电针预防化疗诱导的周围神经病变：随机对照试验

姚瑶; 张曦平; 葛任洁; Im Hee Shin; 姚昶

doi:10.13703/j.0255-2930.20240222-k0001

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电针预防化疗诱导的周围神经病变：随机对照试验

临床研究 | 更新时间：2024-12-12

- 电针预防化疗诱导的周围神经病变：随机对照试验
- Electroacupuncture for the prevention of chemotherapy-induced peripheral neuropathy: a randomized controlled trial
- 中国针灸 2024年44卷第12期页码：1388-1394
- 作者机构：
  
  1.南京中医药大学附属医院乳腺外科，江苏　南京　210029
  2.大邱天主教大学医学院医学统计学系，韩国　大邱　42472
- 作者简介：
  
  ✉姚昶，主任医师。E-mail：yaochang67@126.com
- 基金信息：
  
  江苏省中医院中韩国际合作基金项目(551);2023年江苏省研究生科研与实践创新计划项目(SJCX23_0870)
- DOI：10.13703/j.0255-2930.20240222-k0001
  中图分类号：
- 收稿：2024-02-22，
  
  网络首发：2024-09-30，
  
  纸质出版：2024-12-12
- 稿件说明：
移动端阅览
姚瑶, 张曦平, 葛任洁, 等. 电针预防化疗诱导的周围神经病变：随机对照试验[J]. 中国针灸, 2024,44(12):1388-1394.

YAO Yao, ZHANG Xiping, GE Renjie, et al. Electroacupuncture for the prevention of chemotherapy-induced peripheral neuropathy: a randomized controlled trial[J]. Chinese Acupuncture & Moxibustion, 2024, 44(12): 1388-1394.
姚瑶, 张曦平, 葛任洁, 等. 电针预防化疗诱导的周围神经病变：随机对照试验[J]. 中国针灸, 2024,44(12):1388-1394. DOI： 10.13703/j.0255-2930.20240222-k0001.

YAO Yao, ZHANG Xiping, GE Renjie, et al. Electroacupuncture for the prevention of chemotherapy-induced peripheral neuropathy: a randomized controlled trial[J]. Chinese Acupuncture & Moxibustion, 2024, 44(12): 1388-1394. DOI： 10.13703/j.0255-2930.20240222-k0001.

摘要

目的：

探讨电针预防化疗诱导的周围神经病变（CIPN）的临床疗效。

方法：

将52例拟行紫杉烷辅助/新辅助化疗的乳腺癌患者随机分为电针组（26例，脱落3例）和常规护理组（26例，脱落1例）。常规护理组在标准化疗方案基础上予以常规护理；电针组在常规护理组基础上加用电针干预，穴取印堂及双侧八邪（第二）、外关、合谷、曲池、足三里、阴陵泉、三阴交、太溪、太冲、悬钟、八风（第四），同侧太冲、三阴交连接电针，予疏密波，频率2 Hz/10 Hz，每次30 min，自第1周期化疗前1 d开始，前2周每周2次，后每周1次，共治疗12周。比较两组患者试验第24周CIPN发生率，观察两组患者试验前及试验第12、24周欧洲癌症研究与治疗组织的化疗引起周围神经毒性生活质量问卷20（EORTC QLQ-CIPN20）评分、中医证候量表积分、欧洲癌症研究与治疗组织生命质量量表（EORTC QLQ-C30）评分，检测两组患者试验前及试验第12周感觉神经传导速度、运动神经传导速度。

结果：

试验第24周时，电针组CIPN发生率为17.4%（4/23），低于常规护理组的72.0%（18/25，

0.001）；电针组高级别CIPN发生率为0%（0/23），低于常规护理组28.0%（7/25，

0.05）。试验第12、24周时，常规护理组EORTC QLQ-CIPN20感觉神经症状评分、总分较试验前升高（

0.001，

0.05，

0.01）；试验第24周时，电针组EORTC QLQ-CIPN20感觉神经症状评分低于常规护理组（

0.05）。试验第12周时，常规护理组患者感觉神经中右侧腓浅神经传导速度较试验前下降（

0.05）；电针组感觉神经中左侧正中神经、右侧腓浅神经传导速度高于常规护理组（

0.05，

0.01）。试验第12、24周时，电针组中医证候量表次症积分均较试验前降低（

05），常规护理组中医证候量表主症、次症积分及总积分均较试验前升高（

0.01，

0.001，

0.05）；试验第12周时，电针组主症、次症积分及总积分均低于常规护理组（

0.05，

0.01），试验第24周时，电针组患者次症积分、总积分低于常规护理组（

0.05）。试验第12周时，常规护理组EORTC QLQ-C30疲倦、疼痛、恶心呕吐评分均较试验前升高（

0.05，

0.01）；试验第24周时，电针组EORTC QLQ-C30总体健康状况评分较试验前升高（

0.001），恶心呕吐、食欲丧失评分较试验前降低（

0.01）。试验第12周时，电针组EORTC QLQ-C30总体健康状况评分高于常规护理组（

0.01），疼痛、恶心呕吐评分低于常规护理组（

0.01，

0.05）；试验第24周时，电针组EORTC QLQ-C30总体健康状况评分高于常规护理组（

0.001），食欲丧失评分低于常规护理组（

0.05）。

结论：

电针能降低CIPN的发生率及严重程度，改善神经传导速度，提高患者生活质量。

Abstract

Objective

To investigate the clinical effect of electroacupuncture (EA) in preventing chemotherapy-induced peripheral neuropathy (CIPN)

. Methods

Fifty-two patients with breast cancer in the regimen of taxane-assisted/neoadjuvant chemotherapy

were randomly divided into an EA group (26 cases

3 cases dropped out) and a usual care (UC) group (26 cases

1 case dropped out). In the UC group

on the basis of standard chemotherapy regimen

the routine nursing was administered. In the EA group

on the intervention as the UC group

EA was added

the acupoints included Yintang (GV 24

)

Baxie (EX-UE 9

the second one)

Waiguan (TE 5)

Hegu (LI 4)

Quchi (LI 11)

Zusanli (ST 36)

Yinlingquan (SP 9)

Sanyinjiao (SP 6)

Taixi (KI 3)

Taichong (LR 3)

Xuanzhong (GB 39) and Bafeng (EX-LE 10

the fourth one). Electric stimulation was attached to Taichong (LR 3) and Sanyinjiao (SP 6) on the same side

with disperse-dense wave and the frequency of 2 Hz/10 Hz

for 30 min. EA started one day before the first cycle of chemotherapy

twice weekly in the first two weeks and once weekly in the rest weeks of chemo

therapy. The duration of the intervention with EA was 12 weeks. The incidence of CIPN was compared in week 24 of the trial between the two groups. At the baseline and in week 12 and 24 of the trial

the score of EORTC QLQ-CIPN20 (European Organization for Research and Treatment of Cancer on chemotherapy-induced peripheral nerve toxicity quality of life questionnaire 20)

the score of TCM syndrome scale and the score of EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer on quality of life scale) were observed in the two groups. At the baseline and in week 12 of the trial

the sensory nerve conduction velocity (SCV) and the motor nerve conduction velocity (MCV) was detected.

Results

In week 24 of the trial

the incidence of CIPN was 17.4% (4/23) in the EA group

lower than that (72.0%

18/25) in the UC group (

0.001). The incidence of high-grade CIPN was 0% (0/23) in the EA group

lower than that (28.0%

7/25) in the UC group (

0.05). In week 12 and 24 of the trial

the scores for the sensory nerve symptom of EORTC QLQ-CIPN20 and the total scores were higher when compared with the baseline in the UC group (

0.001

0.05

0.01). In week 24 of the trial

the score for the sensory nerve symptom of EORTC QLQ-CIPN20 in the EA group was lower than that of the UC group (

0.05). In week 12 of the trial

SCV of the right superficial peroneal nerve was reduced when compared with the baseline in the UC group (

0.05)

and SCV of the left median nerve and the right superficial peroneal nerve was higher in the EA group when compared with the UC group (

0.05

0.01). In week 12 and 24 of the trial

the scores for the secondary symptoms of TCM scale were decreased in the EA group compared with the baseline (

0.05)

and the scores for the primary and secondary symptoms

s well as the total scores of TCM scale were all higher than those of the baseline in the UC group (

0.01

0.001

0.05). In week 12 of the trial

the scores for the primary and secondary symptoms

as well as the total score of TCM scale in the EA group were lower than those of the UC group (

0.05

0.01). In week 24 of the trial

the score for the secondary symptoms and the total score of TCM scale in the EA group were lower than those of the UC group (

0.05). In week 12 of the trial

the scores for fatigue

pain

nausea and vomiting in EORTC QLQ-C30 were increased in comparison with the baseline in the UC group (

0.05

0.01); in week 24 of the trial

the score of the general health in EORTC QLQ-C30 was elevated when compared with the baseline in the EA group (

0.001)

and the scores for nausea and vomiting

loss of appetite were decreased in comparison with the baseline (

0.01). In week 12 of the trial

the score of the general health in EORTC QLQ-C30 in the EA group was higher compared with the UC group (

0.01)

and the scores for pain

nausea and vomiting were lower (

0.01

0.05). In week 24 of the trial

the score of the general health in EORTC QLQ-C30 was higher in the EA group compared with the UC group (

0.001)

and the score for loss of appetite was lower (

0.05).

Conclusion

Electroacupuncture reduces the incidence and severity of CIPN

ameliorates nerve conduction velocity and improves the quality of life of the patients.

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