针刺联合隔姜灸治疗儿童变应性鼻炎合并鼻出血的疗效观察及对鼻黏膜菌群的影响  

Effect of acupuncture plus ginger-insulated moxibustion in the treatment of allergic rhinitis with epistaxis in children and its influence on nasal mucosa flora

作　　者：王伊娜 张崧 胡志佳 WANG Yina;ZHANG Song;HU Zhijia(Maternity and Child Care Center of Qinhuangdao,Hebei Province,Qinhuangdao 066000,China)

机构地区：[1]河北省秦皇岛市妇幼保健院,秦皇岛066000

出　　处：《上海针灸杂志》2025年第4期476-481,共6页Shanghai Journal of Acupuncture and Moxibustion

基　　金：国家中医药管理局全国优秀人才研修项目(2020ZYLCY002-026);秦皇岛市科学技术研究与开发计划项目(202301A169)。

摘　　要：目的 观察针刺联合隔姜灸治疗儿童变应性鼻炎合并鼻出血的临床疗效及对鼻黏膜菌群和血清叉状头转录因子p3(forkhead transcription factor p3, Foxp3)、巨噬细胞炎性蛋白1α(macrophage inflammatory protein 1α, MIP-1α)、肿瘤坏死因子受体2(tumor necrosis factor receptor 2,TNFR2)水平的影响。方法 将86例儿童变应性鼻炎合并鼻出血患者按随机数字表法分为西医组(43例)和中医组(43例)。西医组予常规西医治疗,中医组在常规西医治疗基础上予针刺联合隔姜灸治疗。比较两组临床疗效,观察两组治疗前后鼻部症状评分、鼻部症状总评分(total nasal symptom scores, TNSS)、鼻部伴随症状总分(total non-nasal symptom scores,TNNSS)、鼻阻力、鼻黏膜菌群、凝血酶原时间、活化部分凝血活酶时间及血清Foxp3、MIP-1α和TNFR2水平的变化。结果 中医组总有效率为97.7%,西医组总有效率为79.1%,差异具有统计学意义(P<0.05)。中医组治疗后鼻部症状评分、TNSS、TNNSS、鼻阻力和鼻黏膜梭杆菌属的丰度均低于西医组(P<0.05),中医组治疗后鼻黏膜痤疮丙酸杆菌和放线菌门的丰度均高于西医组(P<0.05),中医组治疗后凝血酶原时间和活化部分凝血活酶时间均短于西医组(P<0.05),中医组治疗后血清Foxp3水平高于西医组(P<0.05),中医组治疗后血清MIP-1α和TNFR2水平低于西医组(P<0.05)。结论 在常规西医治疗基础上,针刺联合隔姜灸治疗可提高儿童变应性鼻炎合并鼻出血的临床疗效,能进一步改善鼻黏膜菌群及凝血功能,降低MIP-1α和TNFR2水平,提高Foxp3含量,缓解临床症状。Objective To observe the clinical efficacy of acupuncture combined with ginger-insulated moxibustion in the treatment of allergic rhinitis with epistaxis in children and its effect on nasal mucosa flora and levels of serum forkhead transcription factor p3(Foxp3),macrophage inflammatory protein 1α(MIP-1α),and tumor necrosis factor receptor 2(TNFR2).Method A total of 86 children with allergic rhinitis and epistaxis was allocated to a Western medication group(43 cases)and a traditional Chinese medicine(TCM)group(43 cases)according to the random number table method.The Western medication group treated with conventional Western medicine,and the TCM group was treated with additional acupuncture combined with ginger-insulated moxibustion.The clinical efficacy of the two groups was compared,and the nasal symptom score,total nasal symptom scores(TNSS),total non-nasal symptom scores(TNNSS),nasal resistance,nasal mucosa flora,prothrombin time,activated partial thromboplastin time,and serum Foxp3,MIP-1αand TNFR2 levels before and after treatment were observed in the two groups.Result The total effective rate was 97.7%in the TCM group and 79.1%in the Western medication group,and the difference was statistically significant(P<0.05).After treatment,the nasal symptom score,TNSS,TNNSS,nasal resistance,and the abundance of Fusobacterium in nasal mucosa in the TCM group were lower than those in the Western medication group(P<0.05);the abundance of Propionibacterium Acnes and actinobacteria in nasal mucosa in the TCM group were higher than that in the Western medication group(P<0.05);the prothrombin time and activated partial thromboplastin time was shorter than that in the Western medication group(P<0.05);the level of serum Foxp3 was higher than that in the Western medication group(P<0.05);the levels of serum MIP-1αand TNFR2 were lower than those in the Western medication group(P<0.05).Conclusion Acupuncture combined with ginger-partitioned moxibustion enhances treatment efficacy for pediatric allergic rhinitis with epistaxis b

关 键 词：针刺疗法 间接灸 针药并用 鼻炎 变应性 鼻出血 鼻黏膜菌群 凝血功能 儿童 

分 类 号：R246.4[医药卫生—针灸推拿学]