| BackgroundUrticaria,also known as "rubella block",is a localized edema reaction caused by the expansion and permeability of small blood vessels of skin and mucous membrane,which is mainly characterized by sudden onset,various forms,wind masses and erythema of different sizes.It was accompanied by different degree of pruritus,attacked and disappeared irregularly.It subsided within 24 hours,and did not leave a trace after regression,can also accompanied by vascular edema.Chronic urticaria(CU)refers to the onset of wind mass at least twice a week,the course of disease lasts for 6 weeks or more.The course of disease in some patients can last for months to decades,and the delay does not heal,which brings great distress to life and even mental abnormalities.A small number of patients with chronic urticaria can also show intermittent attacks.Urticaria is one of the most common immune-related diseases in clinic w,hich can occur at any age,the incidence of urticaria is higher in young Chinese women between the ages of 20 and 40.With the differences effecting of geographical,environmental and demographic,the prevalence rate varies from place to place,and with the changes in people's lifestyle and living environment,the incidence continues to increase,and shows an overall upward trend in the world.Not only is the quality of life seriously affected,but the incidence of anxiety and depression is also higher than that of normal people.The causes of chronic urticaria are various and complex,often repeated attacks and difficult to heal.It is related to diet,drugs,inhalants,infections,insect bites,medical diseases,physical factors(such as cold,heat,sunlight,friction and stress,etc.),mental factors,endocrine factors,genetic factors and so on.Its pathogenesis is not completely clear,but it is generally related to genetic,environmental,immune and other factors.At present,many scholars agree that the pathogenesis is due to the imbalance of the immune system,which is allergic or non-allergic stimulating factors causes the IgE antibody to adsorb on the surface of basophilic granulocytes or mast cells,so that the body is in a sensitized state,when the same allergen enters the human body again,it specifically binds to the IgE antibody adsorbed on the surface,make its degranulation release vasoactive substance histamine,increase vascular permeability,or directly act on blood vessels,make capillaries dilate,permeability increase,so that tissue fluid exudate in blood vessels,induce superficial dermal edema,and appear wind mass.Western medicine has a variety of treatment methods for urticaria,but mainly to control clinical symptoms.The treatment methods include taking antihistamine,vitamin B12,corticosteroid(CG),cyclosporine A(CSA),intravenous immunoglobulin,leukotriene receptor antagonist therapy(LTRAS),H2 receptorant agonists(H2RAS),omalizumab anti-IgE and so on.The basic principle of western medicine treatment is to alleviate the symptoms of patients and improve the quality of their lives,but long-term use is easy to rely on drugs,systemic adverse reactions are obvious,and easy to recur within a short period of time after withdrawal of drugs.Therefore,in recent years,there have been a large number of studies to explore and confirm the efficacy of traditional Chinese medicine in the treatment of urticaria.Traditional Chinese medicine(TCM)has its unique advantages in treatment.It sets out from the whole,syndrome differentiation and treatment,and the theoretical system of treating diseases and seeking the root causes,which guides the progress of traditional Chinese medicine.Acupuncture and moxibustion,as a green non-drug therapy,has more advantages,such as simplicity,convenience,cheapness,efficiency,widely and so on.In recent years,acupuncture and moxibustion treatment is easy to be accepted by the majority of patients.Urticaria is also called " hidden rashes " in ancient medicine.The causes of urticaria are summarized into four aspects:congenital deficiency and inborn intolerance;six exogenous pathogenic factors invading the body;intemperate diet,strain on the spleen and stomach;over-extreme and injury emotion.The study confirmed that acupuncture can harmonizing qi and blood,strengthening vital qi and eliminating pathogen,balance yin and yang,improve the internal environment of the body,enhance the immunity of the body significantly.Which in line with the idea of"treating diseases and seeking the root cause".It can treat the disease according to the characteristics of the disease and the characteristics of the patients themselves,and some studies have confirmed that the curative effect is stable,the incidence of adverse reactions is low,and it is not easy to recur after cure.The etiology of chronic urticaria is various and complex,and is difficult to heal.It brings great distress to the lives of patients.The efficiency of learning and work is low.In the long run,many patients will appear with the negative mood such as anxiety and depression.In recent years,there have been many reports on the treatment of chronic urticaria,and the treatment methods are various which contain acupuncture.whether it is the comprehensive treatment of acupuncture or the simple acupuncture treatment,it can achieve a certain curative effect.The acupuncture treatment methods are various,and the selection of acupuncture points is different.In order to select the acupoint combination with remarkable curative effect,we searched the study which published in the past ten years for acupuncture and moxibustion treatment of chronic urticarial.And according to the sequence of acupoints we selected a series of dominant acupoint to treat chronic urticaria.In our study we observed the efficacy of acupuncture and moxibustion in improving the quality of life,anxiety and depression among chronic urticaria patients.Evaluated the safety of acupuncture and moxibustion by observing whether there were adverse reactions.To set up a follow-up period to observe the long-term curative effect,then to provide a new idea for the clinical treatment of chronic urticaria in the future,and to provide a data reference for scientific research.ObjectiveIn this study,chronic urticaria patients are the object of study,acupuncture as the main treatment method,by comparing the changes of urticaria disease activity score before and after treatment,to evaluate the final curative effect;by observing the improvement of quality of life index and the degree of impact of quality of life,to assessment the effect of chronic urticaria onpatients;by observing the improvement of anxiety and depression,to analyze the correlation between chronic urticaria and mental emotion.Finally,evaluated the efficacy,safety and advantages of acupuncture and moxibustion in the treatment of chronic urticaria through clinical efficacy indicators,then provide an effective treatment for urticaria patients who were difficult to control with drugs.And provide research data for further clinical study.MethodUsing a prospective case-observational study,Screen out 46 patients with chronic urticaria according to inclusion criteria and exclusion criteria.All of the patients come from March 2017 to January 2019 Acupuncture combined with cupping was used.The selected points were as follows:Fengchi point,Shenmen point.Neiguan point,Waiguan point,Quchi point,Guanyuan point.Baichongwo point.Zusanli point,Sanyinjiao point,Fengshi point Taichong poin;Cupping point selection:Guanyuan point,Baichongwo point.(All of them are double).The total course of treatment was 4 months,the treatment period was 4 weeks,3 times a week,a total of 12 times,the follow-up period was 3 months.The main outcome measures were Urticaria Activity Score(UAS),used to evaluate the symptoms and signs of patients with chronic urticaria.There were 2 scoring items,including pruritus degree and wind mass number.According to the 4-grade scoring method of 0 to 3 points,the total the scores of 2 items was the score of UAS.The total score ranged from 0 to 6,and the higher the UAS score,the more serious the urticaria symptoms.The scores of 0 week,2 th week,4 th week and 3 months after treatment were recorded in order to evaluate the final curative effect.The secondary indicator of this study is the Dermatology Life Quality Index(DLQI),which is often used to evaluate the living conditions of patients.Including 10 items which are related to daily life such as itching or pain degree,skin embarrassment,skin care and so on,each item was scored by a 4-level method of 0 to 3 points.That is "none","mild","moderate" and "serious".The scores of 10 items were added up as the total score,and the cumulative total score of each item was 0 to 30.According to the total score,judged the quality of urticaria patients' life.Hamilton Anxiety Scale(HAMA),which contains 14 items about physical and mental status,all items were evaluated by a 5-level scoring method of 0 to 4 points.According to the total score of 14 items to evaluate the effect of chronic urticaria on patients' anxiety.Hamilton Depression Scale(HAMD),which contains 24 items,is the most common scale to evaluation the depression conditions of patients.Using the 5-grade scoring method of 0 to 4 points or the 3-grade scoring method of 0 to 2 points to evaluated.According to the total score of 24 items to evaluate the effect of chronic urticaria on patients' depression.The evaluation time points of the three secondary indexes were,0 week,2th week and 4th week.Finally,evaluated the curative effect by analyz the changes of statistical score were and was.Results(1)UAS:Compared with 0 week,the UAS begin down from 2th week'(6 times)treatment,UAS was significantly lower than 0 week(P<0.05).After 4 weeks'(12 times)treatment,the UAS of chronic urticaria patients was significantly lower than that before treatment(P=0.000<0.05).and the difference was statistically significant(2)DLQI:Compared with 0 week,after 2 weeks and 4 weeks' treatment,the DLQI was significantly decreased(P=0.000<0.05).and the difference was statistically significant.The influence of chronic urticaria on the quality of patients' life was divided into 5 grades.Before treatment,more than 90%of the patients were severely and very severely affected;After 4 weeks' treatment nearly 90%of the patients were only slightly and severely affected,and the overall quality of life improved.(3)HAMA:Compared with 0 week,after 2 weeks and 4 weeks' treatment,the HAMA was significantly decreased(P=0.000<0.05),and the difference was statistically significant.According to the 5-grade classification of anxiety,before treatment,no patient suffered from very severe anxiety,only 4 patients had no anxiety,after 4 weeks' treatment,the number of patients without anxiety increased to 38,the number of patients with moderate and severe decreased,the number of patients without anxiety and mild anxiety increased,and the overall anxiety situation was significantly improved.(4)HAMD:Compared with 0 week,after 2 weeks and 4 weeks' treatment,the HAMD was significantly decreased(P=0.000<0.05),and the difference was statistically significant.According to the 4-grade classification of depression,before treatment,no patient suffered from severe depression,only 13 patients had no depression,after 4 weeks' treatment,the number of patients without depression increased to 40,the number of patients with slight and moderate depression decreased,and the overall anxiety situation was significantly improved.(5)Evaluation of curative effect:46 patients of chronic urticaria were included in this study.After 4 weeks' treatment,37 cases(80.43%)were markedly effective,8 cases(17.39%)were effective,2 cases(2.17%)were ineffective,the total effective rate was 97.83%.(6)Follow-up and long-term curative effect evaluation:After 4 weeks'treatment,37 cases were markedly effective.There are 6 cases recurred at the end of 3 months follow-up.The recurrence rate was 16.22%.(7)Adverse reactions:46 patients with chronic urticaria had good compliance,none of them had any adverse reactions such as halo needle,broken needle,congestion,hematoma,infection and so on.Conclusion(1)Acupuncture and moxibustion treatment can improve the symptoms of chronic urticaria patients,the quality of chronic urticaria patients' life,and can regulate the mood of chronic urticaria patients and improve their anxiety and depression conditions;(4)Acupuncture and moxibustion has stable curative effect,low recurrence rate and good safety in the treatment of chronic urticaria. |
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