| Objective:Distribution Charateristics and TCM syndrome factor analysis:First,observe the distribusion characteristics in remission stage of neuromyelitisoptica spectrum disorder(neuromyelitis optica spectrum disorders,NMOSD),including the morbidity,social demographic characteristics,diagnosis,comobidity,family history,clinical manifestations,premonitory symptoms,treatment situation,laboratory test,collect clinical data and analyzed,providing clues for the pathogenesis to further clarify the disease.Second,collect diagnostic data of remission stage of neuromyelitisoptica spectrum disease,analysis and explore the characteristics of TCM(troditional Chinese medcine)syndrome elements,including location syndrome elements and nature syndrome elements,to clarify diagnosis of TCM syndrome type,and provide the objective basis in syndrome type relationship.Clinical research:To explore the efficacy and safety in remission stage of NMOSD by treatment combination of acupuncture and medicine through randomized controlled parallel study.Evaluated and analysis the data of two different groups of patients before and after treatment by EDSS score,fatigue scale score,annual recurrence rate,positive rate of serum immunological antibody,electrophysiological indicators,as well as safety indicators,to make a conclusion.Method:Distribusion characteristics and TCM syndrome factor analysis:Collected clinical data of 54 NMOSD patients in remission stage through the hospital case reviewing and collecting recruit patients.The involved research object selected strictly according to the inclusion and exclusion criteria,signed informed consent,by combination of case record and questionnaire survey,collected data including general medical history,past history,family history,disease history,precursor,laboratory examination,imaging examination,lesion location,treatment results,complications,and four diagnostic information of TCM.The data were analyzed,making a calculation and descriptive to analysis.Meanwhile collected 54 cases in remission stage of NMOSD,according to the "syndrome" diagnostic criteria in the location and nature elements.Classified statistics on the diagnostic data,determine TCM syndrome characteristics in remission stage of NMOSD patients,analysis distribution characteristic of TCM syndrome.Clinical research:Using a randomized,parallel,controlled clinical research method,45 cases of NMOSD patients were included in remission period,5 cases were eliminated,1 cases were lost,and 39 cases were completed.According to the inclusion and exclusion criteria,patients were randomly divided into two groups according to 1:1,the treatment group were treated with acupuncturing Jiaji points and twelve-foot-hand needle method combined with oral azathioprine 2mg/(Kg-D)for 3 months,the depth of puncturing is about 25mm,and then manipulated to deqi,left needle in body for 30 minutes,acupuncture once a day.Each two group of acupoints alternately,5 days a week,for 2 consecutive weeks,a month for 2 weeks to rest for 2 weeks,a total of 3 months of treatment.The control group treated by oral azathioprine 2mg/(Kg-D)for 3 months.Evaluation index:EDSS score,FS-14 scale score,the annual recurrence rate,peripheral serum AQP4 antibody level,visual evoked potential,somatosensory evoked potential,blood routine,urine routine,stool routine,liver and kidney function,blood coagulation function,electrocardiogram before and after treatment;EDSS score,FS-14 Scale score,annual recurrence rate by followed up for 6 months and 12 months.Result:Distribusion characteristics analysis:1.Epidemiology,social and demographic statistics:the study showed that 54 cases of remission stage in NMOSD,male to female ratio was 1:6.7,the average age of 40.13±12.14 years old;Han accounted for the largest proportion,90.7%;professional and technical people was the highest incidence accounted for 22.2%;the degree distribution of the College and undergraduate accounted for 37%;geographical distribution most from the north region accounted for 83.3%and from the south region accounted for 16.7%.2.Diagnostic statistics:AQP4-IgG positive patients were 49 cases(90.7%);19 cases(35.2%)were detected with autoimmune disease antibody positive,20.4%of patients were diagnosticed to autoimmune diseases and 1 cases with cancer;the distribution in the family history of tumor diseases accounted for 9.3%autoimune disease accounted for 5.6%.3,Clinical course:the longest course was 21 years,the shortest was 5 months,the average disease duration was 3.91±4.60 years;the less attack number was at least 2 times,most attack number was 24 times,the average number of episodes was 5.91±4.56 years;the damaged location,the most common involvements of nervous system in this disease were optic nerve,optic chiasma,cervical cord and thoracic cord;32 cases(59.3%)of patients with prodrome history,which infectious,fatigue,poor emotional stress accounted for a higher proportion.4.Examination:49 cases serum AQP4-IgG was positive or used to be positive;5 cases was detected with MOG antibody,1 cases was positive;neuroimaging examination found 12 cases being involved in optic nerve,23 cases being involved in cervical and thoracic spinal cord,16 cases being involved in intracranial lesions;electrophysiological examination showed 18 cases being abnormal in visual evoked potential and 8 cases being abnormal in somatosensory evoked potentials,which display prolonged latency and decreased amplitude,or both of them.Even evoked no positive waveform in severe cases.The TCM syndrome analysis:1.Research statistics shows that the common location syndrome elements distribution is as follows:Spleen>Liver>Kidney>Tri-jiao>Stomach.2.Research statistics shows that the nature elements distribution of common sthenia syndrome is as follows:Damp>Phlegm>Blood stasis>Stagnation>Cold.Dampness,phlegm and Blood stasis are more common.The distribution of common deficiency syndrome is as follows:Qi deficiency>Yin deficiency>Yang deficiency>Blood deficiency>Yang hyperactivity,among which Qi deficiency and Yang deficiency are more common.3.The main syndrome types in the remission stage of NMOSD are spleen stomach Qi deficiency,liver and kidney Yin deficiency,spleen and kidney Yang deficiency,Qi and Blood two deficiency and kidney deficiency,usually accompanied by the syndrome of Phlegm dampness,Blood stasis,Qi stagnation,Cold,Wind.Clinical research:NMOSD patients in remission stage inter group comparison treated by acupuncture combined with drug therapy after 3 months,EDSS score(P<0.01)and FS score(P<0.05)in treatment group was significantly improved compared with before treatment,and the effect lasted 12 months by follow-up;the annual recurrence rate decreased(P<0.01)in treatment group after treated by 3 months,6 months,12 months follow-up.There was no significant difference in the positive ratio of peripheral serum AQP4 antibody(P>0.05)before and after treatment.The latency of P100 in visual evoked potential examination were decreased(P<0.05)and the amplitude of P100 were increased(P<0.05)after the treatment in treatment group.The latency of N13,N1 8,N18-P40,N13-N20 interval in treatment group of somatosensory evoked potentials were decreased(P<0.05)after the treatment.There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).The incidence of adverse reaction of acupuncture in the treatment group was 26.3%,all of which were transient.Conclusion:1.The distribusoin characteristics analysis of NMOSD patients in remission stage showed that:The main incidence of the disease is young and middle-aged women.The Han nationality occupies a significant proportion.The incidence of mental workers is higher than that of manual workers.The average educational level is high.It can be combined with autoimmune diseases,It can be traced to the family history of tumor and autoimmune disease.Most of them have a history of prodrome.The nervous system is the most common involved optic nerve,optic chiasma,cervical spinal cord,and thoracic spinal cord.The positive rate of AQP4-IgG in peripheral blood was high.The neuroimaging examination was common found in the optic nerve,the cervical and thoracic spinal cord and the intracranial lesions.The electrophysiological evoked potential was mainly prolonged in the latent period and decreased in wave amplitude,or both of them.The severe case cannot evoke the positive waveform.2.The NMOSD symptoms analysis research suggests that the location elements of this disease are spleen,liver and kidney.The first three common deficiency syndrome of this disease are Qi deficiency,yin deficiency and yang deficiency.The first three common sthenia syndrome are wet,phlegm and stasis.The disease belongs to deficiency in origin and asthenia in superficiality.Deficiency in origin includes Qi deficiency in middle of Tri-Jiao yin deficiency in liver and kidney,Yang deficiency of spleen and kidney as the disease pathogenesis.Asthenia in superficiality display phlegm dampness,blood stasis and qi stagnation and so on.3.Acupuncture combined with azathioprine in treatment of remission stage of NMOSD patients can significantly improve neurologic impairment and clinical symptoms,reducing the annual recurrence rate,improve the patient's fatigue state,and the effect continues.The latency of P100 can be reduced and the amplitude of P100 can be increased.Increase the extraction rate of somatosensory evoked potential,the latency period of N13,N18,N13-N20 and N8-P40 induced by somatosensory was reduced.It does not improve the positive ratio of antibody in the peripheral serum in short term.Verify the efficacy of acupuncture in the treatment of NMOSD Objectively.And acupuncture is safe and does not increase the risk of adverse reactions. |
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