Clinical Efficacy of Ultrasonic Medicinal Penetration in the Removal of Blood Stasis and Alleviation of Zhuyu Juanbi Formula in the Treatment of Peripheral Neuropathy Induced by Paclitaxel

Objective: To observe the clinical efficacy and differences of the Zhuyu Juanbi formula delivered through ultrasound at Zusanli on patients with chemotherapy-induced peripheral neuropathy (CIPN) due to paclitaxel injection. Methods: A total of 72 breast cancer patients with CIPN were randomly divided into two groups. The treatment group (36 cases) was treated with oral methylcobalamin plus ultrasonic medicine permeating Zhuyu Juanbi formulae, while the control group (36 cases) was treated with oral methylcobalamin alone. Following two 2 cycles of continuous treatment, the efficacy of peripheral neurotoxicity, TCM syndrome score, FACT/GOG-Ntx score, total neuropathy score, and safety indicators of gynecological cancer patients were observed in the two groups. Result: In the treatment of CIPN, the addition of ultrasonic medicine permeating Zhuyu Juanbi formulae was more effective than oral methylcobalamin alone in reducing peripheral neurotoxicity and improving the quality of life of patients. The difference between the two groups was statistically significant (P < 0.05), and ultrasound drug penetration Zhuyu Juanbi formulae significantly reduced the FACT/ GOG-Ntx score and TNS score in the treatment group. In terms of drug safety, it rarely caused adverse reactions such as grade 3 and 4 leukopenia, and the safety profile was therefore good. Conclusion: The combination of ultrasonic medicine permeating Zhuyu Juanbi formulae and methylcobalamin has been demonstrated to be an effective treatment for peripheral neurotoxicity in patients with PIPN. It has been shown to significantly improve the clinical symptoms of PIPN patients, improve the quality of life of patients, and have a good safety profile.

Sigma-1 receptor: a new player in neuroprotection against chemotherapy-induced peripheral neuropathy

Chemotherapy-induced peripheral neuropathy is a very frequent neurological complication in cancer. Oxaliplatin（OXA） is a platinum analogue used as a first-line agent in the treatment of colorectal cancer. OXA induced peripheral neuropathy（OIN） is the main toxicity both during and after the completion of chemotherapy that presents as two distinct syndromes： acute and chronic neuropathy. None of the neuroprotective agents previously tested had prevented or limited the acute and/or chronic OIN. MR309（previously developed as E-52862） is a novel selective sigma-1 receptor（S1R） antagonist with preclinical analgesic activity in OXA-induced neuropathic pain in animal models. This review analyzes the results of the recently published phase Ⅱ, randomized, double-blind, placebo-controlled clinical trial including 124 patients with colorectal cancer（CRC） treated with MR309. This study shows encouraging findings in the setting of neuroprotection against OIN with an acceptable safety profile. The study demonstrated MR309 usefulness in decreasing acute OIN, by reducing cold hypersensitivity experienced by patients, and pointed to the amelioration of chronic OIN by lowering the proportion of patients who developed severe chronic OIN. In addition, we provide a summary and discussion on the pathways that can be modulated by the S1R to explain the observed clinical benefits in the OIN.

Psychosocial adaptation and influencing factors among patients with chemotherapy-induced peripheral neuropathy

BACKGROUND Chemotherapy-induced peripheral neuropathy(CIPN)is a severe and longlasting side effect caused by various anticancer agents that damage sensory,motor and autonomic nerves.It can cause maladaptive behaviors,including disease severity,anxiety,depression,sleep disorders,falls,and social impairment.These disorders have physical,psychological and social effects on patients and can seriously influence their quality of life.AIM To investigate the current situation of psychosocial adaptation to the disease and its influencing factor in patients with CIPN.METHODS A convenience sampling method was used to select 233 patients with CIPN in our hospital from February to August 2021.In addition,a cross-sectional survey was conducted using a sociodemographic questionnaire,the Self-Report Psychosocial Adjustment to Illness Scale,and the European Organisation for the Research and Treatment of Cancer Quality of Life CIPN20(QLQ-CIPN20).Factors influencing psychosocial adaptation in patients with CIPN were analyzed by t-test or one-way analysis of variance,correlation analysis,multiple stepwise regression analysis,and structural equation models.RESULTS The psychosocial adaptation score of patients with CIPN was 52.51±13.18.Multivariate analysis showed that autonomic nerves,tumor stage,motor nerves,education level,availability of caregivers,semi-retirement status,CIPN grade were independent risk factors for patients with CIPN(P<0.05).Structural equation models showed that QLQ-CIPN20 mediated the relationship between CIPN grade,tumor stage,and psychosocial adaptation.CONCLUSION Patients with CIPN have poor psychosocial adaptation and are affected by a variety of physiological,psychological,and social factors.Patients’adaptive responses should be assessed,and targeted interventions implemented.

Insights into platinum-induced peripheral neuropathy–current perspective

Cancer is a global health problem that is often successfully addressed by therapy, with cancer survivors increasing in numbers and living longer world around. Although new cancer treatment options are continuously explored, platinum based chemotherapy agents remain in use due to their efficiency and availability. Unfortunately, all cancer therapies affect normal tissues as well as cancer, and more than 40 specific side effects of platinum based drugs documented so far decrease the quality of life of cancer survivors. Chemotherapy-induced peripheral neuropathy is a frequent side effects of platinum-based chemotherapy agents. This cluster of complications is often so debilitating that patients occasionally have to discontinue the therapy. Sensory neurons of dorsal root ganglia are at the core of chemotherapy-induced peripheral neuropathy symptoms. In these postmitotic cells, DNA damage caused by platinum chemotherapy interferes with normal functioning. Accumulation of DNA-platinum adducts correlates with neurotoxic severity and development of sensation of pain. While biochemistry of DNA-platinum adducts is the same in all cell types, molecular mechanisms affected by DNA-platinum adducts are different in cancer cells and non-dividing cells. This review aims to raise awareness about platinum associated chemotherapy-induced peripheral neuropathy as a medical problem that has remained unexplained for decades. We emphasize the complexity of this condition both from clinical and mechanistical point of view and focus on recent findings about chemotherapy-induced peripheral neuropathy in in vitro and in vivo model systems. Finally, we summarize current perspectives about clinical approaches for chemotherapy-induced peripheral neuropathy treatment.

Treatment of Chronic Oxaliplatin-Induced Peripheral Neuropathy: A Systematic Review

Introduction: Oxaliplatin is a platinum-derivative chemotherapeutic agent used in digestive tumours, in the adjuvant and metastatic setting. Oxaliplatin can cause a chronic peripheral sensory neuropathy which impacts the quality of life and is dose limiting. To date, no therapeutic strategies have proved effective in the treatment of oxaliplatin-induced peripheral neuropathy (OIPN). Methods: A computerized search of the literature on PubMed database was performed. Publisher original articles were included if they focused on treatment of peripheral neuropathy among patients submitted to oxaliplatin. Eleven out of 242 reviewed papers met our inclusion criteria and were subjected to a 19-item quality checklist. Results: The included studies differed with respect to study design, patient population and sample size, neuropathic symptoms assessment and efficacy measure. Most studies had an adequate quality. Ten trials tested one drug, and one pilot study tested a non-pharmacological treatment—the neurofeedback. Of these, 3 trials included only patients submitted to oxaliplatin-based chemotherapy. Duloxetine showed moderate efficacy in 3 trials. Topical treatment with capsaicin or 10% amitriptyline was promisors in 2 single-arm trials with a few samples. Conclusion: In the last decade, there wasn’t an improvement in the treatment of chronic OIPN. The duloxetine is the unique drug with moderate efficacy on the treatment of OIPN. There is insufficient evidence to support a recommendation for any other treatment.

Analgesic efficacy of median nerve stimulation in mice with chemotherapy-induced peripheral neuropathy via modulation of brain-derived neurotrophic factor expression

OBJECTIVE:Chemotherapeutic agents such as docetaxel(DTX)can trigger chemotherapy-induced peripheral neuropathy(CIPN),which is characterized by unbearable pain.This study was designed to investigate the analgesic effect and related neuronal mechanism of low-frequency median nerve stimulation(LFMNS)on DTX-induced tactile hypersensitivity in mice.METHODS:To produce CIPN,DTX was administered intraperitoneally 4 times,once every 2 d,to male ICR mice.LFMNS was performed on the wrist area,and the pain response was measured using von Frey filaments on both hind paws.Western blot and immunofluorescence staining were performed using dorsal root ganglion and spinal cord samples to measure the expression of brainderived neurotrophic factor(BDNF).RESULTS:Repeated LFMNS significantly attenuated the DTX-induced abnormal sensory response and suppressed the enhanced expression of BDNF in the DRG neurons and spinal dorsal area.CONCLUSIONS:LFMNS might be an effective nonpharmaceutical option for treating patients suffering from CIPN via regulating the expression of peripheral and central BDNF.

Chemotherapy-induced neurotoxicity in the treatment of gynecological cancers:State of art and an innovative approach for prevention

Chemotherapy-induced peripheral neuropathy(CIPN)is a common side effect that occurs in 20%of ovarian cancer patients treated with the combination of carboplatin/paclitaxel(CP).This toxicity is directly correlated with the dose of paclitaxel administered.Several studies have investigated whether different formulations of taxane can induce this side effect at a lower rate,but,unfortunately,no significant improvement was obtained.CIPN can be disabling in the daily lives of patients and can cause dose reduction or early termination of the treatment.Neuropathy can last for months and even years after its onset.Moreover,patients responsive to CP treatment are candidates for a reintroduction of the same drugs when disease relapse occurs,and residual neuropathy can affect the continuation of treatment.There are no approved drugs that mitigate or prevent the onset of CIPN.In this review,we summarize the evidence regarding the incidence of CIPN with different taxane formulations,regimen schedules and prevention systems.In particular,the Hilotherm®Chemo care device is a regional cooling system that lowers the temperature of the hands and feet to reduce the flow of chemotherapy into the capillaries.We used hilotherapy during chemotherapy infusion to prevent the onset of CIPN.Updated data from 44 ovarian cancer patients treated with 6 cycle of CP show that hilotherapy was well tolerated;only two patients(4.5%)stopped hilotherapy because of cold intolerance,and only one patient(2.2%)experienced grade≥2 CIPN.

Sodium Aescinate Alleviates Neuropathic Pain in Rats by Suppressing the TLR4/NF KB Pathway Activation after Paclitaxel Chemotherapy

Background: Emerging evidence suggests that chemotherapy-induced peripheral neuropathy (CIPN) is a significant side effect of chemotherapeutic drugs. Many experiments have proved that sodium aescinate (SA) has definite pharmacological effects such as anti-infection, anti-exudation, anti-edema, anti-tumor as well as neuroprotection, and the drug side effects are mild. However, no study has explored whether SA is involved in the analgesic effect of paclitaxel (PAC) induced neuropathic pain in rats. Methods: Rats were given an intraperitoneal injection of PAC (2.5 mg/Kg intraperitoneally on days 1, 3, 5, and 7), while SA 25 mg/kg intraperitoneally was administered daily for 14 consecutive days. The mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL) of rats were examined on experimental days 3, 5, 7, 11, 14. All rats were sacrificed on day 15 of the experiment, and L4-6 spinal cords were removed. Subsequently, immunohistochemistry, HE staining, ELISA, RT-qPCR, Western blotting were applied to evaluate cytoskeletal protein expression (NF-L and NF-M), spinal nerve structural integrity, proinflammatory factor contents (TNF-α, IL-1β, and IL-6), and protein content of the TLR4/NF-κB pathway, respectively. Results: After the rats developed PAC induced pain behaviors, multiple injections of SA rendered the rats with elevated MWT and TWL values, decreased expression of NF-L and NF-M in the spinal cord, materially downregulated content of proinflammatory factors, and reduced amounts of TLR4 and p-NF-κB protein levels. Conclusions: The results of the present study preliminarily indicate that SA has an analgesic effect on rats with CIPN induced by PAC injection, and the mechanism may be related to blocking the TLR4/NF-κB signaling pathway, inhibiting the expression of proinflammatory factors, and alleviating cytoskeletal disorders.

Mechanism of electroacupuncture on “Zusanli( ST 36) ”for chemotherapy-induced peripheral neuropathy

Objective To observe the effects and duration of electroacupuncture on the mechanical pain threshold induced by paclitaxel and explore its analgesic mechanism.Methods Sixty-four C57BL/6J male mice were randomly divided into 4 groups,a normal+sham EA group,a normal+EA group,a medicine+sham EA(Med+sham EA)group,a medicine+EA(Med+EA)group。

SUDOSCAN 检测快速有效评估硼替佐米致周围神经病变

目的:本研究旨在探索SUDOSCAN检测(一种外周自主神经功能检测工具)对硼替佐米致周围神经病变(bortezomib-induced peripheral neuropathy,BIPN)的评估效果。方法:以2021年7月至2022年10月首都医科大学附属北京朝阳医院血液科确诊的86例多发性骨髓瘤(multiple myeloma,MM)患者作为研究对象,另外选取30例无肿瘤史及化疗药物接触史的患者作对照,所有患者均接受了SUDOSCAN皮肤电导率(ESC值)检测,同时与总神经病变评分临床版(TNSc)、美国国立癌症研究所常见毒性分级标准(NCI-CTC)分级评分对比,并对试验组患者进行了评估所需时间比较。结果:试验组患者手部、足部ESC值比对照组明显降低(手部:56.4μs vs.76.5μs,P<0.001;足部:47.5μs vs.78.0μs,P<0.001);SODUSCAN评估患者足部ESC值与TNSc评分呈显著负相关(r=−0.403,P<0.001)、与NCI-CTC等级无明显相关性(r=−0.227,P=0.051);NCI-CTC等级与TNSc评分呈显著正相关(r=0.591,P<0.001)。SUDOSCAN检测所需中位评估时间与NCI-CTC等级相近(均为2.4 min),TNSc评分所需中位评估时间最长(13.4 min)。结论:目前,BIPN缺乏准确、高效评估方式,SUDOSCAN检测简单易行,与TNSc评分呈显著负相关,且比TNSc评分用时更短,能够快速有效评估BIPN。

中医外治法治疗紫杉类药物所致周围神经毒性研究进展

紫杉类化疗药是临床常用的抗肿瘤药物,其所致的周围神经毒性(chemotherapy-induced peripheral neuropathy, CIPN)是最常见的毒副反应之一,现代医学治疗主要包括抗氧化剂、神经营养及抗抑郁药物等。中医药治疗CIPN取得一定成效,尤其是中医外治法(中药熏洗、针刺治疗、中药塌渍及按摩等)不仅可以弥补口服汤剂加重胃肠道反应的不足,且具有安全廉验的优势。目前研究存在的问题是,紫杉烷的神经毒性临床常见,而研究多围绕奥沙利铂引起的周围神经毒性进行,紫杉类药物仍缺乏基础研究和临床试验。无论是中药熏洗还是针灸治疗,都缺乏大资料研究作为支撑点,且中药作用于周围神经毒性的具体机理和靶点仍需深入探索。今后,应开展大样本的随机、对照、双盲实验,为紫杉类药物神经毒性的防治提供切实可行的方案,发挥中医外治法的传统特色。

针灸干预肿瘤化疗、手术后不良反应的临床研究

恶性肿瘤严重威胁人类的生命和健康,已成为人类死亡的主要病因之一,放化疗和手术为主要治疗手段,然而其引起的一系列不良反应严重影响肿瘤患者的生命质量。本文以天津中医药大学针灸临床评价与转化中心近6年来开展的针灸治疗肿瘤放化疗后的恶心呕吐(CINV)、乳腺癌术后上肢淋巴水肿(BCRL)和化疗所致周围神经病变(CIPN)的研究结果,结合美国国家癌症研究所(NCI)发布的针灸在肿瘤研究方面的共识及最新临床证据摘要(PDQ?),对针灸在干预肿瘤化疗、手术后不良反应中的临床研究进行总结评述,以挖掘和探索针灸在肿瘤治疗中的应用价值,为以上病症的治疗提供有效的方法。

硫辛酸联合葡萄糖酸钙及硫酸镁对恶性肿瘤化疗所致的周围神经病变的疗效观察

目的探讨硫辛酸联合葡萄糖酸钙/硫酸镁对恶性肿瘤化疗药物所致周围神经病变(CIPN)的治疗效果。方法将179例接受化疗并明确诊断为CIPN的恶性肿瘤患者随机分为对照组(90例)和研究组(89例),对照组患者给予葡萄糖酸钙10 ml和25%硫酸镁10 ml注入5%葡萄糖溶液静脉滴注;研究组患者在对照组治疗的基础上加用α-硫辛酸注射液600 mg入0.9%氯化钠注射液静脉滴注。2组均治疗24天,观察2组患者治疗前后正中神经和腓总神经的传导速度,采用视觉模拟评分(VAS)评价治疗前后疼痛情况,并评估治疗效果和不良反应。结果研究组和对照组治疗后正中神经和腓总神经的传导速度均较治疗前有不同程度的提高(P<0.05、P<0.01),但研究组较对照组神经传导速度提高更显著(P<0.05)。研究组治疗后VAS评分较治疗前显著下降(P<0.05),而对照组治疗前后VAS评分无显著差异(P>0.05)。治疗24天后,研究组治疗总有效率为95.51%(85/89),显著高于对照组的83.33%(75/90)(P<0.05)。2组不良反应发生率无显著差异(12.36%vs 8.89%,P>0.05),均无严重不良反应发生。结论硫辛酸联合葡萄糖酸钙及硫酸镁能够加快恶性肿瘤CIPN患者感觉及运动神经的传导速度,改善患者的临床症状和体征,具有协同作用,且用药安全,值得临床应用。

化疗所致周围神经毒性评估和管理的证据总结

目的评价和总结化疗所致周围神经病变评估和管理的最佳证据。方法计算机检索中国期刊全文数据库、万方数据库、中国生物医学文献数据库、Up To Date、BMJ best practice、Web of Science、Cochrane Library、JBI OVID、PubMed、国际指南协作网(GIN)、英国国家卫生与临床优化研究所指南网(NICE)、安大略注册护士协会(RNAO)、美国国家综合癌症网(NCCN)、苏格兰院际指南网(SIGN)等国内外数据库,检索数据库中建库至2020年7月29日该研究领域的所有化疗所致周围神经病变(chemotherapy-induced peripheral neuropathy,CIPN)相关文献,汇总有关CIPN评估和管理的证据。结果共纳入9篇文献,其中指南1篇,证据总结1篇,系统评价4篇,临床决策1篇,实践推荐1篇、专家共识1篇。共汇总24条最佳证据,包括评估与计划、多学科合作、健康教育、非药物管理、药物管理5个维。结论护理人员应从循证的角度对化疗所致周围神经毒性进行评估和管理,根据证据的不断更新,汇总最佳证据,提升护理质量。

附子理中丸通过调节MAPK信号通路改善顺铂诱导CIPN模型小鼠损伤的作用机制

目的:基于丝裂原活化蛋白激酶(MAPK)信号通路,探讨附子理中丸改善顺铂诱导化疗所致周围神经病变(CIPN)模型小鼠损伤的作用机制。方法:KM雌性小鼠40只,随机分为正常组,模型组,附子理中丸组(3.5 g·kg^(-1)),阿司匹林组(0.026 g·kg^(-1))。每日腹腔注射顺铂(3 mg·kg^(-1)),连续5 d,制备CIPN模型;造模同时灌胃给予相应药物,连续12 d。观察其一般情况和行为学表现;末次给药后取材,苏木素-伊红(HE)染色观察足掌部皮肤组织病理变化。采用生化学检测血清中超氧化物歧化酶(SOD),过氧化氢(H_(2)O_(2)),丙二醛(MDA),一氧化氮(NO)的水平;采用酶联免疫吸附测定法(ELISA)检测肾脏组织中白细胞介素-6(IL-6),白细胞介素-1β(IL-1β),肿瘤坏死因子-α(TNF-α),谷胱甘肽过氧化物酶-3(GPX-3)的含量。蛋白免疫印迹法(Western blot)检测肾脏组织中细胞外调节蛋白激酶1/2(ERK1/2)及其磷酸化(p-ERK1/2),p38 MAPK及其磷酸化p38 MAPK(p-p38 MAPK)的表达水平。结果:与正常组比较,模型组小鼠足掌部皮肤病理损伤明显,表皮角化过度呈网篮状结构,棘层萎缩,细胞数量减少,细胞内水肿;与模型组比较,附子理中丸组足掌部皮肤组织的病理损伤明显降低。与正常组比较,模型组小鼠体质量、机械痛阈值、热痛阈值显著下降(P<0.01),SOD活性明显降低(P<0.05),H_(2)O_(2),MDA,NO含量显著升高(P<0.01),IL-6,IL-1β,TNF-α表达显著升高(P<0.01);与模型组比较,附子理中丸组小鼠体质量、机械痛阈值、热痛阈值显著升高(P<0.01),SOD活性明显升高,H_(2)O_(2),MDA和NO含量明显降低(P<0.05),IL-6,IL-1β,TNF-α表达显著降低(P<0.01);与正常组比较,模型组ERK1/2,p-ERK1/2,p38 MAPK,p-p38 MAPK蛋白表达显著上升(P<0.01);与模型组比较,附子理中丸组ERK1/2,p-ERK1/2,p38 MAPK,p-p38 MAPK蛋白表达显著下降(P<0.01)。结论:附子理中丸能够改善顺铂诱导CIPN模型小鼠的神经功能损伤,提高小鼠的疼痛阈值,其作用机制可能与调节MAPK信号通路,抑制炎性反应及机体氧化应激水平相关。

159例多发性骨髓瘤化疗相关周围神经病变中医证型研究

【目的】基于聚类分析探索多发性骨髓瘤化疗相关周围神经病变(MM-CIPN)的中医证型分布规律。【方法】纳入159例MM-CIPN患者的中医四诊信息,运用系统聚类分析和K-均值聚类分析方法,归纳总结该病的高频证候及其中医证型。【结果】(1)共筛选出27个高频证候,其中,频率超过50%的证候有5个,分别是肢体麻木151例(占95.0%)、肢体刺痛115例(占72.3%)、畏寒肢凉93例(占58.5%)、疲倦乏力89例(占56.0%)和屈伸不利82例(占51.6%)。(2)根据两种聚类分析方法,可将MM-CIPN的中医证型分为气虚血瘀证、痰瘀痹阻证、肾虚血瘀证、阴虚血瘀证4型,其中,以气虚血瘀证及肾虚血瘀证居多,阴虚血瘀证、痰瘀痹阻证次之。(3)中医证候分型与患者性别无显著相关性(P>0.05)。年龄方面,在34~40岁和41~50岁年龄段,均以痰瘀痹阻证所占比例最高,分别为75.0%(3/4)和44.5%(4/9);在51~60岁和61~70岁年龄段,均以气虚血瘀证所占比例最高,分别为56.9%(29/51)和43.6%(30/69);在71~80岁年龄段,以肾虚血瘀证所占比例最高,为46.2%(12/26),其次为阴虚血瘀证,占26.9%(7/26)。【结论】肢体麻木、肢体刺痛为MM-CIPN的主要证候;MMCIPN的中医证型以气虚血瘀证及肾虚血瘀证居多,阴虚血瘀证、痰瘀痹阻证次之;不同年龄段患者的中医证型有所差异,中年患者以痰瘀痹阻证居多,中老年患者以气虚血瘀证多见,老年患者以肾虚血瘀证及阴虚血瘀证所占比例较高。

夏小军主任医师辨治化疗诱导的周围神经病变经验

从病因病机、治则治法、方药三方面探讨夏小军主任医师辨治化疗诱导的周围神经病变的经验及思路。其认为,本病以久病体虚为发病基础,虚、痰、瘀、毒、湿为致病因素,总属本虚标实之证;治以扶正为要,兼以祛毒除邪、护中扶正,衷中参西、兼治他症;创芎归蠲痹方,临证施用,收效甚佳。附典型病案1则以验证。

电针“足三里”治疗化疗所致周围神经痛的效应机制研究

目的：观察电针＂足三里＂对紫杉醇诱导的化疗机械痛小鼠痛阈的影响及持续时间,探讨其镇痛机制。方法：将健康雄性C 57BL/6J小鼠64只随机分为4组,即空白＋假电针组、空白＋电针组、紫杉醇＋假电针组、紫杉醇＋电针组,每组16只。紫杉醇＋假电针组、紫杉醇＋电针组在第1、3、5、7d腹腔注射紫杉醇制备化疗痛模型。4组小鼠于第9、11、13、16、18、20、23、25、27、30d行假电针或电针治疗,取双侧＂足三里＂,针刺后,电针组施予一定的电流刺激（2Hz/100Hz,1~1.5mA,30min）,假电针组只有针刺激而无电流输入。于造模前,造模后即第8、14、21、28天采用VonFrey法检测小鼠机械痛阈;第31d,每组取8只小鼠心脏快速采血取血清,用ELISA法检测促炎细胞因子中的肿瘤坏死因子α（TNF-α）、白介素-1α（IL-1α）、白介素-1β（IL-1β）含量;每组余下的8只继续用VonFrey法每周检测1次机械痛阈,即在第35、42、49d检测4组小鼠的机械痛阈直至两个紫杉醇组机械痛阈无明显差异。结果：造模前各组小鼠痛阈值差异无统计学意义（P〉0.05）,造模后（第8d）两个紫杉醇组痛阈值低于两个空白组（均P〈0.05）。电针干预后,紫杉醇＋电针组机械痛阈值在各时间点均比紫杉醇＋假电针组高,第14、21、28d差异有统计学意义（均P〈0.05）,且镇痛效应持续至第49d。紫杉醇＋电针组血液中促炎细胞因子TNF-α、IL-1α、IL-1β水平比紫杉醇＋假电针组有不同程度的降低,其中IL-1α比较差异有统计学意义（P〈0.05）。结论：电针能有效抑制紫杉醇诱导的化疗所致周围神经痛,其镇痛机制可能与降低血液促炎细胞因子有关。

药物防治化疗所致周围神经病变的临床研究进展

化疗致周围神经病变(chemotherapy-induced peripheral neuropathy,CIPN)是临床常见剂量限制性不良反应,目前尚未得到妥善解决。已有各种药物针对此不良反应进行了大量的临床研究,但大多数结果都不理想或相互冲突。究其原因,除了药物本身疗效之外,没有一个标准化的评估工具成为试验成功的主要限制。本文通过CIPN症状入手对临床上广泛应用的CIPN评估工具进行阐述和评价,对临床研究CIPN预防和治疗获益的各类药物进行综述,并依据循证证据提出相应的建议。

基于“虚气留滞”探讨化疗所致周围神经病变病机及论治

中医药治疗化疗所致周围神经病变尽管具有较好的临床疗效,但缺乏以病机为核心的理论指导。恶性肿瘤、化疗药物致使机体“气血阴阳失和”“脏腑精气亏虚”后的病理状态——“虚气”;痰、湿、瘀、毒等各种病理产物致使机体经络阻滞——“留滞”,二者是中医对化疗所致周围神经病变病因病机的高度概括。文章根据“虚气”和“留滞”二者的关系对疾病的动态病机演变进行探讨,提出化疗所致周围神经病变的“虚气留滞”病机,总结其论治思路重点在于“培元补虚、开郁行滞”。以期为化疗所致周围神经病变提供新的临床治疗思路,丰富并发展中医相关理论。