.001).(2)Onset time:There were significant differences in onset time among the three groups(Welch F=315.658,P=0.000).Compared with Group A,Group B had a delayed onset time,with significant differences(t=25.348,P=0.000);Group C showed no significant change in onset time

关 键 词：针刺 A型肉毒素 特发性眼睑痉挛 

分 类 号：R246.82[医药卫生—针灸推拿学]