“外治六经法”针刺治疗带状疱疹后遗神经痛的疗效及机制

Therapeutic Effect of "External Treatment of Six Meridians" Acupuncture on Post Herpetic Neuralgia and Its Mechanism

目的分析"外治六经法"针刺治疗带状疱疹后遗神经痛的疗效及其T淋巴细胞、趋化因子水平的影响。方法选取2018年1月—2020年2月期间北京中医药大学第三附属医院皮肤科收治的带状疱疹后遗神经痛患者84例,按随机数字表法将其分为治疗组和对照组,各42例,两组均予以常规西医治疗,在此基础上对照组、治疗组分别予以病变局部围刺治疗、外治六经法针刺治疗,4个疗程后比较两组临床疗效、疼痛视觉模拟评分(Visual Analogue Scale,VAS)、T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))、趋化因子[单核细胞趋化蛋白-1(Monocyte chemotactic protein-1,MCP-1)、干扰素诱导蛋白10(inducible protein 10,IP-10)、δ趋化性细胞因子(Fractalkine,FKN)水平]及不良反应发生率。结果治疗后两组患者VAS评分与治疗前比较均下降(P<0.05),且治疗组治疗1、2、4个疗程后VAS评分均低于对照组(P<0.05)。治疗后两组患者CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平与治疗前比较均升高(P<0.05),CD8^(+)水平与治疗前比较均降低(P<0.05);且治疗组治疗后CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平均高于对照组(P<0.05),而两组患者CD8^(+)水平比较,差异无统计学意义(P> 0.05)。治疗后两组患者MCP-1、IP-10、FKN水平均高于治疗前(P<0.05);且治疗组治疗后MCP-1、IP-10、FKN高于对照组(P<0.05)。治疗后治疗组总有效率90.48%(38/42)高于对照组71.43%(30/42)(χ^(2)=4.941,P<0.05)。两组不良反应发生率比较差异无统计学意义(P> 0.05)。结论外治六经法针刺治疗带状疱疹后遗神经痛疗效较好,可明显改善患者疼痛及T淋巴细胞、趋化因子水平,安全性可靠,值得在临床推广实践。

Objective To analyze the therapeutic effect of "external treatment of six meridians" Acupuncture on post herpetic neuralgia and its effect on the level of T lymphocyte and chemokine.Methods From January 2018 to Februaiy 2020,84 patients with post herpetic neuralgia in our hospital were selected and randomly divided into observation group and control group with 42 cases in each group,which were treated with conventional western medicine.On this basis,the control group and observation group were treated with local peripheral needling and external six channels needling respectively.After four courses,the clinical efficacy,pain visual analogue score(VAS),T lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+),chemokines[monocyte chemoattractant protein-1(MCP-1),interferon inducible protein-10(IP-10),8 chemokine fractalkine(FKN)] and the incidence of adverse reactions were compared between the two groups.Results After treatment,the VAS scores of the two groups of patients decreased compared with those before treatment(P <0.05),and the VAS scores of the treatment group were lower than those of the control group after 1,2,and 4 courses of treatment(P <0.05).After treatment,the levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+),in the two groups were increased compared with before treatment(P <0.05),and the level of CD8^(+) was decreased compared with before treatment(P <0.05);and CD3^(+),CD4^(+),CD4^(+) in treatment group The CD8^(+) level was higher than that of the control group(P <0.05),while the difference in CD8^(+) levels between the two groups of patients was not statistically significant(P> 0.05).After treatment,the levels of MCP-1,IP-10 and FKN in the two groups were higher than those before treatment(P <0.05);and after treatment in the treatment group,MCP-1,IP-10 and FKN were higher than those in the control group(P <0.05).After treatment,the total effective rate of the treatment group was 90.48%(38/42) higher than that of the control group71.43%(30/42)(χ^(2)=4.941,P <0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P> 0.05).Conclusion The external treatment of six meridians acupuncture is effective in the treatment of post herpetic neuralgia.It can obviously improve the level of pain,T-lymphocyte and chemokine,and it is safe and reliable.It is worth popularizing in clinical practice.