中药汤剂、针灸联合西药治疗带状疱疹后遗神经痛的疗效及对炎性因子、疼痛介质的影响研究

Study on the effect of Chinese herbal decoction,acupuncture and moxibustion and Western medicine on postherpetic neuralgia and its influence on inflammatory factors and pain mediators

目的研究中药汤剂(龙胆泻肝汤)、针灸联合西药治疗带状疱疹后遗神经痛(PHN)的作用机制及临床效果。方法140例PHN患者,采用随机数字表法分为实验组(SY组)和对照组(DZ组),每组70例。DZ组患者行单纯的西药治疗,SY组患者在DZ组基础上联合中药汤剂、针灸治疗。比较两组患者临床疗效、血清炎性因子[肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6、IL-1β]、血清疼痛介质[P物质(SP)、神经激肽-1(NK-1)、降钙素基因相关肽(CGRP)]、复发率。结果SY组患者临床总有效率为94.29%,高于DZ组的77.14%(P<0.05)。治疗后,SY组患者血清TNF-α(9.34±1.23)ng/L、IL-6(112.45±13.24)ng/L、IL-1β(4.27±0.43)ng/L均低于DZ组的(15.37±2.43)、(195.35±16.46)、(6.75±0.56)ng/L(P<0.05)。治疗后,SY组患者血清SP(438.45±52.35)pg/ml、NK-1(3.27±0.43)pg/ml、CGRP(70.33±5.34)pg/ml均低于DZ组的(723.12±72.34)、(6.23±1.05)、(100.45±7.24)pg/ml(P<0.05)。经6个月的随访统计,SY组患者中成功随访64例,其中3例患者复发,复发率为4.69%(3/64);DZ组患者中成功随访63例,其中10例患者复发,复发率为15.87%(10/63)。SY组患者复发率低于DZ组(χ^(2)=4.323,P=0.038<0.05)。结论在常规西药的基础上联合开展中药汤剂、针灸治疗,可在有效调节PHN患者血清炎性因子、疼痛介质表达水平的基础上提高患者临床疗效,并降低远期复发率。

Objective To study on the mechanism and clinical effect of Chinese herbal decoction(Longdan Xiegan decoction),acupuncture and moxibustion and Western medicine on postherpetic neuralgia(PHN).Methods 140 patients with PHN were divided into an experimental group (SY group) and a control group (DZ group) by using the random number table method,each consisting of 70 cases.Patients in DZ group were treated with simple western medicine,and patients in SY group were treated with Chinese herbal decoction and acupuncture and moxibustion on the basis of DZ group.Comparison was made on the clinical efficacy,serum inflammatory factors[tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6),IL-1β],serum pain mediators[substance P (SP),neurokinin-1 (NK-1),calcitonin gene-related peptide (CGRP)]before and after treatment and recurrence rate between the two groups.Results The total clinical effective rate was 94.29%in SY group,which was higher than 77.14%in DZ group (P<0.05).After treatment,SY group had serum TNF-α of (9.34±1.23) ng/L,IL-6 of (112.45±13.24) ng/L,IL-1β of (4.27±0.43) ng/L,which were lower than (15.37±2.43),(195.35±16.46)and (6.75±0.56) ng/L in DZ group (P<0.05).After treatment,SY group had serum SP of (438.45±52.35) pg/ml,NK-1 of (3.27±0.43) pg/ml and CGRP of (70.33±5.34) pg/ml,which were lower than (723.12±72.34),(6.23±1.05) and (100.45±7.24) pg/ml in DZ group (P<0.05).After 6-month follow-up statistics,64 patients in the SY group were successfully followed up,of which 3 patients relapsed,with a relapse rate of 4.69%(3/64);in DZ group,63 patients were successfully followed up,of which 10 patients relapsed,with a relapse rate of 15.87%(10/63).The recurrence rate in SY group was lower than that in DZ group (χ^(2)=4.323,P=0.038<0.05).Conclusion The combination of Chinese herbal decoction and acupuncture and moxibustion on the basis of conventional Western medicine can improve the clinical efficacy of PHN patients and reduce the long-term recurrence rate while effectively regulating the expression level of serum inflammatory factors and pain mediators.