Objective: To compare the clinical efficacy between acupuncture combined with western medication and simple western medication for ocular myasthenia gravis (OMG), and to explore its possible mechanism.
Methods: A total of 60 patients of ocular myasthenia gravis were randomized into an acupuncture combined with western medication group (30 cases, 1 case dropped off) and a western medication group (30 cases, 2 cases dropped off). Oral pyridostigmine bromide tablet and prednisone acetate tablet were given in the western medication group. On the basis of the treatment in the western medication group, Tongdu Tiaoqi acupuncture (acupuncture for unblocking the governor vessel and regulating qi ) was applied at Baihui (GV 20), Fengfu (GV 16), Hegu (LI 4), Zusanli (ST 36), etc. in the acupuncture combined with western medication group, once a day, 6 days a week. The treatment was given 8 weeks in both groups. Before and after treatment, the OMG clinical absolute score was observed, electrophysiological indexes of orbicularis oculi (value of mean jitter, percentage of jitter >55 μs and percentage of blocks) were measured by single-fiber electromyography (SFEMG), serum levels of acetylcholine receptor antibody (AChR-Ab), interferon-gamma (IFN-γ) and interleukin-4 (IL-4) were detected by ELISA method.
Results: After treatment, the OMG clinical absolute scores, values of mean jitter, percentages of jitter >55 μs, percentages of blocks and serum levels of AChR-Ab, IFN-γ and IL-4 were decreased compared before treatment in both groups (P<0.05), and those in the acupuncture combined with western medication group were lower than the western medication group (P<0.05).
Conclusion: Acupuncture combined with western medication can effectively improve ptosis, palpebra superior fatigability, eye movement disorder and neuromuscular junction dysfunction in patients with ocular myasthenia gravis, the therapeutic effect is superior to simple western medication. Its mechanism may be related to down-regulating serum levels of AChR-Ab, IFN-γ and IL-4 and promoting the recovery of orbicularis oculi function.
目的：比较针药结合治疗与单纯西药治疗眼肌型重症肌无力（OMG）的临床疗效，并探讨其可能作用机制。方法：将60例OMG患者随机分为针药组（30例，脱落1例）和西药组（30例，脱落2例）。西药组予口服溴吡斯的明片与醋酸泼尼松片治疗；针药组在西药组治疗基础上予“通督调气”法针刺，穴取百会、风府、合谷、足三里等，每日1次，每周6 d，两组均治疗8周。观察两组患者治疗前后OMG临床绝对评分，采用单纤维肌电图（SFEMG）检测患者眼轮匝肌电生理指标[平均颤抖（jitter）值、jitter>55 μs百分比和阻滞百分比]，ELISA法检测患者血清抗乙酰胆碱受体抗体（AChR-Ab）、γ-干扰素（IFN-γ）和白细胞介素-4（IL-4）水平。结果：治疗后，两组患者OMG临床绝对评分、平均jitter值、jitter>55 μs百分比、阻滞百分比及血清AChR-Ab、IFN-γ、IL-4水平均低于治疗前（P<0.05），且以上指标针药组均低于西药组（P<0.05）。结论：针药结合治疗可有效改善眼肌型重症肌无力患者上睑下垂、上睑疲劳、眼球运动障碍及神经肌肉接头损害，疗效优于单纯西药治疗，其机制可能与下调血清AChR-Ab、IFN-γ、IL-4水平，促进眼轮匝肌功能恢复有关。.
Keywords: acetylcholine receptor antibody (AChR-Ab); acupuncture; acupuncture combined with western medication; interferon-gamma (IFN-γ); interleukin-4 (IL-4); ocular myasthenia gravis; single-fiber electromyography (SFEMG).