近十年针灸干预带状疱疹后遗神经痛的研究进展

Research Progress of Acupuncture and Moxibustion in Intervening Postherpetic Neuralgia in Recent Ten Years

带状疱疹后遗神经痛(PHN)是感染带状疱疹后最常见的慢性神经性疼痛。作为HZ的并发症,PHN的疼痛被认为是HZ发作时周围神经损伤的直接后果。针灸对镇痛有明确的优势,故在临床上是治疗PHN的常见方法。本文分析了近十年来针灸干预PHN的临床和实验研究,总结了临床上所用方法学、刺灸法及取穴、疗程和疗效等现状,以及实验研究中针灸对PHN神经系统和免疫机制方面的影响。临床针灸治疗PHN通常以夹脊穴和阿是穴为主穴,包括以毫针刺、电针、火针、梅花针、揿针等在内的针刺和针、灸、罐结合的治疗方法,研究表明针灸对PHN的治疗总有效率较高,最终疗效评估多以缓解PHN患者的主观神经痛为重点。尽管针灸可以缓解PHN带来的疼痛,但现有的临床和机制研究仍然存在不少问题,如临床研究方法学质量不高、研究方法和疗效评判不统一、机制研究涉及面不广等。在今后的研究中,应注意提高临床研究的质量,规范临床研究的方法,扩大并加深实验研究的机制影响,从而为临床治疗提供充分的医学证据。Postherpetic neuralgia (PHN) is the most common chronic neuropathic pain after infection with herpes zoster. As a complication of HZ, pain in PHN is thought to be a direct consequence of peripheral nerve damage during HZ episodes. Acupuncture and moxibustion have definite advantages in analgesia, so it is a common method to treat PHN in clinic. This paper analyzes the clinical and experimental studies of acupuncture and moxibustion for PHN in the past ten years, and summarizes the current situation of clinical methodology, techniques of acupuncture and moxibustion, acupoint selection, course of treatment and curative effect, as well as the mechanisms of acupuncture and moxibustion on the nervous system and immune system in PHN. In clinical acupuncture treatment of PHN, Jiaji and Ashi are the main points, including filiform acupuncture, electroacupuncture, fire acupuncture, plum blossom acupuncture, pressing acupuncture, etc., and acupuncture combined with moxibustion and cupping. It shows that the overall effective rate of acupuncture in the treatment of PHN is high, while the final effect evaluation mainly focuses on relieving the subjective neuralgia of PHN patients. Although acupuncture can relieve the pain caused by PHN, there are still a few problems in existing clinical and mechanism studies, such as low quality of clinical research methodology, inconsistent research methods and effect evaluation, and limited coverage of mechanism research. In future research, we should pay attention to the quality of clinical research, standardize the methods of clinical research, expand and deepen the mechanism of experimental research, so as to provide sufficient medical evidence for clinical treatment.