| BackgroundAllergic rhinitis is caused by exposure to allergens and characterized by sudden and recurrent sneezing,stuffiness,runny nose and itchy nose.The occurrence and development of allergic rhinitis are affected by many factors such as natural environment and social environment.With the development of study,scholars have realized that this disease belongs to psychosomatic diseases,especially persistent moderate to severe allergic rhinitis,mood disorder plays a pivotal role in the occurrence and development of the disease.It is important but difficult to control nasal symptoms and emotional disorder.The effect of western medicine on nasal symptoms is often rapid but the maintenance effect is poor and there are many complications.Acupuncture can regulate patients’ physical and mental state as a whole,but the mechanism is still unclear.The sthdy,which based on the clinical experience of the tutor and the preliminary research,adopt the method of acupuncture intending to regular the mind combined with intranasal corticosteroid(ISN)to treat AR and observe its clinical efficacy.On this basis,representative cytokines,hormones and neurotransmitters are selected to explore the mechanism of the action of the therapy.Objective1 To evaluate the clinical efficacy of mind-regularing acupuncture combined with intranasal corticosteroid for treating patients with persistent moderate to severe allergic rhinitis by evaluating the nasal symptoms,nasal concomitant symptoms,and quality of life.2 To explore the mechanism of mind-regularing acupuncture combined with intranasal corticosteroid by detecting the level of CRH,ACTH,COR,IL-4,IFN-y,5-HT.MethodsIn this study,patients with persistent moderate to severe allergic rhinitis were selected as the study subjects.The three therapies combination of mind-regularing acupuncture with intranasal corticosteroid,combination of conventional acupuncture with intranasal corticosteroid and intranasal corticosteroid were compared with each other in a randomized controlled study and a blind evaluation was performed.1 Acupoint selection,Operation and MedicationISN Group:Treatment was performed according to the stepwise treatment regimen recommended for moderate/severe persistent rhinitis.Rhinocort nasal spray was used for treatment,starting with 1 spray per nostril(64μg/spray),twice daily for morning and evening,and then followed by reduction or maintenance of the original dose as symptoms improve.Combination of Mind-regularing Acupuncture with ISN Group(Mind-regularing Acupuncture Group):Patrents lied on their stomach first,acupoints of GV14,BL13,BL20,BL18 were choosen.GV14 was punctured for 0.5～1 inch perpendicularly,BL13,BL20,BL18 were punctured to spine for 0.5～0.8 inch while BL23 was punctured to spine for 0.5～1 inch.After qi arrived,twisting and reinforcing method was taken on every acupoints for 30s.The needle was retained for 20min.And then patients lied on their back,acupoints of GV20,GV29,LI20,LR3,LI4,ST36 were choosen.GV20 was punctured to forward for 0.5-0.8 inch horizontally,GV29 was punctured to nasal root for 0.3～0.5 inch horizontally,LI20 was punctured along the nasolabial sulcus to forward for 0.3～0.5 inch horizontally,LR3 and LI4 were punctured for 0.5～1 inch perpendicularly,ST36 was punctured for 1～2 inch perpendicularly.After qi arrived,mild reinforcing and attenuating method was taken on every acupoints for 30s.The needle was retained for 20min.Combination of Conventional Acupuncture with INS Group(Conventional Acupuncture Group):Patients lied on their back,acupoints of GV29,LI20,GB20,LI4,ST36 were choosen.GV29 was punctured to nasal root for 0.3～0.5 inch horizontally,LI20 was punctured along the nasolabial sulcus to forward for 0.3～0.5 inch horizontally,GB20 was punctured to apex nasi for 0.8～1.2 inch,LI4 were punctured for 0.5～1 inch perpendicularly,ST36 was punctured for 1～2 inch perpendicularly.After qi arrived,mild reinforcing and attenuating method was taken on every acupoints for 30s.The needle was retained for 20min.The INS therapy in both of the two combination of acupuncture with INS groups were same as that in ISN group.2 Frequency and Course of TreatmentThe initial dose of INS was 256 ug/day for 4 weeks.After reexamination by otorhinolaryngologist,patients continued to take medicine for 4 weeks as needed,for a total of 8 weeks.Patients received acupuncture once every other day,three times a week for 8 weeks.3 Observation Indicators and Evaluation Time PointsAll of the indicators of clinical efficacy nasal symptoms VAS,nasal symptom scale,nasal accompanied symptoms score,rhinoconjunctivitis quality of life questionnaire(RQLQ)score were evaluated before treatment and after the last treatment of 2,4,6,8 weeks.All of the laboratory observation indicators CRH,ACTH,COR,IL-4,IFN-γ,5-HT were detected before treatment and after the last treatment of 8 week.Results1 Indicators of clinical efficacyIntra-group comparison before and after treatment:(1)Nasal symptoms VAS score and nasal objective symptom score in the three groups decreased significantly after treatment compared with before treatment(P<0.01).(2)Nasal accompanied symptoms score and RQLQ score in the two combination of acupuncture with INS groups decreased significantly after treatment compared with before treatment(P<0.01).(3)Score of nasal mucus running through the pharynx,pain in the upper jaw or nose,headache symptoms belonging to nasal accompanied symptoms score in INS group decreased significantly after treatment compared with before treatment(P<0.01)while the other symptoms were of no significant change(P>0.05).RQLQ total score,score of influence of daily life,eye symptoms,emotional state belonging to RQLQ score decreased significantly after treatment compared with before treatment(P<0.01),score of sleep status was of no significant change(P>0.05).Intergroup comparison before and after treatment:There were no difference in all the kinds of scores among the three groups before treatment(P>0.05).After the treatment:(1)Scores of sneezing,running nose,rhinobyon,nasal cavity belonging to nasal objective symptom score in mind-regularing acupuncture group was significantly lower than that in INS group(P<0.01),scores of sneezing,rhinobyon in mind-regularing acupuncture group was lower than that in conventional acupuncture group(P<0.05),scores of running nose,nasal cavity in conventional acupuncture group was lower than that in INS group(P<0.05).(2)There was no difference in VAS score among the three groups(P>0.05).(3)Score of nasal mucus running through the pharynx belonging to nasal accompanied symptoms score in mind-regularing acupuncture group was lower than that in conventional acupuncture group(P<0.05),score of pruritus of nose or pharynx in mind-regularing acupuncture ISN group was lower than that in INS group(P<0.05).(4)Score of sleep status belonging to RQLQ in mind-regularing acupuncture group was significantly lower than that in INS group(P<0.05)while the score in conventional acupuncture group was lower than that in INS group(P<0.05),score of influence of daily life in mind-regularing acupuncture group was lower than that in INS group(P<0.05).2 Laboratory observation indicatorsIntra-group comparison before and after treatment:(1)Hormone level:COR level of allergic rhinitis patients was significantly lower than that of healthy subjects(P<0.01).There were no significant difference in CRH and ACTH levels between allergic rhinitis patients and healthy subjects(P>0.05).CRH level in mind-regularing acupuncture group decreased significantly after treatment compared with before treatment(P<0.01)while ACTH and COR level raised after treatment compared with before treatment(P<0.05,P<0.01).CRH level in conventional acupuncture group decreased significantly after treatment compared with before treatment(P<0.01)while ACTH and COR level raised after treatment compared with before treatment(P<0.05).(2)There was no significant difference in IL-4,IFN-gamma and 5-HT levels between before treatment and after treatment in all the three groups(P>0.05).Intergroup comparison before and after treatment:There were no difference in all the kinds of laboratory observation indicators among the three groups before treatment(P>0.05).After the treatment:(1)Hormone level:CRH level in mind-regularing acupuncture group was lower than that in INS group(P<0.05)while it was significantly lower than that in conventional acupuncture group(P<0.01).ACTH level in mind-regularing acupuncture group was higher than that in INS group(P<0.05).COR level in mind-regularing acupuncture group was higher than that in INS group(P<0.05)whlie the level in mind-regularing acupuncture group was significantly higher than that in INS group(P<0.01).(2)There were no significant differences in IL-4,IFN-y and 5-HT levels among the three groups(P>0.05).Conclusions1 All of the three kinds of therapies can significantly improve nasal symptoms,nasal concomitant symptoms and overall quality of life of patients with persistent moderate to severe allergic rhinitis.In addition,mind-regularing acupuncture combined with intranasal corticosteroid has more advantages.2 In patients with persistent moderate to severe allergic rhinitis,HPA axis function may be inhibited to a certain extent,and acupuncture may promote the recovery of HPA axis function.Acupuncture may promote the rise of COR level by regulating the rise of ACTH level,thus playing a therapeutic role in patients with allergic rhinitis.The regulating effect of mind-regularing acupuncture is more obvious than that of conventional acupuncture. |
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