摘要
目的:观察2 Hz、100 Hz、2 Hz/100 Hz不同频率电针治疗紫杉类化疗药物所致周围神经病变(CIPN的临床疗效。方法:将160例女性乳腺癌采用紫杉类化疗药物所致CIPN患者随机分为2 Hz电针组(40例,脱落1例)、100 Hz电针组(40例,脱落2例)、2 Hz/100 Hz电针组(40例,脱落3例)及西药组(40例,脱落2例)。3个电针组均于双侧曲池、外关、合谷、足三里、阳陵泉等穴进行针刺,同侧合谷与外关、足三里与三阴交分别连接HANS-200E型韩氏穴位神经刺激仪电极,分别予频率2 Hz、100 Hz及2 Hz/100 Hz电针刺激,每次30 min,隔日1次,每周治疗3次。西药组予口服甲钴胺片治疗,每次0.5 mg,每天3次。各组均连续治疗4周。于治疗前、治疗后及全部治疗结束后4周随访,观察各组肿瘤患者神经毒性评估量表(FACT/GOG-Ntx)评分、美国国立癌症研究所评定标准(NCI CTCAE V 5.0)的周围神经毒性分级、周围神经痛视觉模拟量表(VAS)评分,并于治疗后评定临床疗效。结果:治疗后及随访时,各组患者FACT/GOG-Ntx评分较治疗前降低(P<0.01);治疗后,3个电针组FACT/GOG-Ntx评分降低幅度大于西药组(P<0.01,P<0.05),2 Hz电针组与2 Hz/100 Hz电针组降低幅度大于100 Hz电针组(P<0.05);随访时,2 Hz电针组、2 Hz/100 Hz电针组FACT/GOG-Ntx评分降低幅度大于西药组(P<0.01)。治疗后,3个电针组周围神经毒性分级较治疗前改善(P<0.01);随访时,2 Hz电针组与2 Hz/100 Hz电针组周围神经毒性分级较治疗前改善(P<0.01)。治疗后,3个电针组周围神经痛VAS评分较治疗前降低(P<0.01,P<0.05);随访时,2Hz电针组、2Hz/100Hz电针组和西药组周围神经痛VAS评分较治疗前降低(P<0.01,P<0.05);治疗后及随访时,2 Hz/100 Hz电针组VAS评分降低幅度大于西药组(P<0.01,P<0.05)。治疗后,2 Hz电针组、100 Hz电针组、2 Hz/100 Hz电针组、西药组总有效率分别为79.5%(31/39)、68.4%(26/38)、81.1%(30/37)、47.4%(18/38),2 Hz电针组与2 Hz/100 Hz电针组总有效率高于西药组(P<0.05)。结论:电针能有效治疗紫杉类化疗药物所致CIPN,但不同频率电针的疗效总体没有差异,2Hz电针与2 Hz/100 Hz电针的疗效具有潜在优势;对于合并周围神经痛患者,更推荐采用2 Hz/100 Hz电针治疗。
Objective To observe the clinical efficacy of electroacupuncture(EA) at frequencies of 2 Hz, 100 Hz, and 2 Hz/100 Hz for chemotherapy-induced peripheral neuropathy(CIPN). Methods One hundred and sixty female breast cancer patients with CIPN induced by paclitaxel were randomly divided into a 2 Hz EA group(40 cases, 1 case dropped out),a 100 Hz EA group(40 cases, 2 cases dropped out), a 2 Hz/100 Hz EA group(40 cases, 3 cases dropped out), and a medication group(40 cases, 2 cases dropped out). The three EA groups received acupuncture at bilateral Quchi(LI 11),Waiguan(TE 5), Hegu(LI 4), Zusanli(ST 36), and Yanglingquan(GB 34). Electrodes of the HANS-200E acupoint nerve stimulator were connected to the same side Hegu(LI 4) and Waiguan(TE 5), and Zusanli(ST 36) and Sanyinjiao(SP 6), with EA stimulation frequencies of 2 Hz, 100 Hz, and 2 Hz/100 Hz, respectively. Each session lasted 30 min, once every other day, three times a week. The medication group received oral mecobalamin tablets, 0.5 mg per dose, three times a day. All groups were treated for four weeks. The functional assessment of cancer therapy/gynaecologic oncology group-neurotoxicity(FACT/GOG-Ntx), peripheral neurotoxicity grading based on the National Cancer Institute-common terminology criteria for adverse events Version 5.0(NCI-CTCAE V5.0), and peripheral neuropathy pain visual analogue scale(VAS) scores were observed before and after treatment, and at follow-up after 4 weeks of treatment completion, and clinical efficacy was evaluated after theatment. Results Compared before treatment, FACT/GOG-Ntx scores in all groups were decreased after treatment and during follow-up(P<0.01). The score reduction between before and after treatment in the three EA groups was greater than the medication group(P<0.01, P<0.05), with the 2 Hz and 2 Hz/100 Hz EA groups showing a greater reduction than the 100 Hz EA group(P<0.05). The reduction of FACT/GOG-Ntx score between before treatment and follow-up in the 2 Hz and 2 Hz/100 Hz EA groups was greater than the medication group(P<0.01).Peripheral neurotoxicity grading in the three EA groups were improved after treatment(P<0.01). Compared before treatment, the peripheral neurotoxicity grading in the 2 Hz and 2 Hz/100 Hz EA groups was improved at follow-up(P<0.01, P<0.05). The VAS scores for peripheral neuropathy pain in the three EA groups were decreased after treatment(P<0.01, P<0.05). At follow-up, VAS scores in the 2 Hz, 2 Hz/100 Hz, and medication groups were decreased(P<0.01,P<0.05), with a greater reduction in the 2 Hz/100 Hz EA group than the medication group after treatment and follow-up(P<0.01, P<0.05). The overall effective rates for the 2 Hz, 100 Hz, 2 Hz/100 Hz, and medication groups were 79.5%(31/39), 68.4%(26/38), 81.1%(30/37), and 47.4%(18/38), respectively, with the 2 Hz and 2 Hz/100 Hz groups showing higher effective rates than the medication group(P<0.05). Conclusion EA is effective in treating paclitaxel-induced CIPN. While there is no overall difference in efficacy among the different frequencies, 2 Hz and 2 Hz/100 Hz EA showing potential advantages. For patients with concurrent peripheral neuropathy pain, 2 Hz/100 Hz electroacupuncture is recommended.
作者
卢超
冯绪康
沈琼颖
李广亮
吴涛凭
李晓宇
邵喜英
王佩佩
李荣荣
邓亚萍
陈炜吉
LU Chao;FENG Xukang;SHEN Qiongying;LI Guangliang;WU Taoping;LI Xiaoyu;SHAO Xiying;WANG Peipei;LI Rongrong;DENG Yaping;CHEN Weiji(Department of TCM,Zhejiang Cancer Hospital,Hangzhou 310022,China;Third Clinical Medical College of Zhejiang Chinese Medical University;Department of Breast Oncology,Zhejiang Cancer Hospital,Hangzhou 310022,China;Department of Acupuncture and Moxibustion,Third Affiliated Hospital of Zhejiang Chinese Medical University/Zhejiang Zhongshan Hospital)
出处
《中国针灸》
CAS
CSCD
北大核心
2024年第10期1139-1145,共7页
Chinese Acupuncture & Moxibustion
基金
浙江省中医药科技计划科研基金项目:2022ZB058、2022ZB183、2023ZL293
浙江省医药卫生科技计划项目:2023KY883。
关键词
化疗所致周围神经病变
紫杉类药物
乳腺癌
电针
随机对照试验
chemotherapy-induced peripheral neuropathy(CIPN)
paclitaxel
breast cancer
electroacupuncture
randomized controlled trial(RCT)
