针刺蝶腭神经节联合温针灸大椎穴治疗肺脾气虚型鼻鼽临床研究

Clinical Study on Acupuncture at Sphenopalatine Ganglion Combined with Warm Needle Moxibustion at Dazhui (DU14) Point for Biqiu of Lung-Spleen Qi Deficiency Type

摘要:

目的：观察针刺蝶腭神经节联合温针灸大椎穴治疗肺脾气虚型鼻鼽的疗效。方法：选取2021年2月—2025年1月天津中医药大学第一附属医院耳鼻喉科收治的108例肺脾气虚型鼻鼽患者，按随机数字表法分为对照组与观察组各54例。试验期间对照组脱落1例、剔除3例，观察组脱落1例、剔除1例，最终对照组完成试验50例，观察组52例。对照组给予常规西药治疗，观察组给予针刺蝶腭神经节联合温针灸大椎穴治疗。比较治疗4周后2组临床疗效及随访6个月复发率情况，比较2组治疗前后中医证候评分、鼻部症状［鼻部症状总分表（TNSS）、鼻部伴随症状总分表（TNNSS）］、生活质量［鼻结膜炎相关生活质量问卷（RQLQ）］、血清细胞因子水平［白细胞介素-4（IL-4）、干扰素γ（IFN-γ）］、免疫学指标值［免疫球蛋白E（IgE）、嗜酸性粒细胞（EOS） ］ 的变化。结果： 治疗后， 观察组临床疗效总有效率为92.31% （48/52）， 对照组为78.00%（39/50），2组比较，差异有统计学意义（P＜0.05）。治疗后，2组中医证候主症评分、次症评分、总积分均较治疗前下降（P＜0.05），观察组中医证候主症评分、次症评分、总积分均低于对照组（P＜0.05）。治疗后，2组TNSS评分、TNNSS评分、RQLQ评分均较治疗前下降（P＜0.05），观察组TNSS评分、TNNSS评分、RQLQ评分均低于对照组（P＜0.05）。治疗后，2组血清IL-4水平均较治疗前下降（P＜0.05），IFN-γ水平均较治疗前上升（P＜0.05）；观察组血清IL-4水平低于对照组（P＜0.05），IFN-γ水平高于对照组（P＜0.05）。治疗后，2组IgE、EOS水平均较治疗前下降（P＜0.05），观察组IgE、EOS水平均低于对照组（P＜0.05）。2组治疗有效患者经随访6个月，观察组复发率6.25%（3/48），对照组复发率为23.08%（9/39），2组比较，差异有统计学意义（P＜0.05）。结论：针刺蝶腭神经节联合温针灸大椎穴治疗肺脾气虚型鼻鼽的疗效较好，可有效缓解鼻部症状及伴随症状，减轻过敏相关炎症反应，调节机体免疫失衡，降低复发率，提高患者生活质量。

Abstract:

Abstract： Objective： To observe the clinical effects of acupuncture at the sphenopalatine ganglion combined with warm needle moxibustion at Dazhui （DU14） point in the treatment of biqiu （allergic rhinitis） of lung-spleen qi deficiency type. Methods： A total of 108 patients with biqiu of lung-spleen qi deficiency type admitted to the Department of the Otolaryngology of the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from February 2021 to January 2025 were enrolled and randomly divided into the control group and the observation group using the random number table method，with 54 cases in each group. During the trial，1 case was dropped off and 3 cases were excluded in the control group，and 1 case was dropped off and 1 case was excluded in the observation group. Finally，50 cases in the control group and 52 cases in the observation group completed the trial. The control group was treated with conventional western medicine， while the observation group was treated with acupuncture at the sphenopalatine ganglion combined with warm needle moxibustion at Dazhui （DU14） point. After 4 weeks of treatment， the clinical effects and the 6-month follow-up recurrence rate were compared between the two groups. The changes in traditional Chinese medicine （TCM） syndrome scores， nasal symptoms evaluated by the Total Nasal Symptom Score （TNSS） and Total Non-Nasal Symptom Score （TNNSS）， quality of life assessed by the Rhinoconjunctivitis Quality of Life Questionnaire （RQLQ）， serum levels of inflammatory factors including interleukin-4 （IL-4） and interferon-γ （IFN-γ），and immunological indicators including immunoglobulin E （IgE） and eosinophils （EOS） were compared before and after treatment. Results： After treatment， the total effective rate was 92.31% （48/52） in the observation group，which was significantly higher than that of 78.00% （39/50） in the control group （P＜0.05）. After treatment，the main symptom scores，secondary symptom scores，and total TCM syndrome scores of both groups were decreased when compared with those before treatment （P＜0.05），and the observation group had lower scores than the control group （P＜0.05）. The TNSS， TNNSS， and RQLQ scores of both groups were significantly reduced after treatment （P＜0.05），with lower scores in the observation group （P＜0.05）. After treatment，serum IL-4 levels were decreased and IFN-γ levels were increased in both groups （P＜0.05）；the observation group showed lower IL-4 levels and higher IFN-γ levels than the control group （P＜0.05）. The levels of IgE and EOS in both groups declined after treatment （P＜0.05），and were lower in the observation group （P＜0.05）. At the 6-month follow-up of the treatment responders，the recurrence rate was 6.25% （3/48） in the observation group and 23.08% （9/39） in the control group， there being significant difference between the two groups （P＜0.05）. Conclusion：Acupuncture at the sphenopalatine ganglion combined with warm needle moxibustion at Dazhui （DU14） point yields favorable efficacy in treating biqiu of lung-spleen qi deficiency type. It can effectively relieve nasal and associated symptoms，alleviate allergic inflammatory responses，regulate immune imbalance，reduce recurrence rate，and improve patients' quality of life.