火针联合穴位注射治疗带状疱疹后遗神经痛的临床疗效研究

A clinical study on treating postherpetic neuralgia by fire needle plus acupoint injection

目的:通过观察火针联合穴位注射疗法干预带状疱疹后遗神经痛患者的临床疗效及对患者血清中相关神经递质、免疫细胞和炎症因子的影响,探讨火针联合穴位注射疗法的作用机制。方法:收集2022年1月-12月于甘肃省中医院针灸科就诊的带状疱疹后遗神经痛患者60例,将患者随机分为对照组和治疗组,每组30例,对照组给予火针单一疗法,治疗组采用火针联合穴位注射疗法。10 d为一个疗程,隔日1次,2个疗程后观察治疗前后两组患者临床症状,检测血清中相关神经递质血清神经肽Y、P物质、β-内啡肽、T淋巴细胞亚群(CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))和炎症因子白细胞介素-6、白细胞介素-1β、白细胞介素-10、肿瘤坏死因子-α等指标。结果:与对照组治疗后比较,治疗组汉密尔顿焦虑量表(Hamilton Anxiety Scale,HAMA)评分、视觉模拟评分法(Visual Analogue Scale,VAS)评分、匹茨堡睡眠质量指数量表(Pittsburgh Sleep Quality Index,PSQI)评分明显降低,生活质量测定量表(Quality of Life-Brief Scale,QOL-BREF)评分明显增高(治疗组生理评分除外),差异具有统计学意义(P <0.05);治疗组血清相关神经递质神经肽Y、P物质明显降低,β-内啡肽明显增高,治疗组CD8^(+)水平明显降低,CD4^(+)、CD4^(+)/CD8^(+)水平明显增高,炎症因子白细胞介素-6、白细胞介素-1β、肿瘤坏死因子-α明显降低,白细胞介素-10明显增高,上述差异均具有统计学意义(P <0.05)。结论:火针联合穴位注射复合疗法可有效缓解患者焦虑情绪、减轻疼痛程度、改善睡眠状态及提高生活质量,临床疗效显著,优于火针单一疗法。其干预带状疱疹后遗神经痛患者临床疗效的作用机制可能与调控相关神经递质水平、炎症因子水平及调节免疫功能有关。

Objective:The clinical efficacy of fire needle plus acupoint injection therapy on postherpetic neuralgia(PHN)and its effect on related neurotransmitters,immune cells and inflammatory factors in patients’serum were observed to explore the mechanism of action of fire needle plus acupoint injection therapy.Methods:Sixty patients with postherpetic neuralgia from the fire needle department of Gansu Hospital of Traditional Chinese Medicine from January to December 2022.A total of 30 cases were randomly divided into the control group and the treatment grcup,30 cases in each.and the control group were given fire needle monotherapy,the treatment group were given fire needle plus acupoint injection therapy.Ten days was one course of treatment,and the treatment was given once every other day.After two courses of treatment,we observed the clinical symptoms of the patients in both groups before and after the treatment,and detected the related neurotransmitters and inflammatory factors in the blood serum such as serum neuropeptide Y(NPY),substance P(SP),β-endorphins(β-EP),lymphocyte subpopulations(CD4^(+),CD8^(+),CD4^(+)/CD8^(+))and inflammatory factors interleukin (IL)-6, IL-1β, IL-10, tumor necrosis factor-α (TNF-α). Results: Compared with the control group, the Hamilton anxiety scale (HAMA), visual analogue scale (VAS), Pittsburgh sleep quality index (PSQI) scores in the treatment group were significantly lower, and the quality of life scores were hugher. The differences were statistically significant (P<0.05). Serum-related neurotransmitters NPY and SP were significantly lower and β-EP was significantly higher in the treatment group (except for physiology score in the treatment group). CD8^(+) levels were significantly lower, CD4^(+), CD4^(+)/CD8^(+) levels were increased significantly, inflammatory factors IL-6, IL-1β, TNF-α were decreased significantly, and IL-10 was increased significantly, and the above differences were statistically significant (P<0.05). Conclusion: Fire needle plus acupoint injection therapy can effectively relieve patients’ anxiety, reduce pain, improve sleep and quality of life, and its clinical efficacy is significantly better than that of fire needle monotherapy. The mechanism of its intervention on the clinical efficacy on PHN patients may be related to the regulation of neurotransmitter levels, inflammatory factors and immune function.