火针联合拔罐对带状疱疹急性期患者临床疗效时效性及Th17/Treg细胞免疫平衡的影响

Clinical efficacy of fire needling combined with cupping therapy on herpes zoster of acute stage and the effect on Th17/Treg cellular immune balance

目的:比较火针联合拔罐与西药治疗急性期带状疱疹(HZ)的临床疗效及对患者外周血辅助性T细胞17(Th17)、调节性T细胞(Treg)和炎性因子白细胞介素(IL)-10、 IL-17的影响。方法:将80例HZ急性期患者随机分为火针联合拔罐组和西药组,每组40例。火针联合拔罐组分别于阿是穴和病变神经节段夹脊穴行火针点刺、散刺后,再予拔罐治疗,每日1次;西药组予盐酸伐昔洛韦片及维生素B1片口服。两组均治疗10 d。于第1~10天每次治疗前及第11天观察两组患者症状体征积分,于第1~10天每次治疗前及第11、30、60天观察两组患者疼痛视觉模拟量表(VAS)评分及皮损情况,于第60天统计带状疱疹后遗神经痛(PHN)发生率,于治疗前后检测两组患者外周血Th17、Treg水平及计算Th17/Treg值,于治疗前后检测两组血清IL-10、 IL-17含量,并比较两组临床疗效。结果:治疗第6~10天及第11天,火针联合拔罐组症状体征积分低于西药组(P<0.05,P<0.01);治疗第3、6~10天及第11、30天,火针联合拔罐组VAS评分低于西药组(P<0.05,P<0.01);第60天,火针联合拔罐组PHN发生率低于西药组(P<0.05);火针联合拔罐组止疱、结痂时间短于西药组(P<0.05);治疗后火针联合拔罐组Th17水平、Th17/Treg值和IL-10、IL-17含量均低于西药组(P<0.05)。火针联合拔罐组愈显率为82.5%(33/40),高于西药组的62.5%(25/40,P<0.05)。结论:早期应用火针联合拔罐可有效治疗急性期HZ,改善疼痛程度,降低PHN发生率;其作用机制可能与降低HZ急性期患者Th17、Treg细胞水平及Th17/Treg值和IL-10、IL-17含量,进而调节细胞免疫平衡有关。

Objective To compare the clinical efficacy between the combined therapy of fire needling and cupping,and western medication on herpes zoster of acute stage,as well as the effects on Th17 and Treg cells and inflammatory factors,i.e.IL-10 and IL-17 in the peripheral blood.Methods Eighty patients with herpes zoster of acute stage were randomly divided into a combined therapy(fire needling plus cupping)group and a western medication group,40 cases in each one.In the combined therapy group,the pricking and scattering techniques with fire needle were used at ashi points and Jiaji(EX-B 2)corresponding to the affected spinal segments;afterwards,cupping therapy was delivered.The combined treatment was given once daily.In the western medication group,valaciclovir hydrochloride tablet and vitamin B,tablet were administered orally.The duration of treatment in each group was 10 days.Before each treatment from day I to day 10 and on day 11,the score of symptoms and physical signs was observed in the two groups separately.Before each treatment from day 1 to day 10 and on day 11,30,60,the score of visual analogue scale(VAS)and skin lesion indexes were observed in the two groups.On day 60,the incidence of postherpetic neuralgia was recorded in the two groups.The levels of Th17 and Treg cells,Th17/Treg ratio in the peripheral blood,as well as serum levels of IL-10 and IL-17 were detected before and after treatment in the two groups.The clinical efficacy was compared between the two groups.Results From day 6 to day 10 during treatment and on day 11,the scores of symptoms and physical signs in the combined therapy group were lower than those of the western medication group(P<0.05,P<0.01).On day 3,day 6 to day 10 during treatment and day 11,day 30,VAS scores in the combined therapy group were lower than those of the western medication group(P<0.05,P<0.01).On day 60,the incidence of postherpetic neuralgia in the combined therapy group was lower compared with that in the western medication group(P<0.05).The blister arresting time and scabbing time in the combined therapy group were shorter than those of the western medication group(P<0.05).After treatment,the level of Th17,and Th17/Treg ratio in the peripheral blood,as well as the serum levels of IL-10 and IL-17 were all lower in comparison with those in the western medication group(P<0.05).The curative and remarkably effective rate was 82.5%(33/40)in the combined therapy group,higher than 62.5%(25/40)in the western medication group(P<0.05).Conclusion The early application of fire needling combined with cupping therapy can effectively treat herpes zoster of acute stage,relieve pain,and reduce the incidence of postherpetic neuralgia,which may be related to reducing the levels of Th17 and Treg cells,and Th17/Treg ratio in the peripheral blood,as well as the serum levels of IL-10 and IL-17 so that the cellular immune balance is modulated.