基于Th1/Th2失衡和血清P物质探讨刺络拔罐联合中药湿敷治疗带状疱疹的作用机制

Effect mechanism of pricking and cupping therapy combined with Chinese herbal wet compress in treatment of herpes zoster based on Th1/Th2 imbalance and serum substance P

目的:观察刺络拔罐联合中药湿敷对带状疱疹急性期患者Th1/Th2平衡和血清P物质(SP)含量的影响,探讨刺络拔罐联合中药湿敷治疗带状疱疹急性期的临床疗效机制。方法:将240例带状疱疹急性期患者随机均分为治疗组(脱落2例)、对照组1(脱落3例)、对照组2(脱落2例)和对照组3(脱落1例)。治疗组予刺络拔罐+中药湿敷+基础治疗;对照组1予刺络拔罐+基础治疗;对照组2予中药湿敷+基础治疗;对照组3仅给予基础治疗。均治疗9 d。观察各组疼痛程度评分、主观睡眠质量评分、疼痛和疱疹康复情况;ELISA法检测血清白细胞介素4(IL-4)、γ干扰素(IFN-γ)及SP含量;评价临床疗效并观察治疗期间不良反应发生情况。结果:治疗后,4组疼痛程度评分、血清IL-4和SP含量均较治疗前降低(P<0.05),主观睡眠质量评分、血清IFN-γ含量和IFN-γ/IL-4均较治疗前升高(P<0.05);治疗组、对照组1和对照组2疼痛程度评分、血清IL-4和SP含量低于对照组3(P<0.05),主观睡眠质量评分、血清IFN-γ含量和IFN-γ/IL-4高于对照组3(P<0.05),且治疗组较对照组1和对照组2对血液各指标改善更显著(P<0.05)。治疗后,治疗组、对照组1和对照组2疼痛缓解和消失时间以及止疱、结痂和脱痂时间均低于对照组3(P<0.05),且治疗组较对照组1和对照组2各指标降低更显著(P<0.05)。治疗组(96.55%,56/58)、对照组1(92.98%,53/57)和对照组2(91.38%,53/58)总有效率均高于对照组3(74.58%,44/59,P<0.05)。4组均无不良反应发生。结论:刺络拔罐联合中药湿敷治疗带状疱疹急性期可有效促进Th1/Th2平衡恢复并降低血清SP含量,从而促进患者康复,提升治疗效果,且有利于降低后遗神经痛发生风险。

Objective To observe the effects of pricking and cupping therapy combined with Chinese herbal wet compress on Th1/Th2 balance and the concentration of substance P(SP) in treatment of patients with herpes zoster at acute stage and explore the mechanism of clinical efficacy of this combined therapeutic method. Methods The patients of herpes zoster at acute stage were randomly divided into a treatment group(58 cases), a control group No.1(57 cases), a control group No.2(58 cases) and a control group No.3(59 cases). In the treatment group, the therapeutic regimen was pricking and cupping+Chinese herbal wet compress+basic treatment. In the control group No.1, pricking and cupping + basic treatment were administered. In the control group No.2, Chinese herbal wet compress+basic treatment were provided. In the control group No.3, only basic treatment was delivered. The treatment duration was 9 days in each group. The score of pain degree, the score of sleep quality and the rehabilitation conditions of pain and herpes were observed in 4 groups. The concentration of serum interleukin 4(IL-4), interferon gamma(IFN-γ) and SP were detected by ELISA. The clinical efficacy was evaluated. The occurrence of adverse reaction during treatment was observed. Results After treatment, the score of pain degree and the concentrations of serum IL-4 and SP were all lower than those before treatment in 4 groups(P<0.05);and the score of subjective sleep quality, the concentrations of serum IFN-γ and IFN-γ/IL-4 were all increased in comparison with those before treatment(P<0.05). In the treatment group and the control groups No.1 and No.2, the score of pain degree and the concentrations of serum IL-4 and SP were all lower than those in the control group No.3(P<0.05);and the score of subjective sleep quality, the concentrations of serum IFN-γ and IFN-γ/IL-4 were higher than those in the control group No.3, respectively(P<0.05). Besides, every indicator in the treatment group was improved more significantly than that either in the control group No.1 or the control group No.2(P<0.05). After treatment, compared with the control group No.3, the time of pain relief and disappearance, and the time of blister termination, incrustation and decrustation were all shorter in the treatment group, the control group No.1 and the control group No.2 separately(P<0.05);and every indicator in the treatment group was reduced more significantly in comparison with either the control group No.1 or the control group No.2(P<0.05). The total effective rate in the treatment group(96.55%, 56/58), the control group No.1(92.98%, 53/57) and the control group No.2(91.38%, 53/58) was higher than that in the control group No.3(74.58%, 44/59, P<0.05). No any adverse reaction occurred in the 4 groups. Conclusion The pricking and cupping therapy combined with Chinese herbal wet compress effectively promotes the recovery of Th1/Th2 balance and reduces the concentration of serum SP in patients with herpes zoster at acute stage. This combined therapeutic regimen is conductive to the recovery of patients, the improvement of therapeutic effects and the decrease of the risk of pos-therpetic neuralgia.