針刺對婦女肥胖症及心臟自律神經活動性之影響

THE EFFECT OF ACUPUNCTURE ON BODY WEIGHT AND CARDIAC AUTONOMIC FUNCTION IN OBESE WOMEN

肥胖是猝死和心臟血管疾病死亡的危險因子之一，減重可以減低此等危險的機轉至今未明，但推測可能與自律神經活動性的改變有關。本研究利用針刺對肥胖婦女進行治療，同時觀察其心率變異性（Heart Rate Variability, HRV），以評估其自律神經活動。27位身體質量指數（body mass index，BMI）大於27且合乎肥胖症診斷標準婦女為實驗組，另27位BMI小於27之非肥胖症婦女為對照組，以HRV頻譜分析各項參數包括五分鐘之平均RR間期（mean RR）、RR間期變異數（Ln Var）和極低頻功率（Ln VLF）、低頻功率（Ln LF）、高頻功率（Ln HF）、總功率（Ln TP）、低頻功率之正常化單位（LF%）、低頻高頻比（Ln LF/HF）等，以評估自律神經活動度。我們比較針刺治療四週前後各組內及組間之差異，結果顯示：針刺前兩組間的年齡及mean RR、Ln Var、Ln VLF、Ln LF、Ln HF、Ln TP、LF%和Ln LF/HF並無顯著差異。治療四週後，兩組之體重、BMI、體脂比、腰圍、臀圍以及腰臀比都較治療前降低。實驗組及對照組治療後的HF均較針刺前增高，而LF%和Ln LF/HF均較針刺前降低。但治療前後的HF、LF%和Ln LF/HF，兩組均無顯著差異。綜上所述，針刺治療能減輕體重，同時也能提高副交感活動度及降低交感神經活動度，但兩者均需進一步探討。Based on large epidemiological studies, it has been shown that obesity is the risk factor for both sudden death and cardiovascular mortality. The mechanism of reducing such risk via weight loss remained to be elucidated but the possibility of the alteration of cardiac autonomic functions was suggested. The objective of this study was to investigate the impact of acupuncture-induced weight loss on the cardiac autonomic functions of the obese women. By employing power spectral analysis of heart rate variability (HRV), we examined 27 obese women with body mass index (BMI > 27) and 27 non-obese women (BMI<27) for parameters including the 5-min mean R-R interval (mean RR), the variance of R-R interval(Ln Var), the very-low-frequency power (Ln VLF), the low-frequency power (Ln LF), the high-frequency power (Ln HF), the total power (Ln TP), the low-frequency power in normalized unit (LF%), and the ratio of LF to HF (Ln LF/HF). In additions, changes of clinical characteristics and HRV in each group and between groups after acupuncture were also compared. The results have shown that there was no significant difference in age and power spectral analysis of HRV before treatment between two groups. During 4-week observation, we found that acupuncture resulted in a decrease of the body weight, BMI, percentage of body fat, waist circumference, hip circumference, and waist/hip ratio in all cases. After acupuncture, a significant increase of HF and decrease of LF% and LF/HF in both groups was also demonstrated. There appeared to be no significant changes in HRV after acupuncture between two groups. Therefore, we concluded that acupuncture could reduce body weight, and also increase vagal activity and reduce sympathetic activity. The relationship between them required a further investigation.