督灸配合中药治疗重症肌无力的疗效观察  

Therapeutic observation of Governor Vessel moxibustion plus Chinese medication for myasthenia gravis

作　　者：王玲[1] 杨俊红[1] WANG Ling;YANG Junhong(The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450002,China)

机构地区：[1]河南中医药大学第一附属医院,郑州450002

出　　处：《上海针灸杂志》2024年第7期750-756,共7页Shanghai Journal of Acupuncture and Moxibustion

基　　金：河南省科技公关项目(232102311196)。

摘　　要：目的 观察督灸配合益髓健肌颗粒治疗重症肌无力的临床疗效。方法 将94例重症肌无力患者随机分为治疗组和对照组,每组47例。治疗组采用督灸配合益髓健肌颗粒治疗,对照组采用口服甲泼尼龙片治疗。观察两组治疗前后英国医学研究理事会(Medical Research Council, MRC)肌力评测表评分、重症肌无力肌群耐力评分量表(myasthenia gravis muscular endurance scale, MGMES)评分、肌肉含量及各项实验室指标[滤泡辅助性T细胞(T follicular helper cells, Tfh)、滤泡调节性T细胞(T follicular regulatory cells, Tfr)、Tfr/Tfh比值、肿瘤坏死因子-α(tumor necrosis factor-α, TNF-α)、白细胞介素-2(interleukin-2, IL-2)、白细胞介素-17(interleukin-17, IL-17)、鸢尾素(irisin)、过氧化物酶体增殖物激活受体-γ共激活因子-1α(peroxisome proliferator-activated receptor-γ coactivator 1-α, PGC-1α)、Ⅲ型纤连蛋白结构域蛋白5(fibronectin typeⅢdomain-containing protein 5, FNDC5)、磷脂酰肌醇-3-激酶(phosphoinositide3-kinase, PI3K)、蛋白激酶B(AKT)、雷帕霉素靶蛋白(mammalian target of rapamycin, mTOR)]的变化情况,比较两组临床疗效、不良反应发生率及随访6个月复发率。结果 治疗组总有效率为95.7%,明显高于对照组的81.4%(P<0.05)。两组治疗后MRC肌力评测表评分及肌肉含量均较同组治疗前显著上升,MGMES评分均显著下降,差异均具有统计学意义(P<0.05)。治疗组治疗后Tfr、Tfr/Tfh、irisin水平均较同组治疗前显著上升,Tfh、TNF-α、IL-2、IL-17、PGC-1α、FNDC5、PI3K、AKT、mTOR水平均显著下降,差异均具有统计学意义(P<0.05)。对照组治疗后Tfr、Tfr/Tfh水平均较同组治疗前显著上升,Tfh、TNF-α、IL-2、IL-17水平均显著下降,差异均具有统计学意义(P<0.05)。治疗组治疗后MRC肌力评测表评分、MGMES评分、肌肉含量及各项实验室指标与对照组比较,差异均具有统计学意义(P<0.05)。治疗组治疗期间不良�Objective To observe the clinical efficacy of Governor Vessel moxibustion plus Yi Sui Jian Ji granules in treating myasthenia gravis(MG).Method Ninety-four MG patients were randomized into a treatment group and a control group,with 47 cases in each group.The treatment group was treated with Governor Vessel moxibustion plus Yi Sui Jian Ji granules,and the control group was treated with oral administration of Methylprednisolone tablets.After the treatment,changes in the Medical Research Council(MRC)muscle strength scale score,myasthenia gravis muscular endurance scale(MGMES)score,muscle content,and laboratory indexes[T follicular helper cells(Tfh),T follicular regulatory cells(Tfr),Tfr/Tfh,tumor necrosis factor-α(TNF-α),interleukin-2(IL-2),interleukin-17(IL-17),irisin,peroxisome proliferator-activated receptor-γcoactivator 1-α(PGC-1α),fibronectin typeⅢdomain-containing protein 5(FNDC5),phosphoinositide 3-kinase(PI3K),protein kinase B(AKT),and mammalian target of rapamycin(mTOR)]were observed.The two groups were also compared in terms of clinical efficacy,adverse reaction rate,and relapse rate at the 6-month follow-up.Result The total effective rate was 95.7%in the treatment group,significantly higher than 81.4%in the control group(P<0.05).After the treatment,the MRC muscle strength scale score and muscle content increased notably,and the MGMES score dropped markedly in both groups(P<0.05).After the intervention,the treatment group showed significant increases in the levels of Tfr,Tfr/Tfh,and irisin and significant decreases in the levels of Tfh,TNF-α,IL-2,IL-17,PGC-1α,FNDC5,PI3K,AKT,and mTOR(P<0.05).In the control group,the levels of Tfr and Tfr/Tfh increased notably,and the levels of Tfh,TNF-α,IL-2,and IL-17 dropped significantly after the treatment(P<0.05).There were significant differences in the MRC muscle strength scale score,MGMES score,muscle content,and laboratory test results between the treatment and control groups after the treatment(P<0.05).In the treatment group,the adverse reaction rate duri

关 键 词：灸法 铺灸 督灸 重症肌无力 肌力 炎性因子 

分 类 号：R246.6[医药卫生—针灸推拿学]