不同频率电针治疗紫杉类化疗药物所致周围神经病变：随机对照试验

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

doi:10.13703/j.0255-2930.20240123-0001

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不同频率电针治疗紫杉类化疗药物所致周围神经病变：随机对照试验

临床研究 | 更新时间：2024-10-12

- 不同频率电针治疗紫杉类化疗药物所致周围神经病变：随机对照试验
- Electroacupuncture with different frequencies for paclitaxel-induced peripheral neuropathy: a randomized controlled trial
- 中国针灸 2024年44卷第10期页码：1139-1145
- 作者机构：
  
  1.浙江省肿瘤医院中医科，杭州　310022
  2.浙江中医药大学第三临床医学院
  3.浙江省肿瘤医院乳腺肿瘤内科
  4.浙江中医药大学附属第三医院/浙江省中山医院针灸科
- 作者简介：
  
  卢超，主治中医师。E-mail：luchao@zjcc.org.cn
- 基金信息：
  
  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)
- DOI：10.13703/j.0255-2930.20240123-0001
  中图分类号：
- 收稿：2024-01-23，
  
  网络首发：2024-07-29，
  
  纸质出版：2024-10-12
- 稿件说明：
移动端阅览
卢超, 冯绪康, 沈琼颖, 等. 不同频率电针治疗紫杉类化疗药物所致周围神经病变：随机对照试验[J]. 中国针灸, 2024,44(10):1139-1145.

LU Chao, FENG Xukang, SHEN Qiongying, et al. Electroacupuncture with different frequencies for paclitaxel-induced peripheral neuropathy: a randomized controlled trial[J]. Chinese Acupuncture & Moxibustion, 2024, 44(10): 1139-1145.
卢超, 冯绪康, 沈琼颖, 等. 不同频率电针治疗紫杉类化疗药物所致周围神经病变：随机对照试验[J]. 中国针灸, 2024,44(10):1139-1145. DOI： 10.13703/j.0255-2930.20240123-0001.

LU Chao, FENG Xukang, SHEN Qiongying, et al. Electroacupuncture with different frequencies for paclitaxel-induced peripheral neuropathy: a randomized controlled trial[J]. Chinese Acupuncture & Moxibustion, 2024, 44(10): 1139-1145. DOI： 10.13703/j.0255-2930.20240123-0001.

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（

0.01）；治疗后，3个电针组FACT/GOG-Ntx评分降低幅度大于西药组（

0.01，

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（

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（

0.01）。治疗后，3个电针组周围神经毒性分级较治疗前改善（

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（

0.01）。治疗后，3个电针组周围神经痛VAS评分较治疗前降低（

0.01，

0.05）；随访时，2 Hz电针组、2 Hz/100 Hz电针组和西药组周围神经痛VAS评分较治疗前降低（

0.01，

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（

0.01，

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（

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。

Abstract

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 (

0.01). The score reduction between before and after treatment in the three EA groups was greater than the medication group (

0.01

0.05)

with the 2 Hz and 2 Hz/100 Hz EA groups showing a greater reduction than the 100 Hz EA group (

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 (

0.01). Peripheral neurotoxicity grading in the three EA groups were improved after treatment (

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 (

0.01

0.05). The VAS scores for peripheral neuropathy pain in the three EA groups were decreased after treatment (

0.01

0.05). At follow-up

VAS scores in the 2 Hz

2 Hz/100 Hz

and medication groups were decreased (

0.01

0.05)

with a greater reduction in the 2 Hz/100 Hz EA group than the medication group after treatment and follow-up (

0.01

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 (

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.

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