摘要
目的评价针刺联合低频重复经颅磁刺激(rTMS)治疗小儿多发性抽动障碍心肝火旺证的临床疗效,并探讨该方案对患儿血清神经递质水平的影响。方法随机对照试验研究。选择2022年3月-2024年3月本院86例多发性抽动障碍心肝火旺证患儿作为观察对象,采用随机数字表法分为2组,每组43例。对照组予以rTMS治疗,观察组在对照组基础上联合针刺治疗。2组均连续治疗8周。分别于治疗前后进行中医证候评分,采用耶鲁综合抽动严重程度量表(YGTSS)评估临床症状严重程度,采用ELISA法检测血清γ氨基丁酸(γ-GABA)、多巴胺(DA)、5羟色胺(5-HT)水平。记录治疗期间的不良反应,评价临床疗效。结果观察组总有效率为90.70%(39/43)、对照组为72.09%(31/43),2组比较差异有统计学意义(χ^(2)=4.91,P=0.027)。观察组治疗后抽搐蠕动、面红耳赤、心烦易怒、舌红苔黄积分低于对照组(t值分别为3.80、2.94、3.26、4.22,P<0.01),发声性抽动、运动性抽动评分及总分低于对照组(t值分别为7.97、5.23、6.44,P<0.01)。观察组治疗后γ-GABA[(9.72±2.04)μg/L比(8.13±1.87)μg/L,t=3.77]水平高于对照组(P<0.01),DA[(8.98±1.94)μg/L比(12.10±2.27)μg/L,t=6.85]、5-HT[(15.20±3.87)μg/L比(19.93±3.97)μg/L,t=5.59]水平低于对照组(P<0.01)。治疗期间,观察组不良反应发生率为11.63%(5/43)、对照组为9.30%(4/43),2组比较差异无统计学意义(χ^(2)=0.12,P=0.725)。结论针刺联合rTMS可减轻多发性抽动障碍心肝火旺证患儿的抽动症状,改善患儿神经递质水平及主要中医证候,提高临床疗效且治疗安全性良好。
ObjectiveTo evaluate the clinical efficacy of acupuncture combined with low-frequency repetitive transcranial magnetic stimulation(rTMS)in the treatment of heart and liver fire hyperactivity syndrome in children with tic disorder;To explore its effects on the levels of serum neurotransmitters in children.MethodsA randomized controlled trial study was conducted.A total of 86 children with heart and liver fire hyperactivity syndrome of tic disorder in our hospital from March 2022 to March 2024 were selected as the observation objects and divided into 2 groups using the random number table method,with 43 cases in each group.The control group was treated with rTMS,while the observation group was treated with combined acupuncture on the basis of the control group.Both groups were treated continuously for 8 weeks.The TCM syndrome scores were conducted before and after the treatment respectively.The Yale Comprehensive Tic Severity Scale(YGTSS)was used to evaluate the severity of clinical symptoms,and the levels of serumγ-aminobutyric acid(γ-GABA),dopamine(DA),and 5-hydroxytryptamine(5-HT)were detected by ELISA.The adverse reactions during the treatment period were recorded and the clinical efficacy was evaluated.ResultsThe total effective rate was 90.70%(39/43)in the observation group and 72.09%(31/43)in the control group,with statistical significance(χ^(2)=4.91,P=0.027).After treatment,the scores of convulsion and peristalsis,flushed face and ears,irritability and anger,and red tongue with yellow coating in the observation group were lower than those in the control group(t values were 3.80,2.94,3.26,and 4.22 respectively,P<0.01),and the scores of vocal tics,motor tics and the total score were lower than those in the control group(t values were 7.97,5.23,and 6.44 respectively,P<0.01).After treatment,the level ofγ-GABA in the observation group[(9.72±2.04)μg/L vs.(8.13±1.87)μg/L,t=3.77]was higher than that of the control group(P<0.01),and DA[(8.98±1.94)μg/L vs.(12.10±2.27)μg/L,t=6.85],levels of 5-HT[(15.20±3.87)μg/L vs.(19.93±3.97)μg/L,t=5.59]were lower than those in the control group(P<0.01).During the treatment period,the incidence of adverse reactions was 11.63%(5/43)in the observation group and 9.30%(4/43)in the control group,without statistical significance(χ^(2)=0.12,P=0.725).ConclusionAcupuncture combined with rTMS can alleviate the tic symptoms of children of tic disorder with heart and liver fire hyperactivity syndrome,improve the neurotransmitter levels and main TCM syndromes of the children,enhance the clinical efficacy and have good treatment safety.
作者
何莉莉
刘学锋
董菲艳
刘华明
钱丰
He Lili;Liu Xuefeng;Dong Feiyan;Liu Huaming;Qian Feng(Department of Pediatrics,Ningde Normal University Affiliated Ningde City Hospital,Ningde 352100,China)
出处
《国际中医中药杂志》
2025年第8期1072-1076,共5页
International Journal of Traditional Chinese Medicine
基金
福建省临床重点专科建设项目(闽卫医政函〔2022〕884号)
宁德市自然科学基金联合项目(2022J10)。
关键词
儿童
抽动障碍
心肝火旺
低频重复经颅磁刺激
针刺
Child
Tic disorder
Hyperactivity of fire of heart and liver
Repetitive transcranial magnetic therapy apparatus
Acupuncture
