| Objective:To observe the effect and safety of warming acupuncture and moxibustion in improving the degree of breast cancer related lymphedema(BCRL)patients after breast cancer operation.To explore the potential mechanism based on the expression of vascular endothelial growth factor and its receptor to provide scientific basis for clinical treatment.Methods: According tor Randomized controlled trial method,patients with BCRL were randomly divided into two groups according to the ratio of 2:1: warm acupuncture group(n=20)and placebo acupuncture group(n=10).They were treated 3 times a week,once every other day,for 7 weeks,a total of 21 times.Before and after the 7th,14 th and 21 st times of treatment,the therapeutic effect of the main observation indexes——arm circumference of upper limb and the secondary observation indexes——edema degree classification,edema related fibrosis degree,VAS swelling score and upper limb function score were evaluated,and the adverse events occurred in the treatment process were recorded as safety evaluation,so as to define the clinical treatment of warm acupuncture for BCRL Effective.On this basis,the peripheral blood of the subjects in the warm acupuncture group and the placebo acupuncture group were collected before and after the 21 st treatment,including 10 cases in the warm acupuncture group and 5cases in the placebo acupuncture group.The protein and gene expression levels of VEGFA,VEGFC and NRP1 in plasma were detected by ELISA and q RT-PCR to explore the potential mechanism of warm acupuncture in the treatment of BCRL.Results:1.Clinical study results:(1)main indicators: Compared with before treatment,there was no statistical difference in upper limb arm circumference between warm acupuncture group and placebo acupuncture group after treatment,and there was no significant differencebetween the two groups(P>0.05),but the observed value of warm acupuncture group showed a downward trend.(2)Secondary indexes: There was no significant difference in the severity of edema between the warm acupuncture group and the placebo acupuncture group(P>0.05).Both warm acupuncture and splacebo acupuncture had a tendency to improve the degree of edema-related fibrosis,but there was no significant difference between the two groups(P>0.05).Both warm acupuncture and placebo acupuncture could improve the sense of swelling of upper limbs.After 7,14 and21 times of treatment,warm acupuncture had significant difference compared with that before treatment(P < 0.001).There was significant difference between the two groups(P < 0.05).But there was no significant difference between the two groups(P>0.05).Warm acupuncture could improve the upper limb function of the affected side,and the score of upper limb function at the 14 th and 21 st evaluation was significantly different from that before treatment(P < 0.001),but there was no significant difference between the placebo acupuncture group and the pre-treatment group(P>0.05).During the study period,there were no adverse events related to warming acupuncture.2.Mechanism exploration results:(1)ELISA results: the expression of VEGFA protein in plasma of warm acupuncture and moxibustion group increased significantly after treatment,and there was significant difference compared with that before treatment(P=0.039,P<0.05).The expression of VEGFA protein in placebo acupuncture group showed a downward trend,and there was no significant difference between the two groups after treatment(P>0.05).After treatment,VEGFC in the warm acupuncture group showed an upward trend,while that in the placebo acupuncture group showed a downward trend,but there was no significant difference between the two groups before treatment(P>0.05),and there was no significant difference between the two groups after treatment(P>0.05).After treatment,the expression of NRP1 protein in the warm acupuncture group increased,but there was no significant change in the placebo acupuncture group before and after treatment,but there was nosignificant difference between the two groups before and after treatment(P>0.05).There was no significant difference between the two groups after treatment.(2)PCR results: after treatment,the relative expression of VEGFA gene in plasma of warm acupuncture and moxibustion group showed no significant difference compared with that before treatment(P>0.05),but showed an upward trend,while that of placebo acupuncture group showed no significant difference compared with that before treatment(P>0.05),but showed a downward trend,and there was significant difference between the two groups after treatment(P=0.045,P<0.05).After treatment,the relative expression of VEGFC gene in plasma of warm acupuncture and moxibustion group increased significantly,and there was significant difference compared with that before treatment(P=0.038,P<0.05).The relative expression of VEGFC gene in placebo acupuncture group showed a downward trend,and there was no significant difference between the two groups after treatment(P>0.05).There was no significant change in the relative expression of NRP1 gene in plasma after treatment in the warm acupuncture group(P>0.05),and there was no significant difference compared with that before treatment in the placebo acupuncture group(P>0.05).The relative expression of NRP1 gene in the placebo acupuncture group showed an upward trend compared with that before treatment,and there was no significant difference between the two groups after treatment(P>0.05).Conclusion:1.Warm acupuncture has potential advantages in the treatment of breast cancer related lymphedema,and it has a certain effect in reducing upper limb swelling and improving upper limb function.2.The improvement of breast cancer related lymphedema by warming acupuncture and moxibustion may be related to the increased expression of VEGFA and VEGFC. |
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