围刺联合穴位注射对带状疱疹急性期疼痛的神经保护作用
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摘要
目的:探讨围刺联合穴位注射对带状疱疹急性期疼痛(AHN)的疗效及作用机制。方法:99例T_6～T_(10)节段AHN患者随机分为3组,每组33例,其中围刺组脱落2例,穴位注射组脱落4例,联合组脱落3例。各组患者均口服盐酸伐昔洛韦片,每次0.3 g,每日2次,共10 d。围刺组穴取疱疹周围阿是穴,斜刺后予连续波耐受量电刺激20 min;穴位注射组取穴同上,注射甲钴胺注射液配伍利多卡因注射液;联合组围刺后再予穴位注射。各组均每日1次,14次为一疗程,治疗1个疗程。比较各组治疗后皮肤愈合情况(止疱、结痂、脱痂时间),观察各组治疗前后疼痛评分、疼痛面积和生活质量评分,检测各组患者治疗前后局部疱液中神经元特异性烯醇化酶(NSE)、P物质(SP)和降钙素基因相关肽(CGRP)的含量。结果:联合组止疱、结痂、脱痂时间均早于其他两组(均P<0.05)。各组患者治疗后疼痛评分、疼痛面积均较治疗前明显减少,生活质量评分较治疗前明显提高(均P<0.05),联合组疼痛评分、生活质量评分较其他两组改善更明显(均P<0.05)。治疗后各组患者局部疱液中NSE、SP和CGRP含量较治疗前均明显下降(均P<0.05),联合组各指标较其他两组下降更显著(均P<0.05)。结论:围刺和穴位注射均对AHN有辅助疗效,两者结合疗效更优,皮肤愈合迅速,镇痛显著,局部NSE、SP和CGRP的含量下降明显,其作用机制在于发挥神经保护作用。
Objectives To explore the effect and mechanism of surround needling combined with acupoint injection on acute herpetic neuralgia(AHN). Methods Ninety-nine patients with T_6-T_(10) segment AHN were randomly divided into 3 groups, 33 cases in each group, including 2 cases dropped off in the surround needling group, 4 cases dropped off in the acupoint injection group, and 3 cases dropped off in the combined group. Oral valacyclovir was given in each group, 0.3 g each time, 2 times a day for 10 days. Oblique insertion of needle used at ashi points around the herpes in the surround needling group, and continuous wave was stimulated to tolerance for 20 min; the same acupoints were selected as the surround needling group, stimulated with the mixture injection of mecobalamin and lidocaine in the acupoint injection group;After the surround needling, acupoint injection was performed in the combined group. The treatment was given once a day, 14 times for a course, and one course was needed in all groups. The skin healing conditions(blistering, crusting, and dislocation time) of each group were compared after treatment. The pain scores, pain area and quality of life scores in each group were observed before and after treatment. The levels of neuron specific enolase(NSE), substance P(SP) and calcitonin gene-related peptide(CGRP) in the local blister fluid were measured before and after treatment in all groups. Results The blistering,crusting and dislocation time in the combined group were earlier than the other two groups(all P<0.05). The pain score and pain area in the each group were significantly lower than those before treatment, and the quality of life score was significantly higher than that before treatment(all P<0.05). The improvements of pain score and quality of life score in the combined group were more obvious than the other two groups(all P<0.05). After treatment, the levels of NSE, SP and CGRP in the local blister fluid in each groups were significantly lower than those before treatment(all P<0.05). The indexes in the combined group were significantly lower than those in the other two groups(all P<0.05). Conclusion Both surround needling and acupoint injection have an adjuvant effect on AHN. The combination of the two is better, the skin is healed quickly, the analgesia is significant, and the contents of local NSE, SP and CGRP are significantly decreased. The mechanism of action is to exert neuroprotective effects.
Objectives To explore the effect and mechanism of surround needling combined with acupoint injection on acute herpetic neuralgia(AHN). Methods Ninety-nine patients with T_6-T_(10) segment AHN were randomly divided into 3 groups, 33 cases in each group, including 2 cases dropped off in the surround needling group, 4 cases dropped off in the acupoint injection group, and 3 cases dropped off in the combined group. Oral valacyclovir was given in each group, 0.3 g each time, 2 times a day for 10 days. Oblique insertion of needle used at ashi points around the herpes in the surround needling group, and continuous wave was stimulated to tolerance for 20 min; the same acupoints were selected as the surround needling group, stimulated with the mixture injection of mecobalamin and lidocaine in the acupoint injection group;After the surround needling, acupoint injection was performed in the combined group. The treatment was given once a day, 14 times for a course, and one course was needed in all groups. The skin healing conditions(blistering, crusting, and dislocation time) of each group were compared after treatment. The pain scores, pain area and quality of life scores in each group were observed before and after treatment. The levels of neuron specific enolase(NSE), substance P(SP) and calcitonin gene-related peptide(CGRP) in the local blister fluid were measured before and after treatment in all groups. Results The blistering,crusting and dislocation time in the combined group were earlier than the other two groups(all P<0.05). The pain score and pain area in the each group were significantly lower than those before treatment, and the quality of life score was significantly higher than that before treatment(all P<0.05). The improvements of pain score and quality of life score in the combined group were more obvious than the other two groups(all P<0.05). After treatment, the levels of NSE, SP and CGRP in the local blister fluid in each groups were significantly lower than those before treatment(all P<0.05). The indexes in the combined group were significantly lower than those in the other two groups(all P<0.05). Conclusion Both surround needling and acupoint injection have an adjuvant effect on AHN. The combination of the two is better, the skin is healed quickly, the analgesia is significant, and the contents of local NSE, SP and CGRP are significantly decreased. The mechanism of action is to exert neuroprotective effects.
引文
[1]高月,季凤清,李彦平,等.带状疱疹急性期临床症状与皮损区病理性改变的相关性研究[J].临床和实验医学杂志,2013,12(1):1-3,6.
[2]郝蓬亮,杨一玲,关玲.刺络拔罐加围刺法对急性期带状疱疹患者末梢和局部血炎性相关指标的影响[J].中国针灸,2016,36(1):37-40.
[3]Marinkovi?S,Gibo H,Todorovi?V,et al.Ultrastructure and immunohistochemistry of the trigeminal peripheral myelinated axons in patients with neuralgia[J].Clin Neurol Neurosurg,2009,111(10):795-800.
[4]马天明,韩宪伟.带状疱疹患者血清神经元特异性烯醇化酶水平的变化及意义[J].实用临床医药杂志,2017,21(13):100-102.
[5]Thelin EP,Zeiler FA,Ercole A,et al.Serial sampling of serum protein biomarkers for monitoring human traumatic brain injury dynamics:a systematic review[J].Front Neurol,2017,8(7):300.
[6]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:259-260.
[7]中华医学会.临床诊疗指南·皮肤病与性病分册[M].北京:人民卫生出版社,2006:2-4.
[8]中国针灸学会.循证针灸临床实践指南:带状疱疹(修订版)[M].北京:中国中医药出版社,2014:12-13.
[9]Coplan PM,Schmader K,Nikas A,et al.Development of a measure of the burden of pain due to herpes zoster and postherpetic neuralgia for prevention trials:adaptation of the brief pain inventory[J].J Pain,2004,5(6):344-356.
[10]Farrar JT,Young JP,LaMoreaux L,et al.Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale[J].Pain,2001,94(2):149-158.
[11]EuroQol Group.EuroQol-a new facility for the measurement of health-related quality of life[J].Health Policy,1990,16(3):199-208.
[12]张曼.穴位注射治疗带状疱疹临床研究[J].中医学报,2014,29(3):448-449.
[13]Xu G,Xu S,Tang WZ,et al.Local injection of methylcobalamin combined with lidocaine for acute herpetic neuralgia[J].Pain Med,2016,17(3):572-581.
[14]Ni J,Wang X,Tang Y,et al.Subcutaneous injection of triamcinolone and lidocaine to prevent postherpetic neuralgia[J].Pain Physician,2017,20(5):397-403.
[15]Casale R,Mattia C.Building a diagnostic algorithm on localized neuropathic pain(LNP)and targeted topical treatment:focus on5%lidocaine-medicated plaster[J].Ther Clin Risk Manag,2014,10(4):259-268.
[16]Petersen KL,Rice FL,Farhadi M,et al.Natural history of cutaneous innervation following herpes zoster[J].Pain,2010,150(1):75-82.
[17]Kennedy PG.Viruses,apoptosis,and neuroinflammation-a double-edged sword[J].J Neurovirol,2015,21(1):1-7.
[18]Hamza MA,Higgins DM,Ruyechan WT.Two alphaherpesvirus latency-associated gene products influence calcitonin gene-related peptide levels in rat trigeminal neurons[J].Neurobiol Dis,2007,25(3):553-560.
[19]刘太华,唐丽君,周舟,等.血清降钙素基因相关肽、5-羟色胺浓度与带状疱疹疼痛程度相关性分析[J].实用皮肤病学杂志,2014,7(4):256-258.
[20]童晓云,陈益丹,吴小萍,等.针刺联合西药治疗带状疱疹的临床观察及其对血浆P物质的影响[J].中国中西医结合皮肤性病学杂志,2010,9(4):225-227.
[21]杨莉,陈丽平.针灸治疗带状疱疹的临床研究现状[J].湖南中医杂志,2015,31(3):182-183.
[22]刘勤.泛昔洛韦治疗带状疱疹临床效果及对患者T细胞亚群、细胞因子和疼痛物质P的影响[J].临床和实验医学杂志,2016,15(21):2126-2129.
[2]郝蓬亮,杨一玲,关玲.刺络拔罐加围刺法对急性期带状疱疹患者末梢和局部血炎性相关指标的影响[J].中国针灸,2016,36(1):37-40.
[3]Marinkovi?S,Gibo H,Todorovi?V,et al.Ultrastructure and immunohistochemistry of the trigeminal peripheral myelinated axons in patients with neuralgia[J].Clin Neurol Neurosurg,2009,111(10):795-800.
[4]马天明,韩宪伟.带状疱疹患者血清神经元特异性烯醇化酶水平的变化及意义[J].实用临床医药杂志,2017,21(13):100-102.
[5]Thelin EP,Zeiler FA,Ercole A,et al.Serial sampling of serum protein biomarkers for monitoring human traumatic brain injury dynamics:a systematic review[J].Front Neurol,2017,8(7):300.
[6]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:259-260.
[7]中华医学会.临床诊疗指南·皮肤病与性病分册[M].北京:人民卫生出版社,2006:2-4.
[8]中国针灸学会.循证针灸临床实践指南:带状疱疹(修订版)[M].北京:中国中医药出版社,2014:12-13.
[9]Coplan PM,Schmader K,Nikas A,et al.Development of a measure of the burden of pain due to herpes zoster and postherpetic neuralgia for prevention trials:adaptation of the brief pain inventory[J].J Pain,2004,5(6):344-356.
[10]Farrar JT,Young JP,LaMoreaux L,et al.Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale[J].Pain,2001,94(2):149-158.
[11]EuroQol Group.EuroQol-a new facility for the measurement of health-related quality of life[J].Health Policy,1990,16(3):199-208.
[12]张曼.穴位注射治疗带状疱疹临床研究[J].中医学报,2014,29(3):448-449.
[13]Xu G,Xu S,Tang WZ,et al.Local injection of methylcobalamin combined with lidocaine for acute herpetic neuralgia[J].Pain Med,2016,17(3):572-581.
[14]Ni J,Wang X,Tang Y,et al.Subcutaneous injection of triamcinolone and lidocaine to prevent postherpetic neuralgia[J].Pain Physician,2017,20(5):397-403.
[15]Casale R,Mattia C.Building a diagnostic algorithm on localized neuropathic pain(LNP)and targeted topical treatment:focus on5%lidocaine-medicated plaster[J].Ther Clin Risk Manag,2014,10(4):259-268.
[16]Petersen KL,Rice FL,Farhadi M,et al.Natural history of cutaneous innervation following herpes zoster[J].Pain,2010,150(1):75-82.
[17]Kennedy PG.Viruses,apoptosis,and neuroinflammation-a double-edged sword[J].J Neurovirol,2015,21(1):1-7.
[18]Hamza MA,Higgins DM,Ruyechan WT.Two alphaherpesvirus latency-associated gene products influence calcitonin gene-related peptide levels in rat trigeminal neurons[J].Neurobiol Dis,2007,25(3):553-560.
[19]刘太华,唐丽君,周舟,等.血清降钙素基因相关肽、5-羟色胺浓度与带状疱疹疼痛程度相关性分析[J].实用皮肤病学杂志,2014,7(4):256-258.
[20]童晓云,陈益丹,吴小萍,等.针刺联合西药治疗带状疱疹的临床观察及其对血浆P物质的影响[J].中国中西医结合皮肤性病学杂志,2010,9(4):225-227.
[21]杨莉,陈丽平.针灸治疗带状疱疹的临床研究现状[J].湖南中医杂志,2015,31(3):182-183.
[22]刘勤.泛昔洛韦治疗带状疱疹临床效果及对患者T细胞亚群、细胞因子和疼痛物质P的影响[J].临床和实验医学杂志,2016,15(21):2126-2129.