Study on the Intervention of Acupuncture and Moxibustion on Deficiency of Spleen and Kidney in Children with Idiopathic Short Stature Based on Fuyang Theory
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摘要:
目的 探讨基于扶阳理论指导下运用针灸联合重组人生长激素(rhGH)治疗儿童脾肾两虚型特发性矮小症(ISS)的临床疗效。 方法 选取2018年10月至2021年12月在江阴市中医院治疗的240例脾肾两虚型ISS患儿, 随机分为对照组和治疗组各120例。对照组予常规宣教联合rhGH治疗, 治疗组在对照组治疗基础上加予针灸干预, 2组疗程均为12个月。观察治疗前后2组患儿中医证候积分及综合疗效，评估不同年龄阶段的生长情况[身高、身高增长速度(GV)], 检测胰岛素样生长因子-1(IGF-1)、胰岛素样生长因子结合蛋白-3(IGFBP-3)、生长素(Ghrelin)表达水平，并观察不良反应发生情况。 结果 治疗后, 治疗组的中医证候积分低于对照组(P＜0.05), 治疗组的总有效率为95.83%高于对照组的总有效率87.50%(P＜0.05), 治疗后2组患儿不同年龄阶段的身高、GV均高于治疗前(P＜0.01), 且治疗组明显高于对照组(P＜0.01);治疗后各年龄段治疗组患儿的IGF-1、IGFBP-3水平高于对照组(P＜0.05), Ghrelin水平低于对照组(P＜0.05);治疗期间2组患儿的不良反应无显著差异(P＞0.05)。 结论 扶阳理论指导下的针灸联合rhGH能显著改善患儿临床证候, 有效促进ISS患儿的生长发育, 调节胰岛素样生长因子、生长素水平。 Abstract:OBJECTIVE To explore the clinical effect of acupuncture and moxibustion combined with recombinant human growth hormone (rhGH) on children with idiopathic short stature (ISS) of spleen kidney deficiency type under the guidance of strengthening yang theory. METHODS 240 children with spleen kidney deficiency type ISS who were treated at Jiangyin Traditional Chinese Medicine Hospital from October 2018 to December 2021 were randomly divided into a control group and a treatment group of 120 cases each. The control group was treated with routine education combined with rhGH, and the treatment group received acupuncture and moxibustion intervention on the basis of the treatment of the control group. The course of treatment for both groups was 12 months. Observe the TCM syndrome score and comprehensive efficacy of the two groups of pediatric patients before and after treatment; evaluate the growth at different age stages, i.e., height, height growth velocity (GV); detect the expression levels of insulin-like growth factor-1 (IGF-1), insulin-like growth factor binding protein-3 (IGFBP-3), auxin; and observe the occurrence of adverse reactions. RESULTS After treatment, the TCM syndrome score of the treatment group was lower than that of the control group (P < 0.05), with a total effective rate of 95.83% in the treatment group and 87.50% in the control group (P < 0.05); the height, and GV of the two groups of pediatric patients at different age stages were higher than before treatment(P < 0.01), and the treatment group was significantly higher than the control group (P < 0.01); the levels of IGF-1 and IGFBP-3 in the treatment group were higher than those in the control group(P < 0.05), while the levels of Ghrelin were lower than those in the control group (P < 0.05). There was no significant difference in adverse reactions between the two groups of pediatric patients during the treatment period (P > 0.05). CONCLUSION The combination of acupuncture and moxibustion and rhGH under the guidance of strengthening yang theory can significantly improve the clinical symptoms of children with ISS, effectively promote the growth and development, regulate the levels of insulin-like growth factor and auxin, with high safety. -
表 1 4~6岁患儿2组基线资料比较(x±s, n=40)
Table 1. Comparison of baseline data between two groups of pediatric patients aged 4-6 years old (x±s, n=40)
组别 性别 年龄/岁 身高/cm 骨龄/岁 男 女 治疗组 23 17 5.35±0.71 95.13±4.71 3.24±0.65 对照组 21 19 5.84±0.84 95.47±5.32 3.54±0.74 
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表 2 7岁到青春期前患儿2组基线资料比较(x±s, n=40)
Table 2. Comparison of baseline data between two groups of pediatric patients aged 7 to pre-adolescence (x±s, n=40)
组别 性别 年龄/岁 身高/cm 骨龄/岁 男 女 治疗组 16 24 9.16±0.57 117.30±7.40 8.37±0.69 对照组 18 22 9.83±0.84 118.45±7.12 8.41±0.74
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表 3 青春期患儿2组基线资料比较(x±s, n=40)
Table 3. Comparison of baseline data between two groups of adolescent pediatric patients (x±s, n=40)
组别 性别 年龄/岁 身高/cm 骨龄/岁 男 女 治疗组 19 21 14.58±0.74 143.80±9.42 12.81±2.94 对照组 21 19 14.87±0.69 142.07±8.52 12.91±2.72
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表 4 2组不同年龄段患儿身高比较(x±s, cm)
Table 4. Comparison of height between two groups of pediatric patients of different ages (x±s, cm)
组别 时间 4~6岁(n=40) 7岁到青春期前(n=40) 青春期(n=40) 治疗组 治疗前 95.13±4.71 117.30±7.40 143.80±9.42 治疗后 104.25±6.37**## 128.35±6.87**## 152.72±9.26**## 对照组 治疗前 95.47±5.32 118.45±7.12 142.07±8.52 治疗后 102.06±5.71** 124.73±6.08** 148.23±9.13** 注: 组内比较, **P＜0.01;组间比较, ##P＜0.01。
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表 5 2组不同年龄段患儿GV比较(x±s, cm)
Table 5. Comparison of GV between two groups of pediatric patients of different ages (x±s, cm)
组别 时间 4~6岁(n=40) 7岁到青春期前(n=40) 青春期(n=40) 治疗组 治疗前 4.82±1.23 4.21±0.99 5.16±0.84 治疗后 8.95±1.54**## 10.35±2.44**## 11.37±2.59**## 对照组 治疗前 4.64±1.52 4.34±1.16 5.28±0.92 治疗后 6.13±1.72** 7.72±1.95** 8.24±2.54** 注: 组内比较, **P＜0.01;组间比较, ##P＜0.01。
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表 6 2组患儿治疗前后中医证候积分比较(x±s, n=120)
Table 6. Comparison of Chinese medicine syndrome scores between two groups of pediatric patients before and after treatment (x±s, n=120)
组别 时间 身材矮小 生长缓慢 形体虚羸 厌食 面色少华 治疗组 治疗前 4.47±0.86 4.13±1.04 3.58±0.77 4.22±1.51 1.14±0.68 治疗后 0.92±0.39**# 1.06±0.24**# 0.52±0.24**# 0.76±0.52**# 0.50±0.57**# 对照组 治疗前 4.82±0.99 4.43±1.22 3.76±0.86 4.59±1.62 1.27±0.79 治疗后 1.05±0.39** 1.45±0.26** 0.71±0.54** 0.96±0.61** 0.67±0.66** 组别 时间 发黄稀疏 肢冷畏寒 大便稀溏 总积分 治疗组 治疗前 1.37±0.57 0.85±0.78 0.95±0.77 20.71±4.13 治疗后 0.17±0.38**# 0.30±0.47**# 0.17±0.38**# 4.40±1.05**# 对照组 治疗前 1.40±0.63 1.07±0.74 0.97±0.81 22.41±4.56 治疗后 0.53±0.70** 0.50±0.57** 0.20±0.41** 6.07±1.62** 注: 组内比较, **P＜0.01;组间比较, #P＜0.05。
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表 7 2组患儿临床疗效比较(n=120)
Table 7. Comparison of clinical efficacy between two groups of pediatric patients (n=120)
组别 显效 有效 无效 总有效率/% 治疗组 86 29 5 95.83* 对照组 77 28 15 87.50 注: 组间比较, χ2=3.827, *P＜0.05。
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表 8 2组患儿治疗前后血清实验室指标比较(x±s)
Table 8. Comparison of serum laboratory indicators between two groups of pediatric patients (x±s)
组别 时间 IGF-1/(ng·mL-1) IGFBP-3/(ng·mL-1) Ghrelin/(pg·mL-1) 4~6岁(n=40) 7岁到青春期前(n=40) 青春期(n=40) 4~6岁(n=40) 7岁到青春期前(n=40) 青春期(n=40) 4~6岁(n=40) 7岁到青春期前(n=40) 青春期(n=40) 治疗组 治疗前 97.68±11.23 176.01±33.04 225.46±59.84 3.45±0.34 4.18±0.72 5.40±1.66 4.39±0.31 6.32±0.29 7.12±0.69 治疗后 159.45±14.89*# 207.69±38.77*# 359.65±74.46*# 4.82±0.67*# 5.14±0.97*# 6.86±1.80*# 3.02±0.29*# 4.19±0.31*# 4.85±0.72*# 对照组 治疗前 99.21±12.56 175.21±32.96 231.63±52.49 3.57±0.71 4.15±0.76 5.67±1.29 4.17±0.36 6.16±0.32 6.98±0.86 治疗后 141.24±15.16* 181.36±37.98* 341.25±69.52* 4.21±0.59* 4.75±0.89* 6.33±1.61* 3.25±0.31* 5.07±0.25* 5.23±0.56* 注: 组内比较, *P＜0.05;组间比较, #P＜0.05。
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表 9 2组患儿不良反应比较(n=120)
Table 9. Comparison of adverse reactions between two groups (n=120)
组别 局部皮肤红肿 膝关节疼痛 甲状腺功能异常 肝功异常 治疗组 2 2 0 0 对照组 3 2 0 0
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