神经注射治疗术联合益气活血止痛汤治疗带状疱疹后遗神经痛的疗效及其对Th17/Treg细胞平衡和炎症因子的影响

Effect of nerve injection therapy combined with Yiqi huoxue zhitong tang on postherpetic neuralgia and its effect on Th17/Treg cell balance and inflammatory factors

目的:探究神经注射治疗术联合益气活血止痛汤治疗带状疱疹后遗神经痛(PHN)的疗效及其对辅助性T细胞17(Th17)/调节性T细胞(Treg)平衡和炎症因子的影响。方法:将300例PHN患者按不同治疗方式分为对照组和观察组,每组各150例。对照组予以神经妥乐平注射治疗;观察组在对照组的基础上增加益气活血止痛汤治疗。比较两组临床疗效及治疗前后中医证候积分[灼烧感、瘙痒感]、疼痛[疼痛视觉模拟评分(VAS)]、睡眠质量[匹兹堡睡眠质量指数(PSQI)]、Th17/Treg细胞平衡[Th17、Treg及Th17/Treg]及炎症因子[白细胞介素-6(IL-6)、IL-10、肿瘤坏死因子-α(TNF-α)]水平。结果:观察组临床总有效率高于对照组(91.33%vs.82.00%,P<0.05)。治疗后,观察组灼烧感、瘙痒感评分及VAS、PSQI评分均低于对照组(P<0.05)。与对照组相比,观察组治疗后Th17、Treg、Th17/Treg及血清IL-6、TNF-α水平更低,血清IL-10水平则更高(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(8.00%vs.9.33%,P>0.05)。结论:神经注射治疗术联合益气活血止痛汤治疗PHN的疗效和安全性俱佳,可缓解患者灼烧感、瘙痒感、疼痛症状,改善睡眠质量,调节Th17/Treg细胞平衡与IL-6、IL-10、TNF-α水平可能是其作用机制之一。

Objective:To investigate the efficacy of nerve injection therapy combined with Yiqi huoxue zhitong tang in the treatment of postherpetic neuralgia(PHN) and its effect on Th17/Treg balance and inflammatory factors.Methods:300 patients with PHN were selected and divided into the control group and the observation group according to different treatment methods,with 150 cases in each group.The control group was treated with neurotropin injection,and the observation group was treated with yiqi huoxue zhitong tang on the basis of the control group.The clinical efficacy,TCM syndrome scores [burning sensation and itching sensation],pain [pain visual analogue scale(VAS)],sleep quality [pittsburgh sleep quality index(PSQI)],Th17/Treg cell balance [Th17,Treg and Th17/Treg ] and inflammatory factors [interleukin-6(IL-6),IL-10,tumor necrosis factor-α(TNF-α)] before and after treatment were compared between the two groups.Results:The total clinical efficacy of the observation group was significantly higher than that of the control group(91.33% vs.82.00%,P<0.05).The scores of burning sensation,pruritus,VAS and PSQI in the observation group were significantly lower than those in the control group(P<0.05).Compared with the control group,the levels of Th17,Treg,Th17/Treg,serum IL-6 and TNF-α in the observation group were significantly lower,and the serum IL-10 level was significantly higher(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(8.00% vs.9.33%,P>0.05).Conclusion:Nerve injection therapy combined with Yiqi Huoxue Zhitong Decoction has good efficacy and safety in the treatment of PHN,which can significantly relieve the burning,itching and pain symptoms of patients,improve sleep quality,and regulate the balance of Th17/Treg cells and the levels of IL-6,IL-10 and TNF-α may be its mechanism.