加巴喷丁联合复方倍他米松治疗带状疱疹后遗神经痛的疗效研究

Gabapentin Combined with Compound Betamethasone in the Treatment of Postherpetic Neuralgia

目的对比观察加巴喷丁联合复方倍他米松在带状疱疹后遗神经痛中的应用效果,并探讨其部分作用机制。方法选取2017年5月至2019年5月平度市人民医院皮肤科收治的84例带状疱疹后遗神经痛患者作为研究对象,并按照随机数表法将其随机分为研究组(42例)与对照组(42例),研究组患者行加巴喷丁口服联合复方倍他米松局部注射治疗,对照组患者行复方倍他米松局部注射治疗,对比两组患者疼痛视觉模拟评分法(visual analogue scale,VAS)评分、睡眠质量评分量表(quality ofsleep,QS)评分、β-内啡肽(β-endorplhin,β-EP)与P物质(substance P,SP)水平变化情况,临床疗效以及不良反应发生情况。结果治疗后,两组患者VAS评分、QS评分、SP水平均较治疗前降低,β-EP水平均较治疗前升高,且研究组患者VAS评分、QS评分、SP水平均明显低于对照组(t=18.360、11.670、7.293,P均=0.000),β-EP水平明显高于对照组(t=9.588,P=0.000);治疗6周后,研究组患者痊愈14例、显效14例、有效12例、无效2例,明显优于对照组患者的痊愈2例、显效15例、有效14例、无效11例(Z=-3.491,P=0.000);治疗过程中,研究组患者出现头晕1例、恶心3例,与对照组患者头晕2例、恶心2例、心悸1例的不良反应发生情况无明显差异(χ~2=0.124,P=0.724)。结论加巴喷丁联合复方倍他米松可有效缓解带状疱疹后遗神经痛患者的疼痛程度,改善睡眠质量,提高临床疗效,抑制SP产生、促进β-EP释放可能是其部分作用机制,值得进一步深入研究探讨。

Objective To observe the effect of gabapentin combined with compound betamethasone in the treatment of postherpetic neuralgia and explore some of its mechanism of action.Methods Eighty-four patients with postherpetic neuralgia,admitted to the Department of Dermatology of Pingdu People’s Hospital from May 2017 to May 2019,were selected as research subjects and divided,according to the random number table,into a study group(42 cases)and a control group(42 cases).The patients in the study group were given oral administration of gabapentin and topical injection of compound betamethasone,whereas the patients in the control group were only injected with compound betamethasone.The visual analogue scale(VAS)score,quality of sleep(QS)score,the changes of levels ofβ-endorplhin(β-EP)and substance P(SP),clinical effect and adverse reactions were observed in the two groups.Results After treatment,the VAS score,QS score and SP level in the two groups were all lower than their corresponding levels before treatment,while theβ-EP level was higher than that before treatment.The VAS score,QS score and SP level in the study group were significantly lower than that in the control group(t=18.360,11.670 and 7.293 respectively,all P=0.000)whereas theβ-EP level in the study group was significantly higher than that in the control group(t=9.588,P=0.000).After 6 weeks of treatment,there were 14 cases cured,14 cases markedly effective,12 cases effective and 2 cases ineffective in the study group,which was significantly better than the results of 2 cases cured,15 cases markedly effective,14 cases effective,and 11 cases ineffective in the control group(Z=-3.491,P=0.000).During the course of treatment,1 case suffered from dizziness and3 cases suffered from nausea in the study group,while 2 cases suffered from dizziness,2 cases nausea and 1 case palpitation in the control group,and no significantly difference was observed in terms of adverse reactions between the two groups(χ~2=0.124,P=0.724).Conclusion Gabapentin combined with compound betamethasone can effectively relieve the pain of patients with postherpetic neuralgia,improve their quality of sleep and clinical therapeutic effect.Part of its mechanism of action may lie in that the combined application of the two drugs can inhibit the production of SP and promote the release ofβ-EP,which is worthy of further study.