不同针灸方法治疗胃肠腑热型单纯性肥胖并发高脂血症患者成本-效果分析

目的:观察不同针灸方法治疗胃肠腑热型单纯性肥胖并发高脂血症患者的临床疗效,同时对其进行成本-效果分析。方法:纳入216例胃肠腑热型单纯性肥胖并发高脂血症患者,采用信封法将患者随机分为电针组、穴位埋线组与耳穴贴压组,每组各72例。电针组和穴位埋线组取穴均为中脘、水分、气海、天枢(双)、大横(双)、带脉(双)、三阴交(双)、足三里(双)、丰隆(双)。电针组在双侧天枢、大横接电针仪,治疗为隔日1次;穴位埋线组为15天1次。耳穴贴压组取穴为内分泌、三焦、饥点、神门、皮质下、渴点、肝、脾、胃、腹,两耳交替,隔日更换1次。1个月为1个疗程,共治疗3个疗程,治疗结束分别计算3组患者的临床有效率、生活质量改善程度(IWQOL-Lite评分值)、治疗总时间比、成效比,并进行敏感性分析验证结果的可靠性。结果:电针组临床总有效率为92.3%(60/65),高于穴位埋线组89.9%(62/69),组间差异无统计学意义(P>0.05);电针组和穴位埋线组临床有效率均高于耳穴贴压组63.8%(37/58)(P<0.01)。电针组、穴位埋线组、耳穴贴压组患者IWQOL-Lite评分值均有不同程度下降(P<0.01);电针组和穴位埋线组效果相当,均优于耳穴贴压组(P<0.05或P<0.01)。电针组、穴位埋线组和耳穴贴压组治疗总时间分别为1450、90、225,穴位埋线组的总时间成本最低,电针组成效比为85.2,穴位埋线组成效比为43.7,耳穴贴压组成效比为109.3,3组的成效比为:穴位埋线组<电针组<耳穴贴压组。结论:电针、穴位埋线、耳穴贴压疗法治疗单纯性肥胖并发高脂血症减肥降脂疗效确切,能改善患者生活质量,穴位埋线疗法的稳定疗效和时间、成本优势值得进一步关注。

Cost-Effectiveness Analysis of Different Acupuncture in Treating Single Obesity of Heat in Stomach and Intestine Complicated with Hyperlipidemia

Objective:To observe the clinical efficacy of different acupuncture in treating single obesity of heat in Stomach and Intestine complicated with hyperlipidemia,and to evaluate their cost-effectiveness.Methods:216 patients met the inclusion criteria were randomly divided into the electro-acupuncture group,the acupoint catgut embedding group and the ear acupoint application group,with 72 cases in each group.Points chosen in the electro-acupuncture group and the acupoint catgut embedding group were CV12,CV9,CV6,ST25(bilateral),SP15(bilateral),GB26(bilateral),SP6(bilateral),ST36(bilateral)and ST40(bilateral).The electro-acupuncture group was treated once every other day with bilateral ST25 and bilateral SP15 attached to electro-acupuncture apparatus.The acupoint catgut embedding group was treated once every 15 days.The reflection points of endocrine,triple energizer,hunger point,Shenmen,subcortical,thirst point,liver,spleen,stomach,abdomen of alternative ears were selected in the ear acupoint application group,the application was replaced once every other day.One month was taken as one course of treatment.After three courses of treatment,the clinical effectiveness,quality of life improvement(IWQOL-Lite score),total treatment time ratio,cost-effectiveness ratio,and reliability of the sensitivity analysis were calculated in the three groups.Results:The total clinical effective rate of the electro-acupuncture group was 92.3%(60/65),which was higher than 89.9%(62/69)of the acupoint catgut embedding group;but there was no statistical difference between the two groups(P>0.05 or P<0.01).The clinical effective rate of the ear acupoint application group was 63.8%(37/58),which was significantly lower than that of the electro-acupuncture group and the acupoint catgut embedding group(P<0.01).In terms of the IWQOL-Lite scores,they were decreased in the three groups to different degrees(P<0.01);the electro-acupuncture group and the acupoint embedding group were equally effective and both were superior to the ear acupoint application group(P<0.05).The total therapy time of the electro-acupuncture group,the acupoint catgut embedding group and the ear acupoint application group was respectively 1450,90 and 225,the total therapy time in the acupoint catgut embedding group was the shortest.The cost-effectiveness ratio of the electro-acupuncture group was 85.2,it was 43.7 in the acupoint catgut embedding group and 109.3 in the ear acupoint application group;of which the lowest was that of the acupoint catgut embedding,and the highest was that of the ear acupoint application.Conclusion:Electro-acupuncture,acupoint catgut embedding and ear acupoint application are effective for simple obesity complicated with hyperlipidemia in reducing weight and fat.It can improve the life quality of the patients.The stable efficacy,time and cost advantages of acupoint catgut embedding therapy deserve further observing.