Clinical Study on Ginger Moxibustion Combined with Adalimumab to Improve Anxiety and Life Quality in Patients with Crohn's Disease at Mild and Moderate Active Stages
-
摘要:
目的 观察铺姜灸联合阿达木单抗治疗对轻、中度活动期克罗恩病伴焦虑患者情绪及生活质量的影响。 方法 选择符合纳入标准的轻、中度活动期伴焦虑的克罗恩病患者60例, 随机分为治疗组和对照组各30例。对照组予阿达木单抗标准化治疗, 治疗组在对照组基础上联合铺姜灸治疗, 疗程均为12周, 观察2组患者中医证候积分及临床疗效、焦虑缓解应答率、治疗前后克罗恩病活动指数(CDAI)评分、炎症性肠病生存质量(IBDQ)评分及安全性指标的变化情况。 结果 治疗后, 2组患者中医证候积分均明显降低(P < 0.05, P < 0.01), 治疗组优于对照组(P < 0.05, P < 0.01);治疗组临床疗效、焦虑情绪缓解应答率优于对照组(P < 0.05);2组患者IBDQ评分均明显升高(P < 0.05, P < 0.01), 治疗组优于对照组(P < 0.05);2组患者CDAI评分均显著降低(P < 0.05, P < 0.01), 治疗组优于对照组(P < 0.05, P < 0.01)。 结论 铺姜灸联合阿达木单抗治疗可改善轻、中度活动期克罗恩病患者焦虑及生活质量。 Abstract:OBJECTIVE To observe the effect of ginger moxibustion combined with Adalimumab on the mood and life quality of patients with anxiety and Crohn's disease at mild and moderate active stages. METHODS 60 patients with anxiety and Crohn's disease at mild and moderate active stages who met the inclusion criteria were selected and randomly divided into the treatment group and control group with 30 cases each.The control group was given a standardized treatment of Adalimumab, and the treatment group was treated with ginger moxibustion on the basis of the control group.The course of treatment was 12 weeks.Observe the changes in TCM syndrome score and clinical efficacy, anxiety relief response rate, Crohn's disease activity index (CDAI) score, Inflammatory bowel disease quality of life (IBDQ) score, and safety indicators of the two groups of patients before and after treatment. RESULTS After treatment, the TCM syndrome scores of both groups were significantly reduced (P < 0.05, P < 0.01), and the treatment group was superior to the control group (P < 0.05, P < 0.01);the clinical efficacy and anxiety relief response rate of the treatment group were better than those of the control group (P < 0.05);the IBDQ scores of both groups were significantly increased (P < 0.05, P < 0.01), and the treatment group was better than the control group (P < 0.05);the CDAI scores of both groups significantly decreased (P < 0.05, P < 0.01), and the treatment group was better than the control group (P < 0.05, P < 0.01). CONCLUSION Ginger moxibustion combined with Adalimumab can improve the anxiety and life quality of patients with Crohn's disease at mild and moderate active stages. -
Key words:
- ginger moxibustion /
- Adalimumab /
- Crohn's disease /
- anxiety /
- quality of life
-
表 1 2组患者基线数据[M(P25, P75), n=30]
Table 1. Comparison of baseline information between the two groups of patients [M(P25, P75), n=30]
组别 男 女 活动期 年龄/岁 病程/月 学历 HAMA评分 轻 中 专科及以下 专科以上 治疗组 26 4 12 18 22.00(17.75, 31.25) 1.00(1.00, 28.50) 16 14 14.00(11.50, 16.00) 对照组 25 5 14 16 24.00(17.00, 30.00) 4.00(0.00, 36.00) 21 9 14.50(12.00, 18.00) 
下载: 导出CSV
表 2 中医证候积分评分标准
Table 2. Evaluation standard of TCM syndrome score
症状 0 1 2 3 主症 腹痛 无 轻微，隐痛 隐痛或胀痛 剧痛或绞痛 腹泻 无 每日＜4次 每日≥4次，＜6次 每日≥6次 便质 成形 不能成形 稀溏 如水样 脓血便 无 偶有 脓血便为主 全部为脓血便 腹胀 无 腹胀或食后腹胀 较重，每日≥6 h 腹胀如鼓 次症 情绪抑郁或急躁易怒 无 偶有 易发 急躁易怒难以控制 食少纳呆 无 饮食稍有减少 饮食减少 饮食明显减少 疲乏 无 偶感疲乏 疲乏较重 四肢无力 善太息 无 偶有 精神刺激后发作 频作
下载: 导出CSV
表 3 2组患者治疗前后中医证候积分比较[M(P25, P75), n=30]
Table 3. Comparison of TCM syndrome scores before and after treatment between the two groups of patients [M(P25, P75), n=30]
组别 时间 腹痛 腹泻 便质 脓血便 腹胀 治疗组 治疗前 1.00(0, 1.00) 1.00(1.00, 1.25) 1.00(0, 1.25) 0(0, 1.00) 0(0, 0) 治疗后 0(0, 0)**## 0(0, 0)**## 0(0, 1.00)**# 0(0, 0)**# 0(0, 0) 对照组 治疗前 0.50(0, 1.00) 1.00(1.00, 1.00) 1.00(1.00, 1.00) 0(0, 1.00) 0(0, 1.00) 治疗后 0(0, 1.00) 1.00(0, 1.00)** 1.00(0, 1.00)** 0(0, 0)* 0(0, 1.00) 组别 时间 情绪抑郁或急躁易怒 食少纳呆 疲乏 善太息 总积分 观察组 治疗前 1.00(1.00, 2.00) 1.00(1.00, 2.00) 1.00(0, 1.00) 1.00(1.00, 2.00) 7.00(5.75, 9.00) 治疗后 0(0, 0)**## 0(0, 0)**## 0(0, 0)** 0(0, 0)**## 1.00(0, 3.00)**## 对照组 治疗前 1.00(1.00, 1.00) 1.00(1.00, 2) 0(0, 0) 1.00(1.00, 1.00) 7.00(6.00, 9.00) 治疗后 0(0, 1.00)** 1.00(0, 1.00)** 0(0, 1.00)** 0(0, 1.00)** 3.00(1.75, 4.00)** 注: 组内比较, *P < 0.05, * *P < 0.01;组间比较, #P < 0.05, ##P < 0.01。
下载: 导出CSV
表 4 2组患者中医临床疗效比较(n=30)
Table 4. Comparison of TCM clinical curative effect between the two groups(n=30)
组别 例数 有效 无效 有效率/% 治疗组 30 26 4 86.70# 对照组 30 18 12 60.00 注: 组间比较, χ2=5.455, #P < 0.05。
下载: 导出CSV
表 5 2组患者治疗后焦虑缓解应答率比较(n=30)
Table 5. Comparison of anxiety relief response rate after treatment between the two groups(n=30)
组别 治疗后焦虑缓解 应答率/% 有效 无效 治疗组 25 5 83.30# 对照组 18 12 60.00 注: 组间比较, χ2=4.022, #P < 0.05。
下载: 导出CSV
表 6 2组患者治疗前后CDAI评分比较(x±s, n=30)
Table 6. Comparison of CDAI scores before and after treatment between the two groups(x±s, n=30)
组别 治疗前 治疗后 治疗组 222.81±39.95 111.77±31.93**# 对照组 221.52±37.94 132.60±41.50** 注: 组内比较, * *P < 0.01;组间比较, #P < 0.05。
下载: 导出CSV
表 7 2组患者治疗前后IBDQ评分比较(x±s, n=30)
Table 7. Comparison of IBDQ scores before and after treatment between the two groups(x ±s, n=30)
组别 时间 肠道症状(B) 全身症状(S) 情感功能(E) 社会功能(SF) 总分 治疗组 治疗前 49.67±9.33 22.10±4.60 51.80±9.21 18.94±5.92 142.77±25.54 治疗后 64.00±3.82**## 28.93±4.35**## 67.17±5.40**## 28.63±4.34**# 188.73±15.59**## 对照组 治疗前 52.53±10.21 20.90±6.12 55.70±10.79 22.17±7.31 150.33±29.30 治疗后 56.93±9.46* 24.87±4.29** 60.30±9.89* 26.20±4.36** 168.30±24.98** 注: 组内比较, *P < 0.05, * *P < 0.01;组间比较, #P < 0.05, ##P < 0.01。
下载: 导出CSV
-
[1] 李冠炜, 任建安. 重视我国克罗恩病流行病学的研究[J]. 肠外与肠内营养, 2017, 24(3): 135-137. https://www.cnki.com.cn/Article/CJFDTOTAL-CWCN201703004.htmLI GW, REN JA. Attach importance to the epidemiological study of Crohn's disease in China[J]. Parenter Enter Nutr, 2017, 24(3): 135-137. https://www.cnki.com.cn/Article/CJFDTOTAL-CWCN201703004.htm [2] MACALUSO FS, PAPI C, ORLANDO A, et al. Use of biologics for the management of Crohn's disease: IG-IBD clinical guidelines based on the GRADE methodology[J]. Dig Liver Dis, 2023, 55(4): 442-453. doi: 10.1016/j.dld.2023.01.155 [3] 容加梅, 罗娟, 黄奇, 等. 炎症性肠病治疗中生物制剂的个体化选择[J]. 世界华人消化杂志, 2021, 29(15): 893-900. https://www.cnki.com.cn/Article/CJFDTOTAL-XXHB202115011.htmRONG JM, LUO J, HUANG Q, et al. Individualized selection of biological agents in treatment of inflammatory bowel disease[J]. World Chin J Dig, 2021, 29(15): 893-900. https://www.cnki.com.cn/Article/CJFDTOTAL-XXHB202115011.htm [4] 沈洪, 朱磊, 张露. 生物制剂背景下克罗恩病中西医结合治疗策略探讨[J]. 南京中医药大学学报, 2022, 38(8): 739-742. doi: 10.14148/j.issn.1672-0482.2022.0739SHEN H, ZHU L, ZHANG L. Exploration of treatment strategies with integrated traditional Chinese and western medicine for Crohn's disease under the background of biological agents[J]. J Nanjing Univ Tradit Chin Med, 2022, 38(8): 739-742. doi: 10.14148/j.issn.1672-0482.2022.0739 [5] 曾理, 刘迈兰, 谭舒怀, 等. 灸法对新型冠状病毒肺炎密切接触者心理障碍的影响: 随机对照研究[J]. 中国针灸, 2021, 41(10): 1109-1112. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZE202110011.htmZENG L, LIU ML, TAN SH, et al. Moxibustion on mental disorder in close contacts of coronavirus disease 2019: A randomized controlled trial[J]. Chin Acupunct Moxibustion, 2021, 41(10): 1109-1112. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZE202110011.htm [6] ZHANG D, YUAN XX, WANG BY, et al. Observation on effects of moxibustion at abdominal acupoints for slow transit constipation due to Yang deficiency of the spleen and kidney[J]. J Acupunct Tuina Sci, 2017, 15(6): 426-433. doi: 10.1007/s11726-017-1040-9 [7] 吴开春, 梁洁, 冉志华, 等. 炎症性肠病诊断与治疗的共识意见(2018年·北京)[J]. 中国实用内科杂志, 2018, 38(9): 796-813. https://www.cnki.com.cn/Article/CJFDTOTAL-SYNK201809007.htmWU KC, LIANG J, RAN ZH. et al. Chinese consensus on diagnosis and treatment of inflammatory bowel disease(Beijing, 2018)[J]. Chin J Pract Intern Med, 2018, 38(9): 796-813. https://www.cnki.com.cn/Article/CJFDTOTAL-SYNK201809007.htm [8] 张明园. 精神科评定量表手册[M]. 2版. 长沙: 湖南科学技术出版社, 1998: 122.ZHANG MY. Handbook of Rating Scales in Psychiatry[M]. 2nd ed. Changsha: Hunan science & technology press, 1998: 122. [9] 中华中医药学会脾胃病分会. 中医消化病诊疗指南[M]. 北京: 中国中医药出版社, 2006: 87.Spleen and Stomach Disease Branch of China Association of Chinese Medicine. Guidelines for Diagnosis and Treatment of Digestive Diseases in Traditional Chinese Medicine[M]. Beijing: China press of traditional Chinese medicine, 2006: 87. [10] 中药新药临床研究指导原则: 试行[M]. 北京: 中国医药科技出版社, 2002: 343-345.Guiding Principles for Clinical Research of New Chinese Medicine: Trial Implementation[M]. Beijing: China medical science press, 2002: 343-345. [11] 中华医学会消化病学分会炎症性肠病学组. 抗肿瘤坏死因子α单克隆抗体治疗炎症性肠病专家共识(2017)[J]. 协和医学杂志, 2017, 8(4/5): 239-243. https://www.cnki.com.cn/Article/CJFDTOTAL-XHYX2017Z2011.htmInflammatory Bowel Disease Group, Gastroenterology Branch of Chinese Medical Association. Expert consensus of anti-TNF-α monoclonal antibody in the treatment of inflammatory bowel disease (2017)[J]. Med J Peking Union Med Coll Hosp, 2017, 8(4/5): 239-243. https://www.cnki.com.cn/Article/CJFDTOTAL-XHYX2017Z2011.htm [12] 周青杨, 杨红, 钱家鸣. 克罗恩病的疾病活动度评分及相关评估指标研究[J]. 胃肠病学和肝病学杂志, 2020, 29(9): 961-964. https://www.cnki.com.cn/Article/CJFDTOTAL-WCBX202009001.htmZHOU QY, YANG H, QIAN JM. Research on disease activity assessment index and predictor of Crohn's disease[J]. Chin J Gastroenterol Hepatol, 2020, 29(9): 961-964. https://www.cnki.com.cn/Article/CJFDTOTAL-WCBX202009001.htm [13] 穆尔扎·别克, 杨雪松, 张拓红. 简体中文版炎性肠病量表的信度和效度评价[J]. 北京大学学报(医学版), 2011, 43(3): 477-480. https://www.cnki.com.cn/Article/CJFDTOTAL-BYDB201103037.htmMURZA B, YANG YS, ZHANG TH. Reliability and validity evaluation of simplified Chinese version of inflammatory bowel disease scale[J]. J Peking Univ Heath Sci, 2011, 43(3): 477-480. https://www.cnki.com.cn/Article/CJFDTOTAL-BYDB201103037.htm [14] 唐毛毛, 汪春莲, 张洁, 等. 克罗恩病患者93例使用阿达木单抗治疗的疗效和安全性分析[J]. 中华消化杂志, 2022, 42(6): 406-410.TANG MM, WANG CL, ZHANG J, et al. Efficacy and safety of adalimumab in 93 patients with Crohn ' s disease[J]. Chin J Dig, 2022, 42(6): 406-410. [15] 叶子萍, 赵小静, 焦春花, 等. 克罗恩病患者精神心理及迷走神经功能改变与临床特征的相关性分析[J]. 南京医科大学学报(自然科学版), 2022, 42(11): 1553-1559. https://www.cnki.com.cn/Article/CJFDTOTAL-NJYK202211008.htmYE ZP, ZHAO XJ, JIAO CH, et al. The correlation between the changes of psychophysiology and vagus nerve function and clinical characteristics in patients with Crohn's disease[J]. J Nanjing Med Univ Nat Sci, 2022, 42(11): 1553-1559. https://www.cnki.com.cn/Article/CJFDTOTAL-NJYK202211008.htm [16] 吴昆. 医方考[M]. 南京: 江苏科学技术出版社, 1985: 111.WU K. Investigations of Medical Formulas[M]. Nanjing: Jiangsu science & technology press, 1985: 111. [17] 韩金钱, 张宜佳, 蒋恩社. 艾灸对癌症病人癌因性疲乏干预效果的Meta分析[J]. 循证护理, 2021, 7(6): 719-726. https://www.cnki.com.cn/Article/CJFDTOTAL-XZHL202106003.htmHAN JQ, ZHANG YJ, JIANG ES. Intervention effect of moxibustion on cancer-related fatigue in cancer patients: A Meta-analysis[J]. Chin Evid Based Nurs, 2021, 7(6): 719-726. https://www.cnki.com.cn/Article/CJFDTOTAL-XZHL202106003.htm [18] 路玫, 张丽繁, 袁晔, 等. 隔姜灸、悬灸对不同穴位各时段热感度的对比研究[J]. 中国针灸, 2011, 31(3): 232-235. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZE201103017.htmLU M, ZHANG LF, YUAN Y, et al. Comparison on heat sensation degree of ginger-partition moxibustion and suspended moxibustion at different acupoints for different time[J]. Chin Acupunct Moxibust, 2011, 31(3): 232-235. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZE201103017.htm [19] 李景荣. 备急千金要方校注[M]. 北京: 人民卫生出版社, 1998: 651.LI JR. Corrections and Annotations to Important Formulas Worth A Thousand Gold Pieces[M]. Beijing: People's medical publishing house, 1998: 651. [20] 韩兴军, 郑雅峰, 王璇, 等. 灸神阙、针刺组穴对抑郁型大鼠不同脑区神经递质影响[J]. 辽宁中医药大学学报, 2018, 20(8): 154-158. https://www.cnki.com.cn/Article/CJFDTOTAL-LZXB201808047.htmHAN XJ, ZHENG YF, WANG X, et al. Effect of moxibustion on Shenque and acupuncture at different acupoints on neurotransmitters in different brain regions of depression rats[J]. J Liaoning Univ Tradit Chin Med, 2018, 20(8): 154-158. https://www.cnki.com.cn/Article/CJFDTOTAL-LZXB201808047.htm [21] 杨淑荃, 范德辉, 袁智先, 等. 基于"脑肠相通"的腹针埋线疗法治疗轻中度阿尔茨海默病及对血清APP、Aβ1-42的影响[J]. 中国针灸, 2021, 41(11): 1231-1235. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZE202111014.htmYANG SQ, FAN DH, YUAN ZX, et al. Abdominal acupoint thread embedding therapy based on "brain-intestinal connection" for mild-to-moderate Alzheimer's disease and its effects on serum levels of APP and Aβ1-42[J]. Chin Acupunct Moxibust, 2021, 41(11): 1231-1235. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZE202111014.htm -
点击查看大图
表(7)
计量
- 文章访问数: 193
- HTML全文浏览量: 16
- PDF下载量: 13
- 被引次数: 0
