AIM：针灸或有助缓解慢阻肺症状

近日，日本一个研究团队在美国《内科学文献》Archives of Internal Medicine网站上发表论文说，他们完成的小型临床试验显示，针灸可能有助缓解慢性阻塞性肺病（慢阻肺）患者的呼吸困难症状。
 
研究人员将68名有呼吸困难症状的慢阻肺患者随机分为两组，其中一组患者每周接受针灸治疗，针灸部位为手臂、后背、胸部以及腿部可能与哮喘及其他肺部疾病有关的穴位，对照组则接受虚拟针灸治疗，针头实际上并未刺入他们的皮肤。在为期1２周的试验期内，两组患者继续服用此前已在服用的慢阻肺药物。
 
开始治疗前以及治疗结束后，患者都进行6分钟的步行测试，研究人员据此衡量他们在这一时间段内的步行距离，并利用仪器测量他们的呼吸情况。在测量表中，零代表呼吸良好，10代表严重呼吸困难。数据显示，接受针灸治疗患者的平均数值由最初的5.5下降至1.9，平均步行距离由370米提高到440米；对照组中，相关数据和步行距离均无太大的变化。
 
当前慢阻肺的典型疗法包括类固醇、支气管扩张药物以及呼吸锻炼。研究人员说，需要更大规模的长期研究来进一步验证针灸对慢阻肺患者的益处。
 
英国南安普敦大学教授乔治·刘易斯在一篇文章中说，日本研究人员的试验表明，针灸能改善慢阻肺患者的生活质量，这种疗法似乎有助患者放松胸壁上的肌肉，让患者更容易呼吸，从而达到传统治疗手段所追求的疗效。
 
慢阻肺是一种不可逆的肺部疾病，常见症状是呼吸困难、痰过多以及慢性咳嗽。世界卫生组织认为，慢阻肺可以预防，但目前无法治愈。治疗有助减缓病情发展，但这一疾病通常在一段时间后逐渐恶化，导致患者肺功能下降，死亡风险加大，并伴随严重焦虑。

doi:10.1001/archinternmed.2012.1233
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A Randomized, Placebo-Controlled Trial of Acupuncture in Patients With Chronic Obstructive Pulmonary Disease (COPD)

Masao Suzuki, LAc, PhD; Shigeo Muro, MD, PhD; Yuki Ando, MSc; Takashi Omori, PhD; Tetsuhiro Shiota, MD, PhD; Kazuo Endo, MD; Susumu Sato, MD, PhD; Kensaku Aihara, MD; Masataka Matsumoto, MD; Shinko Suzuki, MD; Ryo Itotani, MD; Manabu Ishitoko, MD; Yoshikazu Hara, MD; Masaya Takemura, MD, PhD; Tetsuya Ueda, MD, PhD; Hitoshi Kagioka, MD, PhD; Masataka Hirabayashi, MD; Motonari Fukui, MD, PhD; Michiaki Mishima, MD, PhD

Background Dyspnea on exertion (DOE) is a major symptom of chronic obstructive pulmonary disease (COPD) and is difficult to control. This study was performed to determine whether acupuncture is superior to placebo needling in improving DOE in patients with COPD who are receiving standard medication. Methods Sixty-eight of 111 patients from the Kansai region of Japan who were diagnosed as having COPD and were receiving standard medication participated in a randomized, parallel-group, placebo-controlled trial (July 1, 2006, through March 31, 2009) in which the patients, evaluators, and statistician were unaware of the random allocation. Participants were randomly assigned to traditional acupuncture (real acupuncture group, n = 34) or placebo needling (placebo acupuncture group, n = 34). Both groups received real or placebo needling at the same acupoints once a week for 12 weeks. The primary end point was the modified Borg scale score evaluated immediately after the 6-minute walk test. Measurements were obtained at baseline and after 12 weeks of treatment. Result After 12 weeks, the Borg scale score after the 6-minute walk test was significantly better in the real acupuncture group compared with the placebo acupuncture group (mean [SD] difference from baseline by analysis of covariance, −3.6 [1.9] vs 0.4 [1.2]; mean difference between groups by analysis of covariance, −3.58; 95% CI, −4.27 to −2.90). Patients with COPD who received real acupuncture also experienced improvement in the 6-minute walk distance during exercise, indicating better exercise tolerance and reduced DOE. Conclusion This study clearly demonstrates that acupuncture is a useful adjunctive therapy in reducing DOE in patients with COPD.