【作者】 陈传伟；

【导师】 庄礼兴；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2010， 博士

【摘要】 背景随著社会经济和科学技术的迅速发展,在快节奏的现代社会,激烈的竞争,越来越大的工作和学习压力和不规律的饮食作息习惯,临床上以慢性疲劳为主诉的患者日益增多。迄今为止对慢性疲劳综合征的病因病理和发病机制尚不明确,一般认为与病毒感染、免疫系统和内分泌系统活动异常有关。推测慢性疲劳综合征可能与包括心理压力、人际关系、下丘脑、垂体、肾上腺轴异常、激素紊乱、神经缺陷、免疫异常、感染等在内的多种因素相关。加上诊断又缺乏特异性指标,所以对于慢性疲劳综合征临床上还缺乏根本性的治疗方法,疗效也仍不理想。故此,寻找一种防治慢性疲劳综合征的有效而无副作用的方法具有积极的临床意义及社会意义。目的本研究以慢性疲劳综合征的患者为临床研究对象,探讨针刺对慢性疲劳综合征的临床疗效；实验部分,探讨针刺及电针对慢性疲劳综合征的干预作用机制,而为针灸方法干预慢性疲劳综合征的治疗提供理论依据。方法文献研究综述了古代及现代中医医家对慢性疲劳的病因病机及其治疗方法；针灸治疗慢性疲劳的临床研究进展及针灸对慢性疲劳的作用机制的研究进展；综述了现代医家对慢性疲劳及慢性疲劳综合征的发病机制、慢性疲劳综合征干预方法,在此基础上进行评述和展望。临床研究以符合慢性疲劳综合征的诊断标准,根据纳入和排除标准选取符合病例60例,按照随机数字法进行分组,按照1：1的比例随机分配到针刺组(A组)、伪针刺组(B组),两组均每周治疗3天,休息2天后继续下一周治疗,共治疗2周,疗程14天。将世界卫生组织生存质量测定表(WHOQOL-BREF)总分变化、4类因子变化)、Chalder 14项疲劳量表总分变化(Fatigue Scale-14, FS-14)、中医证候评定量表评分作为临床评定指标,分别于治疗前、治疗后7天、14天、21天进行评定及治疗后21天进行中医证候疗效评定。实验研究：将40只成年SD大鼠,随机分为正常组(A组)、模型组(B组)、针剌组(C组)及电针组(D组),共4组,每组10只。应用冷水(16±1)℃中游泳8 min及夹尾刺激10天,造成慢性疲劳大鼠模型。针刺组予以针刺足三里、太溪每日1次,连续10日；电针组(D组)针刺足三里、太溪后,针柄接WQ-6F型电针治疗仪,电压4.5V,疏密波型,频率2-20Hz,强度以局部皮肤肌肉轻微颤动为度,每日1次,连续10日。并于治疗前、治疗后5、10天观察CFS模型大鼠体重、Open-field旷场测试、竭力游泳时间及鼠尾悬挂实验的改变,应用针刺和电针的方法给予干预,以研究针剌和电针对CFS模型大鼠在行为学方面的影响。治疗结束后处死小鼠时称脾重并计算脾脏系数、心脏系数、肝脏系数。结果1临床研究结果两组治疗前后WHOQOL-BREF总分比较,治疗前两组间WHOQOL-BREF评分比较无统计学差异(P>0.05)。针刺组于7天、14天、21天WHOQOL-BREF总分均显著升高,与0天比较均有显著性差异(P<0.01)。针刺组于14天、21天WHOQOL-BREF总分均较伪针刺组总分升高,针刺组与伪针刺组比较有统计学差异(P<0.01)。WHOQOL-BREF生理领域因子评分比较,治疗前两组间WHOQOL-BREF生理领域因子评分比较无统计学差异(P>0.05)。针刺组于7天、14天、21天WHOQOL-BREF生理领域因子分均显著升高,与0天比较均有统计学差异(P<0.01)。针刺组于14天、21天WHOQOL-BREF生理领域因子分均较伪针刺组总分升高,针刺组与伪针刺组比较有统计学差异(P<0.01)。WHOQOL-BREF心理领域因子评分比较,治疗前两组间WHOQOL-BREF心理领域因子评分比较无统计学差异(P>0.05)。针刺组于14天、21天WHOQOL-BREF心理领域因子分均显著升高,与0天比较均有统计学差异(P<0.01)。针刺组于14天、21天WHOQOL-BREF心理领域因子分均较伪针刺组评分升高,针刺组与伪针刺组比较有统计学差异(P<0.05)。WHOQOL-BREF社会关系因子评分比较,治疗前两组间WHOQOL-BREF社会关系因子评分比较无统计学差异(P>0.05)。针刺组于21天WHOQOL-BREF社会关系因子分升高,与0天比较均有统计学差异(P<0.05)。伪针刺组于21天WHOQOL-BREF社会关系因子分升高,与0天比较均有统计学差异(P<0.05)。两组均较治疗前WHOQOL-BREF社会关系因子分升高。而两组于治疗前,7天、14天、21天之间作比较,均无统计学意义(P>0.05)。WHOQOL-BREF环境领域因子评分比较,治疗前两组间WHOQOL-BREF环境领域因子评分比较无统计学差异(P>0.05)。针刺组于7天、14天、21天WHOQOL-BREF环境领域因子分均显著升高,与0天比较均有统计学差异(P<0.01)。针刺组于21天WHOQOL-BREF环境领域因子分均较伪针刺组升高,针刺组与伪针刺组比较有统计学差异(P<0.05)。两组治疗前14项疲劳量表(FS-14)总分比较无统计学差异(P>0.05)。针刺组治疗7天后、14天后、21天后FS-14评分总分均明显下降,与治疗前比较均有统计学差异(P<0.01)。而两组于14天、21天之间作比较,针刺组总分均低于伪针刺组,针刺组与伪针刺组比较有统计学差异(P<0.01)。两组治疗前中医证候评定量表评分无统计学差异(P>0.05)。针刺组方面,治疗7天、14天、21天患者评分均显著降低,与治疗前比较均有统计学差异(P<0.01)。而两组于14天、21天之间作比较,针刺组评分均低于伪针刺组,针刺组与伪针刺组比较有统计学差异(P<0.01)。根据两组中医证候疗效比较,针刺组显效共3例,有效共21例,无效3例,总有效率为88.89%。伪针刺组显效共0例,有效共5例,无效21例,总有效率为19.23%。针刺组与伪针刺组比较有统计学差异(P<0.01)。2实验研究结果各组大鼠体重变化,在第1、5、10天,各组大鼠与正常组比较,体重无统计学差异(P>0.05),虽然随时间的延长,模型组的体重较正常组下降,但无统计学差异(P>0.05)。各组大鼠力竭游泳时间,4组治疗前大鼠力竭游泳时间无统计学差异(P>0.05)。模型组的力竭时间于第5、10天明显缩短,与治疗前比较均有统计学差异(P<0.01)。与模型组比较,针刺组与电针组的力竭时间于第5、10天均明显缩短,与模型组比较均有统计学差异(P<0.01)。Open-field旷场测试中,4组治疗前大鼠Open-field旷场测试正中央格停留时间无明显差异(P>0.05)。模型组的正中央格停留时间于第10天明显增加,与治疗前比较均有统计学差异(P<0.01)。与模型组比较,针刺组与电针组的正中央格停留时间第10天均明显缩短,与模型组比较均有统计学差异(P<0.01)。各组大鼠Open-field旷场测试水平运动次数比较,4组治疗前大鼠Open-field旷场测试水平运动无统计学差异(P>0.05)。模型组的水平运动次数于第5、10天明显减少,与治疗前比较均有统计学差异(P<0.01)。与模型组比较,针刺组的次数于第5、10天均明显增加,但只有第10天与模型组比较有统计学差异(P<0.01)。电针组的水平运动次数于第5、10天均明显增加,与模型组比较均有统计学差异(P<0.01)。各组大鼠Open-field旷场测试垂直运动次数比较,4组治疗前大鼠Open-field旷场测试垂直运动次数无统计学差异(P>0.05)。模型组的水平运动于第5天、10天明显减少,与治疗前比较均有统计学差异(P<0.01)。与模型组比较,针刺组与电针组的垂直运动次数于第5天、10天均明显增加,第5天、10天与模型组比较有统计学差异(P<0.01)。各组大鼠Open-field旷场测试垂直运动时间比较,4组治疗前大鼠Open-field旷场测试垂直运动时间无统计学差异(P>0.05)。模型组的垂直运动时间于10天明显减少,与治疗前比较均有统计学差异(P<0.01)。与模型组比较,针刺组与电针组的垂直运动时间于第5天、10天均明显较长,但两组都是只有第10天与模型组比较有统计学差异(P<0.01)。各组大鼠鼠尾悬挂实验时间比较,4组治疗前大鼠鼠尾悬挂时间无统计学差异(P>0.05)。模型组的鼠尾悬挂时间于10天明显增加,与治疗前比较均有统计学差异(P<0.01)。与模型组比较,针刺组与电针组的时间于第10天均明显较短,两组都是于第10天与模型组比较有统计学差异(P<0.05)。模型组的脾脏系数比针刺组与电针组较轻,两组与模型组比较有统计学差异(P<0.05)。模型组的心脏系数比针刺组与电针组较重,两组与模型组比较有统计学差异(P<0.05)。模型组的肝脏系数比针刺组与电针组略轻,但两组与模型组比较无统计学差异(P>0.05)。结论针刺干预慢性疲劳综合征具有显著的临床疗效,为患者提供了一个良好的治疗方案。而针刺和电针干预慢性疲劳大鼠模型的作用机制体现在：改善其行为学异常；调节其脾脏系数及心脏系数。更多还原

【Abstract】 BackgroundWith the rapid socio-economic and technology developments in the modern society where competition, increasing work, study pressure and irregular eating habits which is increasing chronic fatigue in patients. The cause of chronic fatigue syndrome in pathology and pathogenesis is unclear, generally believed that is related to infection with the virus, the immune system and the endocrine system activity abnormalities. Speculated that chronic fatigue syndrome may include psychological stress, interpersonal relationships, hypothalamus and pituitary, adrenal axis abnormalities, hormone disorders, neurological defects, immunological abnormalities, and infection-related. Without specific diagnostic indicator for chronic fatigue syndrome is a main reason that is not effective in clinical treatment. Therefore, using acupuncture for prevention and treatment of chronic fatigue syndrome is an effective way in clinical significance.ObjectiveIn this study, patients with chronic fatigue syndrome are used by acupuncture for the clinical study. To explore acupuncture and electrical acupuncture for chronic fatigue syndrome of mechanism action, which provide a theoretical basis for a treatment of chronic fatigue syndrome. MethodsA literature review in an ancient and modern Chinese medicine practitioner focused on chronic fatigue pathogenesis and treatment. There was acupuncture treatment of chronic fatigue in clinical research and acupuncture in chronic fatigue mechanism of research. Meanwhile, modern physicians on chronic fatigue and chronic the pathogenesis of fatigue syndrome, chronic fatigue syndrome intervention were also discussed.The clinical study was performed on patients of chronic fatigue syndrome, according to inclusion and exclusion criteria selected cases of 60 cases by random were assigned to the acupuncture group (group A), sham acupuncture group (group B). Two groups were treated 3 days per week, and a total of 2 weeks of treatment. The World Health Organization Quality of Life Form (WHOQOL-BREF) and four factors, Chalder 14 fatigue total score (FS-14), Chinese Syndrome Rating Scale score were as a clinical assessment index, respectively before treatment and after 7 days,14 days,21 days for evaluation and treatment 21 days.The experimental study was performed on 40 adult SD rats which were randomly divided into normal group (group A), model group (group B), acupuncture group (group C) and Electric Acupuncture group (group D). In A, B, C groups, the rats were swimming in cold water (16±1)℃about 8 mins and got a tail stimulation for 10 days, resulting in a rat model of chronic fatigue. Acupuncture group (group C) was using ZuSanLi and TaiXi in 10 days consecutively. EA group (group D) acupuncture was using ZuSanLi and TaiXi, which the needle handles accessing with WQ-6F of electric acupuncture apparatus of voltage 4.5V, density wave and frequency 2-20Hz, intensity of local skin and muscle to quiver slightly for 10 days consecutively. And the rats were observed on the 1st,5th,10th of weight, Open-field test, strive to swim and tail suspension test. After the treatment, the mice were killed, and calculate the spleen index, heart index and liver index. Results1. The clinical studyBefore the treatment, there was no significant difference of WHOQOL-BREF score, WHOQOL-BREF physical score, WHOQOL-BREF psychological score, WHOQOL-BREF social relationships score, WHOQOL-BREF score in the field of environment, FS-14 score, Chinese Medicine syndromes rating scale score between two groups (P＞0.05).There was a significant difference in Acupuncture group at 7th day,14th day,21st day of WHOQOL-BREF total score comparing with 0 day (P＜0.01). And Acupuncture group compared with sham acupuncture group had a significant difference (P＜0.01).There was a significant difference in Acupuncture group at 7th day,14th day,21st day of WHOQOL-BREF physical score comparing with 0 day (P＜0.01). And acupuncture group compared with sham acupuncture group had a significant difference at 14th and 21st day (P＜0.01).There was a significant difference in Acupuncture group at 7th day,14th day,21st day of WHOQOL-BREF psychological score comparing with 0 day (P＜0.01). And acupuncture group compared with sham acupuncture group had a significant difference at 14th and 21st day (P＜0.05).Two groups were observed before the treatment, and WHOQOL-BREF social relationship factor scores were increased. But there was no statistical significance at the 7th,14th and 21st day (P＞0.05).There was a significant difference in Acupuncture group at 7th day,14th day,21st day of WHOQOL-BREF score in the field of environment comparing with 0 day (P＜0.01). And acupuncture group compared with sham acupuncture group had a significant difference at 14th and 21st day (P＜0.05).There was a significant difference in Acupuncture group at 7th day,14th day,21st day of FS-14 score comparing with 0 day (P＜0.01). And acupuncture group compared with sham acupuncture group had a significant difference at 14th and 21st day (P＜0.01). There was a significant difference in Acupuncture group at 7th,14th,21st day of TCM syndrome rating score comparing with 0 day (P＜0.01). And acupuncture group compared with sham acupuncture group had a significant difference at 14th and 21st day (P＜0.01).According to TCM syndrome effective rate efficacy compared two groups; the effective rate of group A was 88.89%. And the effective rate of group B was 19.23%. There was a significant difference between Acupuncture group and the sham acupuncture group (P＜0.01). 2. The Experimental resultsThere was no significant difference of weight, Open-field test, tail suspension test and exhaustive swimming time between four groups (P＞0.05).The results of exhaustive swimming test showed that there was a significant difference comparing with the model group and two other groups which were acupuncture and EA group at the 5th,10th day (P＜0.01).The results of Open-field centre of retention time showed that there was a significant difference comparing with the model group and two other groups which were acupuncture and EA group at the 5th,10th day (P＜0.01).The results of Open-field number of horizontal movement showed that there was a significant difference comparing with the model group and two other groups which were acupuncture and EA group at the 5th,10th day (P＜0.01).The results of Open-field number of vertical movement showed that there was a significant difference comparing with the model group and two other groups which were acupuncture and EA group at the 5th,10th day (P＜0.01).The results of Open-field vertical movement of time showed that there was a significant difference comparing with the model group and two other groups which were acupuncture and EA group at 10th day (P＜0.01).The results of tail suspension time showed that there was a significant difference comparing with the model group and two other groups which were acupuncture and EA group at 10th day (P＜0.05).Conclusion Acupuncture intervention in chronic fatigue syndrome had significant clinical efficacy for patients which were an ideal method. The mechanism of acupuncture and electro-acupuncture of chronic fatigue rat model includes in improving mice’abnormal behavior, regulating its spleen ratio and heart ratio.更多还原