刺络拔罐联合加巴喷丁治疗中重度带状疱疹后遗神经痛患者的疗效及其对疼痛相关神经肽与炎性因子的影响

Efficacy of Bleeding and Cupping Combined with Gabapentin in the Treatment of Moderate to Severe Postherpetic Neuralgia Patients and the Impact on Pain-related Neuropeptides and Inflammatory Cytokines

目的观察刺络拔罐联合加巴喷丁治疗中重度带状疱疹后遗神经痛(PHN)患者的疗效与安全性,并比较2种疗法对疼痛相关神经肽与炎性因子的影响。方法将115例中重度PHN患者随机分为2组:试验组57例,给予刺络拔罐联合加巴喷丁胶囊(0.3~1.8 g/d,分次口服);对照组58例,仅口服加巴喷丁胶囊。根据2组治疗前及治疗4周后的视觉模拟量表(VAS)评分来评价治疗效果,并采用酶联免疫吸附测定(ELISA)法检测治疗前和治疗4周结束时患者血清中疼痛相关神经肽[β-内啡肽(EP)、血清P物质(SP)及降钙素基因相关肽(CGRP)]和炎性因子[肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6及IL-1β]的表达水平。结果所有患者均完成了4周治疗:①2组患者VAS评分在治疗结束时均显著下降,但除中度疼痛患者组外,试验组VAS评分下降程度在总PHN患者以及各亚组患者中均显著高于对照组(均P<0.05);②在总PHN患者以及躯干受累者或重度疼痛者,试验组的痊愈率(均>10%)均明显高于对照组(均P<0.05),而试验组的显著有效率(均>60%)在总PHN患者及躯干受累者或重度疼痛者中均显著高于对照组(均P<0.05);③在中度或重度PHN患者中,2组的TNF-α、IL-6、IL-1β、β-EP、SP及CGRP血清水平较治疗前均有不同程度改变,但仅在重度PHN患者中检测到试验组的IL-6、IL-1β及CGRP下降程度和β-EP升高程度均显著高于对照组(均P<0.05);④各治疗组均未发生严重不良反应。结论对于中重度PHN患者,尤其是躯干受累时,刺络拔罐联合加巴喷丁能显著提高临床治疗效果,并有效改善疼痛相关神经肽与炎性因子失衡,值得推广应用。

Objective In order to observe the efficacy and safety of bleeding and cupping combined with Gabapentin in the treatment of patients with moderate to severe postherpetic neuralgia (PHN),and to evaluate the impact of the combination therapy on pain-related neuropeptides and inflammatory cytokines. Methods A total of 115 moderate to severe PHN patients were randomly divided into two groups. The experimental group (57 cases) was treated with bleeding and cupping combined with oral Gabapentin (0.3 g/d to 1.8 g/d),but the control group (58 cases) was only treated with Gabapentin. The treatment effects were evaluated according to the visual analogue scale (VAS) scores before and after four weeks of treatment in both groups. Also,the serum levels of pain-related neuropeptides such as substance P (SP),β-endorphin (β-EP),calcitonin gene-related peptide (CGRP),and inflammatory cytokines such as tumor necrosis factor (TNF)-α,interleukin (IL)-6 and IL-1β were detected by enzyme-linked immunosorbent assay (ELISA) before and after treatment. Results All patients completed four weeks of treatment:①The VAS scores in both groups decreased significantly after treatment,however,the experimental group got significantly higher decline in VAS scores than the control group (all P<0.05) in total PHN patients and all subgroups except for the moderate PHN. ②In total PHN patients and trunk involved or severe PHN,the recovery rates in the experimental groups (all >10%) were all significantly higher than the control groups (all P<0.05). While the remarkable effectiveness in the experimental groups (all>60%) were all significantly higher than the control groups in total PHN patients and all subgroups (all P<0.05). ③The levels of serum TNF-α,IL-6,IL-1β,β-EP,SP,and CGRP in the two treatment groups were changed with different degrees after four weeks of treatment in moderate or severe PHN patients. But only in severe PHN patients,more decline in IL-6,IL-1β and CGRP and elevation in β-EP were detected in experimental group than control group (all P<0.05). ④No serious adverse reactions occurred in every treatment group. Conclusion For patients with moderate to severe PHN,bleeding and cupping combined with gabapentin can significantly enhance the curative effect and effectively improve the imbalance of pain-related neuropeptides and inflammatory cytokines,which is worth to be applied widely.