穴位贴敷治疗气滞血瘀型带状疱疹后遗神经痛及对相关炎性因子、5-HT的影响

Acupoint application for postherpetic neuralgia with qi stagnation and blood stasis and its effect on related inflammatory factors and 5-HT

目的:观察穴位贴敷治疗气滞血瘀型带状疱疹后遗神经痛(PHN)的临床疗效及对患者血清炎性因子和5-羟色胺(5-HT)的影响。方法:将136例PHN患者随机分为观察组(68例,脱落6例)和对照组(68例,脱落5例)。观察组给予消肿止痛贴+中药细粉穴位贴敷治疗,穴取三阴交(双侧)、神阙、阿是穴,三阴交每次贴敷30 min,7 d 1次,神阙、阿是穴每次贴敷6~8 h,1 d 1次;对照组在支配相应痛区神经节段的夹脊穴注射甲钴胺注射液,每次1 mL,1 d 1次。均7 d为一疗程,共治疗4个疗程。观察两组患者治疗前后疼痛视觉模拟量表(VAS)评分、健康状况调查简表(SF-36)评分、中医证候积分和血清炎性因子[单核细胞趋化蛋白-1(MCP-1)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)]、5-HT含量,并评定两组临床疗效。结果:治疗后,两组患者VAS评分、中医证候积分及血清MCP-1、IL-6、TNF-α、5-HT含量均较治疗前降低(P<0.05),且观察组低于对照组(P<0.05);两组患者SF-36评分较治疗前升高(P<0.05),且观察组高于对照组(P<0.05)。观察组总有效率为74.2%(46/62),高于对照组的52.4%(33/63,P<0.05)。结论:消肿止痛贴+中药细粉穴位贴敷治疗气滞血瘀型PHN疗效较好,能减轻患者症状,提高生活质量,并降低血清MCP-1、IL-6、TNF-α、5-HT含量。

Objective To observe the clinical efficacy of acupoint application in treating postherpetic neuralgia(PHN)with qi stagnation and blood stasis,and its effects on serum inflammatory factors and 5-hydroxytryptamine(5-HT)in patients.Methods A total of 136 PHN patients were randomly divided into an observation group(68 cases,6 case dropped out)and a control group(68 cases,5 cases dropped out).In the observation group,the combination of swelling-reducing and painrelieving patches and acupoint application with herbal powder was used at bilateral Sanyinjiao(SP 6),Shenque(CV 8)and ashi points.Sanyinjiao(SP 6)was applied for 30 min per session,once every 7 days;and Shenque(CV 8)and ashi points were applied for 6-8 h per session,once every 1 day.In the control group,mecobalamin injection was administered at Jiaji(EX-B 2)corresponding to the neural segments governing the painful area,1 mL per injection,once a day.Each treatment course consisted of 7 days,4 treatment courses were required in both groups.The visual analog scale(VAS)score for pain,36-item short form health survey(SF-36)score,traditional Chinese medicine syndrome score,and the serum levels of inflammatory factors(monocyte chemoattractant protein-1[MCP-1],interleukin-6[IL-6],tumor necrosis factor-alpha[TNF-α])and 5-HT were compared in the patients of the two groups before and after treatment,and the clinical efficacy was evaluated.Results After treatment,the VAS scores,traditional Chinese medicine syndrome scores,serum MCP-1,IL-6,TNF-α,and 5-HT levels were decreased compared with those before treatment in both groups(P<0.05),and the results in the observation group were lower than those in the control group(P<0.05).The SF-36 scores were increased compared with those before treatment in the two groups(P<0.05),and the result in the observation group was higher than that in the control group(P<0.05).The total effective rate of the observation group was 74.2%(46/62),which was higher than 52.4%(33/63,P<0.05)of the control group.Conclusion The combination of swelling-reducing and pain-relieving patches and acupoint application with herbal powder has shown better efficacy in treating PHN with qi stagnation and blood stasis,which can significantly alleviate patients symptoms,improve their quality of life,and reduce serum levels of MCP-1,IL-6,TNF-α,and 5-HT.