针刺配合铺灸疗法治疗气虚血瘀型糖尿病周围神经病变患者的临床疗效及机制研究

Study on the clinical efficacy and mechanism of acupuncture and moxibustion therapy on diabetic peripheral neuropathy patients with qi-deficiency and blood-stasis type

关键词:  针刺  铺灸疗法  糖尿病周围神经病变  颈动脉血管弹性  血管内皮功能  纤维蛋白胶凝素-3

Key words:  acupuncture  moxibustion therapy  diabetic peripheral neuropathy  carotid vascular elasticity  vascular endothelial function  fibrin gelatin-3

摘要:

[目的] 观察针刺配合铺灸疗法对气虚血瘀型糖尿病周围神经病变患者颈动脉血管弹性的改善及糖脂代谢、血管内皮和血清糖化血红蛋白（HbA1c）、纤维蛋白胶凝素-3（ficolin-3）的影响。[方法] 选择2021年6月—2023年6月于秦皇岛市中医医院治疗的92例糖尿病周围神经病变患者，按照随机数字表法将患者分为3组，其中常规组30例，给予常规西医治疗；针刺组31例，常规组治疗基础上给予针刺治疗；铺灸疗法配合组31例，针刺组治疗方法同时给予铺灸疗法治疗。比较常规组、针刺组、铺灸疗法配合组临床疗效，治疗前、后给予患者腹泻或便秘，神疲倦怠，肢末时痛、入夜痛甚，动则汗出，肢体如有蚁行且麻木无力，气短懒言评价，检测颈总动脉血管压力应变弹性模量，检测患者一氧化氮（NO）、内皮素（ET）、三酰甘油（TG）、HbA1c、ficolin-3、高密度脂蛋白（HDL-C）水平。[结果] 研究发现铺灸疗法配合组、针刺组总有效率高于常规组（P<0.05）；铺灸疗法配合组腹泻或便秘，神疲倦怠，肢末时痛、入夜痛甚，动则汗出，肢体如有蚁行且麻木无力，气短懒言评分低于常规组、针刺组（P<0.05），针刺组腹泻或便秘，神疲倦怠，肢末时痛、入夜痛甚，动则汗出，肢体如有蚁行且麻木无力，气短懒言评分低于常规组（P<0.05）；铺灸疗法配合组患者颈总动脉血管压力应变弹性模量低于常规组、针刺组（P<0.05），针刺组颈总动脉血管压力应变弹性模量低于常规组（P<0.05）；铺灸疗法配合组患者HDL-C表达水平高于常规组、针刺组（P<0.05），针刺组HDL-C表达水平高于常规组（P<0.05），铺灸疗法配合组患者TG、HbA1c表达水平低于常规组、针刺组（P<0.05），针刺组TG、HbA1c表达水平低于常规组（P<0.05）；铺灸疗法配合组患者ficolin-3、NO表达水平高于常规组、针刺组（P<0.05），针刺组ficolin-3、NO表达水平高于常规组（P<0.05），铺灸疗法配合组患者ET表达水平低于常规组、针刺组（P<0.05），针刺组ET表达水平低于常规组（P<0.05）。[结论] 给予糖尿病周围神经病变患者针刺配合铺灸疗法治疗，可改善糖脂代谢、颈动脉血管弹性、血管内皮功能，提升ficolin-3水平，缓解病情，提升临床疗效。

Abstract:

[Objective] To observe the effects of acupuncture combined with moxibustion therapy on carotid artery elasticity，glucose and lipid metabolism，vascular endothelium，serum HbA1c and fibrin agglutinin-3（ficolin-3） in diabetic peripheral neuropathy patients with qi-deficiency and blood-stasis type. [Methods] Ninety-two patients with diabetic peripheral neuropathy were selected for hospital treatment，and all cases were successively enrolled in the group from June 2021 to June 2023，and the grouping method was random number table. The conventional group of 30 cases was given conventional Western medicine treatment；acupuncture group（31 cases） was given acupuncture treatment on the basis of conventional treatment. Moxibustion treatment combined with 31 cases，acupuncture group was treated with moxibustion treatment. The clinical efficacy of the conventional group，acupuncture group and moxibustion therapy combined with the group was compared. The patients were given diarrhea or constipation，fatigue and lethargy，pain at the end of the limb and pain at night，sweating when moving，numbness and weakness in the limb，shortness of breath and lazy speech before and after treatment. The common carotid artery pressure strain elastic modulus was detected. The levels of nitric oxide（NO），endothelin（ET），triglyceride（TG），HbA1c，ficolin-3 and high-density lipoprotein（HDL-C） were detected. [Results] The total effective rate in moxibustion group and acupuncture group was higher than that in conventional group（P<0.05）. In the combination group of moxibustion therapy，diarrhea or constipation，exhaustion，pain at the end of the limb，pain at night，sweating after movement，and ants in the limb and numbness and weakness，shortness of breath and lazy speech score were lower than those in the conventional group and acupuncture group（P<0.05）. In the acupuncture group，diarrhea or constipation，exhaustion，pain at the end of the limb and pain at night，movement，sweating，and ants in the limb and numbness and weakness，the score of shortness of breath and lazy speech was lower than that of normal group（P<0.05）；the common carotid artery pressure strain elastic modulus in combination group was lower than that in conventional group and acupuncture group（P<0.05），and the common carotid artery pressure strain elastic modulus in acupuncture group was lower than that in conventional group（P<0.05）. The expression level of HDL-C in laying moxibustion therapy with the group was higher than that in conventional group and acupuncture group（P<0.05）. The expression level of HDL-C in acupuncture group was higher than that in conventional group and acupuncture group（P<0.05），and the expression level of TG and HbA1c in laying moxibustion therapy with the group was lower than that in conventional group and acupuncture group（P<0.05）. The expression levels of TG and HbA1c in acupuncture group were lower than those in conventional group（P<0.05）. The expression levels of ficolin-3 and NO in moxibustion combined group were higher than those in conventional group and acupuncture group（P<0.05）. The expression levels of ficolin-3 and NO in laying moxibustion therapy with the group were higher than those in conventional group and acupuncture group（P<0.05），and the expression levels of ET in laying moxibustion therapy with the group were lower than those in conventional group and acupuncture group（P<0.05）. The acupuncture group’s expression level of ET was lower than conventional group（P<0.05）. [Conclusion] Moxibustion treatment combined acupuncture in patients with diabetic peripheral neuropathy can improve glucose and lipid metabolism，carotid vascular elasticity，vascular endothelial function，enhance ficolin-3 level，alleviate the disease and improve clinical efficacy.