化痰定痫汤联合醒脑开窍针刺法治疗痰气郁结型癫痫的临床疗效及对炎症因子与神经营养因子的影响

Clinical efficacy of Huatan Dingxian Decoction combined with Xingnao Kaiqiao Acupuncture in treating epilepsy of Phlegm-Qi stagnation type and its effects on inflammatory factors and neurotrophic factors

摘要:

目的 探讨化痰定痫汤联合醒脑开窍针刺法对痰气郁结型癫痫患者的临床疗效及对炎症因子与神经营养因子的影响。方法 选取2024年1月—2025年1月在南京中医药大学附属常州市武进中医医院接受治疗的102例痰气郁结型癫痫患者为研究对象，采用随机数字表法分为对照组和观察组，各51例。对照组给予化痰定痫汤治疗，观察组在对照组基础上联合醒脑开窍针刺法治疗，两组疗程均为3个月。记录3个月后的癫痫发作频率和每次发作持续时间；检测治疗前后的炎症因子［肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）］水平，神经营养因子［胶质细胞源性神经营养因子（GDNF）、脑源性神经营养因子（BDNF）、神经生长因子（NGF）］水平；数字化脑电图仪记录患者的脑电图参数（痫样放电数、累及导联数）；评价患者治疗前后的中医证候积分和生活质量，同时记录不良反应发生情况。结果 观察组治疗总有效率为92.16%（47/51），高于对照组的76.47%（39/51）（P <0.05）。治疗后观察组癫痫发作频率和发作持续时间均低于对照组（P <0.05），两组治疗后癫痫发作频率和发作持续时间均低于治疗前（P < 0.05）。治疗后观察组TNF-α、IL-1β、IL-6水平均低于对照组（P <0.05）；两组治疗后TNF-α、IL-1β、IL-6水平均低于治疗前（P <0.05）。治疗后观察组GDNF、BDNF、NGF水平均高于对照组（P <0.05），两组治疗后GDNF、BDNF、NGF水平均高于治疗前（P <0.05）。治疗后观察组痫样放电数、累及导联数低于对照组（P <0.05）；两组治疗后痫样放电数、累及导联数均低于治疗前（P <0.05）。治疗后观察组中医证候积分低于对照组（P <0.05），癫痫患者生活质量量表-31（QOLIE-31）评分高于对照组（P <0.05）；两组治疗后中医证候积分低于治疗前（P <0.05），QOLIE-31评分高于治疗前（P <0.05）。两组不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 化痰定痫汤联合醒脑开窍针刺法治疗痰气郁结型癫痫，较单用化痰定痫汤更能提升疗效，改善临床症状及生活质量，且安全性良好。

Abstract:

Objective To explore the therapeutic effect of Huatan Dingxian Decoction combined with Xingnao Kaiqiao acupuncture on patients with epilepsy of phlegm-qi stagnation type.Methods A total of 102 patients with epilepsy of phlegm-qi stagnation syndrome who received treatment at Changzhou Wujin Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine between January 2024 and January 2025 were enrolled as research subjects. All patients were divided into the control group and the observation group using the random number table method, with 51 cases in each group. The control group was treated with Huatan Dingxian Decoction, while the observation group received Xingnao Kaiqiao acupuncture combined with the same decoction. Both groups underwent a 3-month treatment course. The seizure frequency and duration were recorded after 3 months of treatment. The levels of inflammatory factors and neurotrophic factors were detected before and after treatment. Digital electroencephalography was used to record electroencephalogram parameters. The TCM syndrome scores and quality of life of patients were evaluated, and adverse reactions were documented throughout the treatment.Results The effective rate of treatment in the observation group was 92.16% (47/51), which was higher than 76.47% (39/51) in the control group (P < 0.05). After treatment, the seizure frequency and seizure duration in the observation group were lower than those in the control group (P < 0.05); these two indicators were decreased in both groups after treatment compared with baseline (P < 0.05). The levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and interleukin-6 (IL-6) in the observation group were lower than those in the control group post-treatment (P < 0.05), and all the above inflammatory factors were significantly reduced in both groups after treatment (P < 0.05). After intervention, the levels of glial cell line-derived neurotrophic factor (GDNF), brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) in the observation group were higher than those in the control group (P < 0.05); the levels of these neurotrophic factors were elevated in both groups after treatment (P < 0.05). The number of epileptiform discharges and involved leads in the observation group were lower than those in the control group after treatment (P < 0.05), and both parameters declined significantly in the two groups relative to pretreatment levels (P < 0.05). The traditional Chinese medicine (TCM) syndrome score of the observation group was lower, while the score of the Quality of Life in Epilepsy Inventory-31 (QOLIE-31) was higher than those of the control group after treatment (P < 0.05). In both groups, the TCM syndrome score decreased and the QOLIE-31 score increased after treatment (P < 0.05). There was no significant difference in the overall incidence of adverse reactions between the two groups (P > 0.05).Conclusion Huatan Dingxian Decoction combined with Xingnao Kaiqiao acupuncture improves therapeutic efficacy, clinical symptoms, and quality of life in patients with phlegm-qi stagnation-type epilepsy without increasing the risk of adverse reactions.