中国针灸

目的：观察穴位埋线治疗青年痰湿质超重和肥胖患者的临床疗效。方法：将66例青年痰湿质超重和肥胖患者随机分为观察组（33例，2例脱落、1例中止）和对照组（33例，3例脱落）。对照组予健康教育指导；观察组在对照组的基础上予穴位埋线治疗，穴取双侧天枢、大横、带脉、水道、滑肉门、丰隆和双侧肺俞、膈俞、胃脘下俞、脾俞、肾俞、大肠俞，两组穴位交替使用，每周1次。两组均治疗8周。分别于治疗前及治疗4、8周测量两组患者体质量、体脂率、腰围、臀围，并计算体质量指数（BMI）；观察两组患者治疗前后痰湿质评分及心率变异性（HRV）相关指标[总功率（TP）、低频功率（LF）、高频功率（HF）、LF/HF、正常窦性RR间期总体标准差（SDNN）、正常相邻窦性RR间期差值均方根（RMSSD）、正常相邻RR间期差值>50 ms百分比（PNN50）]，并比较两组患者临床疗效及体质改善率。治疗结束后6个月，随访临床疗效为有效的患者体质量，比较两组患者体质量回升率。结果：治疗4周，两组患者体质量、BMI、体脂率、腰围、臀围较治疗前降低（P<0.05）；治疗8周，观察组患者体质量、BMI、体脂率、腰围、臀围较治疗前及治疗4周降低（P<0.05），对照组患者体质量较治疗前降低（P<0.05）。治疗8周，观察组患者体质量、BMI、腰围、臀围及痰湿质评分低于对照组（P<0.05）。观察组患者体质量、BMI、体脂率、腰围、臀围的治疗前与治疗4周差值、治疗4周与治疗8周差值高于对照组（P<0.05）。治疗后，观察组患者TP、LF、HF、SDNN、RMSSD高于对照组（P<0.05）。治疗后观察组总有效率为90.0%(27/30)，高于对照组的46.7%(14/30,P<0.05)；痰湿质改善率为90.0%(27/30)，高于对照组的50.0%(15/30,P<0.05)。治疗结束后6个月，观察组体质量回升率为37.0%(10/27)，低于对照组的71.4%(10/14,P<0.05)。结论：穴位埋线能够有效改善青年痰湿质超重和肥胖患者的体质量、BMI、腰围、臀围及痰湿体质，调节自主神经紊乱，提高迷走神经活性，且具有一定远期疗效。

Objective To observe the clinical efficacy of acupoint thread-embedding for overweight and obese young adults with phlegm-dampness constitution. Methods A total of 66 young adults with overweight and obesity of phlegm-dampness constitution were randomly divided into an observation group(33 cases, 2 cases dropped out, 1 case was discontinued) and a control group(33 cases, 3 cases dropped out). Health education guidance was adopted in the control group. On the basis of the intervention in the control group, acupoint thread-embedding was applied in the observation group,two groups of acupoints were used alternately, i.e. bilateral Tianshu(ST25), Daheng(SP15), Daimai(GB26), Shuidao(ST28),Huaroumen(ST24), Fenglong(ST40) and bilateral Feishu(BL13), Geshu(BL17), Weiwanxiashu(EX-B3), Pishu(BL20),Shenshu(BL23), Dachangshu(BL25), once a week. Treatment of 8 weeks was required in the two groups. Before treatment,after 4 weeks and 8 weeks of treatment, the body weight, body fat rate, waist circumference and hip circumference were measured, and the body mass index(BMI) was calculated in the two groups; before and after treatment, the phlegm-dampness constitution score and the heart rate variability(HRV) related indexes(total power [TP], low frequency [LF], high frequency [HF], LF/HF, standard deviation of the normal to normal inter beat intervals [SDNN], root mean square of the successive differences [RMSSD], percentage of normal RR intervals with duration [PNN50]) were observed, and the clinical efficacy and constitution improvement rate were compared in the two groups. Six months after the treatment completion, the body weight of patients with effective clinical efficacy was observed, and the body weight rebound rate was compared in the two groups.Results After 4 weeks of treatment, the body weight, BMI, body fat rate, waist circumference and hip circumference were decreased compared with those before treatment in the two groups(P<0.05); after 8 weeks of treatment, the body weight,BMI, body fat rate, waist circumference and hip circumference were decreased compared with those before treatment and after 4 weeks of treatment in the observation group(P<0.05), and the body weight was decreased compared with that before treatment in the control group(P<0.05). After 8 weeks of treatment, the body weight, BMI, waist circumference, hip circumference and phlegm-dampness constitution score in the observation group were lower than those in the control group(P<0.05). The differences in the body weight, BMI, body fat rate, waist circumference and hip circumference between before treatment and after 4 weeks of treatment, as well as after 4 weeks of treatment and after 8 weeks of treatment in the observation group were higher than those in the control group(P<0.05). After treatment, the TP, LF, HF, SDNN and RMSSD in the observation group were higher than those in the control group(P<0.05). After treatment, the total effective rate was 90.0%(27/30) in the observation group, which was higher than 46.7%(14/30) in the control group(P<0.05); the improvement rate of phlegm-dampness constitution was 90.0%(27/30) in the observation group, which was higher than 50.0%(15/30) in the control group(P<0.05). Six months after treatment completion, the weight rebound rate was 37.0%(10/27) in the observation group, which was lower than 71.4%(10/14) in the control group(P<0.05). Conclusion Acupoint thread-embedding can effectively reduce the body weight, BMI, waist circumference, hip circumference and improve the phlegm-dampness constitution in overweight and obese young adults with phlegm-dampness constitution, regulate autonomic nerve disorders and improve vagus nerve activity, and has a certain long-term effect.