揿针围刺辅助治疗肝经郁热型蛇串疮疗效观察
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摘要
目的:观察揿针围刺辅助西药治疗与单纯西药治疗肝经郁热型蛇串疮的疗效差异。方法:将60例肝经郁热型蛇串疮患者采用随机数字表法分为观察组和对照组,每组30例。两组患者均给予盐酸伐昔洛韦分散片(每次口服0.3 g,每日2次)、甲钴胺片(每次口服0.5 mg,每日3次)、维生素B1(每次口服10 mg,每日3次),连续15 d。观察组同时根据疱疹的面积,在疱疹周围1 cm处进行埋针,两个揿针间隔3 cm。每3天埋针1次,每次留针48 h,休息1 d,共治疗5次(15 d)。评估两组患者治疗前后疱疹评价指标(止疱时间、结痂时间、脱痂时间)、视觉模拟量表(VAS)评分、血清免疫相关因子[免疫球蛋白G(IgG)、免疫球蛋白M(IgM)和免疫球蛋白A(IgA)]和血清炎性反应相关因子[白细胞介素4(IL-4)、白细胞介素17(IL-17)、肿瘤坏死因子α(TNF-α)和转化生长因子β1(TGF-β1)]指标变化。结果:观察组的止疱时间、结痂时间及脱痂时间均短于对照组(均P<0.05)。两组治疗后VAS评分均较治疗前降低(均P<0.05),治疗后组间比较差异无统计学意义(P>0.05),但观察组VAS评分治疗前后差值高于对照组(P<0.05)。两组治疗后血清免疫相关因子IgG、IgM和IgA含量均较治疗前升高(均P<0.05),且观察组治疗后血清IgG、IgM和IgA含量均高于对照组(均P<0.05)。两组治疗后炎性反应相关因子血清IL-4、IL-17、TNF-α和TGF-β1水平均较治疗前降低(均P<0.05),且观察组治疗后血清IL-4、IL-17、TNF-α和TGF-β1水平均低于对照组(均P<0.05)。结论:揿针围刺辅助西药治疗肝经郁热型蛇串疮优于单纯西药治疗,起效快、镇痛效果好,可改善血清免疫相关因子,减轻炎性反应。
Objective To compare the efficacy difference between thumb-tack acupuncture with surrounding needling method plus medication and medication alone for herpes zoster(HZ) of stagnated heat in liver meridian type. Methods According to random number table method, 60 patients with HZ of stagnated heat in liver meridian type were randomly divided into an observation group and a control group, 30 cases in each one. All the patients were treated with oral valaciclovir hydrochloride dispersible tablets(0.3 g per time, twice per day), mecobalamin tablets(0.5 mg per time, three times a day) and vitamin B1(10 mg per time, three times a day) for 15 days. In addition, the patients in the observation group were treated with thumb-tack acupuncture at area 1 cm outside the herpes, with an interval of 3 cm between thumb-tack needles. The thumb-tack acupuncture was given once every 3 days, retained for 48 h, with an interval of 1 day between treatments, and totally 5 treatments were given. The index of herpetic evaluation(stopping time of herpes, scarring time, decrustation time), visual analogue scale(VAS), serum immune-related factors(IgG, IgM, IgA) and serum inflammatory factors(IL-4, IL-17, TNF-α, TGF-β1) were observed before and after treatment in the two groups. Results After treatment, the stopping time of herpes, scarring time, decrustation time in the observation group were shorter than those in the control group(all P<0.05). Compared before treatment, the VAS score in the two groups were reduced after treatment(both P<0.05), and no significant difference was observed between the two groups(P>0.05), but the difference before and after treatment in the observation group was superior to that in the control group(P<0.05).Compared before treatment, the levels of serum immune-related factors IgG, IgM, IgA were increased in the two groups after treatment(all P<0.05), and the levels in the observation group after treatment were higher than those in the control group(all P<0.05). Compared before treatment, the levels of serum inflammatory factors IL-4, IL-17, TNF-α, TGF-β1 were reduced in the two groups after treatment(all P<0.05), and the levels in the observation group after treatment were lower than those in the control group(all P<0.05). Conclusion The thumb-tack acupuncture with surrounding needling method plus medication have the advantages of rapid onset and analgesic effect for HZ of stagnated heat in liver meridian type, which could also improve serum immune-related factors and reduce inflammatory reaction.
Objective To compare the efficacy difference between thumb-tack acupuncture with surrounding needling method plus medication and medication alone for herpes zoster(HZ) of stagnated heat in liver meridian type. Methods According to random number table method, 60 patients with HZ of stagnated heat in liver meridian type were randomly divided into an observation group and a control group, 30 cases in each one. All the patients were treated with oral valaciclovir hydrochloride dispersible tablets(0.3 g per time, twice per day), mecobalamin tablets(0.5 mg per time, three times a day) and vitamin B1(10 mg per time, three times a day) for 15 days. In addition, the patients in the observation group were treated with thumb-tack acupuncture at area 1 cm outside the herpes, with an interval of 3 cm between thumb-tack needles. The thumb-tack acupuncture was given once every 3 days, retained for 48 h, with an interval of 1 day between treatments, and totally 5 treatments were given. The index of herpetic evaluation(stopping time of herpes, scarring time, decrustation time), visual analogue scale(VAS), serum immune-related factors(IgG, IgM, IgA) and serum inflammatory factors(IL-4, IL-17, TNF-α, TGF-β1) were observed before and after treatment in the two groups. Results After treatment, the stopping time of herpes, scarring time, decrustation time in the observation group were shorter than those in the control group(all P<0.05). Compared before treatment, the VAS score in the two groups were reduced after treatment(both P<0.05), and no significant difference was observed between the two groups(P>0.05), but the difference before and after treatment in the observation group was superior to that in the control group(P<0.05).Compared before treatment, the levels of serum immune-related factors IgG, IgM, IgA were increased in the two groups after treatment(all P<0.05), and the levels in the observation group after treatment were higher than those in the control group(all P<0.05). Compared before treatment, the levels of serum inflammatory factors IL-4, IL-17, TNF-α, TGF-β1 were reduced in the two groups after treatment(all P<0.05), and the levels in the observation group after treatment were lower than those in the control group(all P<0.05). Conclusion The thumb-tack acupuncture with surrounding needling method plus medication have the advantages of rapid onset and analgesic effect for HZ of stagnated heat in liver meridian type, which could also improve serum immune-related factors and reduce inflammatory reaction.
引文
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[20]李绍康,周德华,王涵,等.围刺法治疗骶髂关节致密性骨炎临床研究[J].新中医,2014,46(8):163-165.
[21]邹魁,张立明,冯曼玲.针刺肾俞穴联合局部围刺治疗黄褐斑的疗效[J].武警医学,2016,27(8):761-763.
[22]吕中茜,郭义.反观中医临床提出“皮肤是人的第三大脑”[J].江西中医药,2016,47(7):11-13.
[23]Muthana SM,Xia L,Campbell CT,et al.Competition between Serum IgG,IgM,and IgA anti-Glycan antibodies[J].PLoS One,2015,3(10):118-126.
[24]Chlibek R,Pauksens K,Rombo L,et al.Longterm immunogenicity and safety of an nvestigational herpes zoster subunit vaccine in older adults[J].Vaccine,2016,34(6):863-868.
[25]Luchting B,Rachinger-Adam B,Heyn J,et al.Anti-inflammatory T-cell shift in neuropathic pain[J].J Neuroinflammation,2015,12(1):12-17.
[2]Bricout H,Perinetti E,Marchettini P,et al.Burden of herpes zoster-associated chronic pain in Italian patients aged 50 years and over(2009-2010):a GP-based prospective cohort study[J].BMC Infect Dis,2014,14:637.
[3]Gnaim JW Jr,Whitly RJ.Clinical practice.Herpes zoster[J].NEngl J Med,2002,347(5):340-346.
[4]Oster G,Harding G,Dukes E,et al.Pain,medicationn use and health-related quality of life in older persons with posthrpetic neuralgia:results from a populationbased survey[J].J Pain,2005,6(6):356-363.
[5]Robert W,Marie-JoséAlvarez-Pasquin,Marc Bijl,et al.Herpes zoster epidemiology,management,and disease and economic burden in Europe:a multidisciplinary perspective[J].Ther Adv Vaccines,2015,3(4)109-120.
[6]Studahl M,Petzold M,Cassel T.Disease burden of herpes zoster in Sweden-predominance in the elderly and in women-a register based study[J].BMC Infect Dis,2013,12(13):586.
[7]彭唯娜,刘志顺,邓艳华,等.针灸治疗带状疱疹文献质量评价与施治规律探讨[J].中国针灸,2008,28(2):147-150.
[8]高寅秋,李辛洁,贾擎,等.皮内针疗法在疼痛治疗中的应用[J].北京中医药,2017,36(4):373-375.
[9]张学军.皮肤性病学[M].8版.北京:人民卫生出版社,2016:65-67.
[10]中华中医药学会皮肤科分会.蛇串疮中医诊疗指南(2014年修订版)[J].中医杂志,2015,56(13):1163-1168.
[11]María DEV,M Felicitas DB,Ruth GP,et al.Sociodemographic characteristics and chronic medical conditions as risk factors for herpes zoster:a population-based study from primary care in Madrid(Spain)[J].Hum Vaccin Immunother,2014,10(6):1650-1660.
[12]邵伟,伐昔洛韦治疗带状疱疹的有效性和安全性[J].临床医学研究与实践,2018,3(13):36-37.
[13]刘元华,刘源才.火针针刺带状疱疹模型动物“补火助阳”机制的探索性研究[J].时珍国医国药,2017,28(9):2305-2306.
[14]杨惠妮.带状疱疹中西医学疾病特征及相关资料横断面研究[D].广州:广州中医药大学,2010.
[15]韩光,周杰,王晓娟,等.中医药治疗带状疱疹临床研究进展[J].临床医药文献电子杂志,2017,4(30):5935-5936.
[16]陈玉莲.中医药治疗带状疱疹文献评价[D].广州:广州中医药大学,2009.
[17]曾婧纯.针灸治疗带状疱疹的网状Meta优化方案及随机对照研究[D].广州:广州中医药大学,2017.
[18]黄泰铮.揿针埋针疗法治疗背肌筋膜疼痛综合征的临床研究[D].广州:广州中医药大学,2015.
[19]颜雪珍,万欢,李丹丹.围刺配合电针治疗乳腺增生疗效观察[J].上海针灸杂志,2014,33(3):228-230.
[20]李绍康,周德华,王涵,等.围刺法治疗骶髂关节致密性骨炎临床研究[J].新中医,2014,46(8):163-165.
[21]邹魁,张立明,冯曼玲.针刺肾俞穴联合局部围刺治疗黄褐斑的疗效[J].武警医学,2016,27(8):761-763.
[22]吕中茜,郭义.反观中医临床提出“皮肤是人的第三大脑”[J].江西中医药,2016,47(7):11-13.
[23]Muthana SM,Xia L,Campbell CT,et al.Competition between Serum IgG,IgM,and IgA anti-Glycan antibodies[J].PLoS One,2015,3(10):118-126.
[24]Chlibek R,Pauksens K,Rombo L,et al.Longterm immunogenicity and safety of an nvestigational herpes zoster subunit vaccine in older adults[J].Vaccine,2016,34(6):863-868.
[25]Luchting B,Rachinger-Adam B,Heyn J,et al.Anti-inflammatory T-cell shift in neuropathic pain[J].J Neuroinflammation,2015,12(1):12-17.