针刺加穴位注射夹脊穴治疗带状疱疹后遗神经痛的临床研究

带状疱疹是一种非传染性皮肤病,其主要是由水痘-带状疱疹病毒所引起。发病时,患者皮肤起疱疹,轻触皮肤会产生强烈的刺痛、灼痛感,有过敏反应,发病时令人难以忍受,使患者产生焦虑、恐慌、厌烦、失眠等情况,严重影响日常工作与休息。针刺加穴位注射夹脊穴是治疗带状疱疹后遗神经痛的重要疗法,其显著的疗效值得广泛推广。     

阿昔洛韦联合糖皮质激素治疗对带状疱疹后遗神经痛的影响

带状疱疹神经痛是带状疱疹患者的一种严重的并发症，疼痛难忍，严重影响患者的生活质量。笔者应用阿昔洛韦联合泼尼松治疗带状疱疹神经痛，在减轻和预防后遗神经痛方面取得了满意的疗效。现报告如下：     

带状疱疹后遗神经痛的针灸治疗

本人曾在南京中医药大学附属医院进修期间,跟随江苏省名中医盛灿若教授指导的针灸治疗带状疱疹后遗神经痛课题组共同工作,现将其中6个月治疗的病例介绍如下,供同道参考:1临床资料本组病例共42人,其中男性29人,女性13人;病程(指疱疹痊愈消失后,出现神经痛者)在1个月以内者6例;1-     

短时程脊髓电刺激治疗带状疱疹后遗神经痛合并爆发痛的疗效分析

目的探讨短时程脊髓电刺激(SCS)治疗带状疱疹后遗神经痛合并爆发痛的临床疗效分析。方法回顾性分析2016年4月至2019年4月我科收治的33例带状疱疹后遗神经痛合并爆发痛患者的临床资料,在治疗前、治疗后1 d、1周、2周、1个月、3个月分别采用MPQ疼痛询问量表、数字化疼痛评分(NRS)、爆发性疼痛(BTP)次数、匹兹堡睡眠质量指数(PSQI)对其进行疗效分析评估。结果MPQ量表评分显示,治疗后1 d、1周、2周与术前比较,差异有统计学意义(P<0.05),治疗后1个月、3个月同治疗前比较,差异有极显著性统计学意义(P<0.01);治疗后1 d、1周、2周随访NRS、BTP次数及PSQI评分同治疗前比较,差异有统计学意义(P<0.05),治疗后1个月、3个月与治疗前比较,差异有极显著性统计学意义(P<0.01),且随着随访时间的延长评分呈持续下降趋势。结论脊髓电刺激对带状疱疹后遗神经痛合并爆发痛有较好的临床镇痛疗效。     

加巴喷丁胶囊联合普瑞巴林治疗带状疱疹的疗效及对后遗神经痛不良反应的影响

目的:探究加巴喷丁胶囊联合普瑞巴林治疗带状疱疹的疗效及对后遗神经痛不良反应的影响。方法:选取56例带状疱疹患者,随机分为两组,对照组仅给予普瑞巴林治疗,实验组在对照组的基础上给予加巴喷丁胶囊治疗,观察两组患者疗效及不良反应发生。结果:治疗后,实验组疼痛评分、胀痛评分均低于对照组,临床治疗有效率(92.86%)显著高于对照组(75.00%),差异均具有统计学意义(P<0.05),但两组不良反应发生情况比较,差异无显著差异(P>0.05)。结论:带状疱疹患者经加巴喷丁胶囊联合普瑞巴林治疗临床效果显著,不良反应少,值得临床推广。     

带状疱疹所致神经痛的中西医结合治疗进展

带状疱疹(herpes zoster,HZ)是由水痘-带状疱疹病毒(varicella-zostervirus,VZV)引起,沿周围神经单侧分布,表现为在红斑基础上,出现带状分布的簇集性水泡,并伴明显的神经痛.当治疗不及时或者病毒含量高、患者免疫功能低下时,部分患者在疱疹消退后,受累部位出现长期而明显神经痛,称为带状疱疹后遗神经痛(postherpetic neuralgia,PHN)[1].本病迁延难愈,往往单一的治疗手段难以明显改善疼痛,患者的生活质量受到极大影响.本文综述了采用中西医结合方法治疗PHN的最新进展,以期对治疗PHN带来一些启示.     

半导体激光联合甲钴胺片治疗带状疱疹后遗神经痛临床观察

带状疱疹后遗神经痛(postherpetic neuralgia,PHN)是急性带状疱疹临床治愈后疼痛持续超过一个月及以上时间 [1],多发生于中老年,严重影响生活质量.笔者采用半导体激光联合甲钴胺治疗PHN,取得较理想的疗效,现报告如下……     

肉毒素A联合加巴喷丁治疗带状疱疹后神经痛的临床观察

目的：探讨皮下注射肉毒素A联合口服加巴喷丁片治疗带状疱疹后神经痛的临床疗效观察。方法选取2010年6月~2014年3月在我院治疗的带状疱疹后神经痛患者120例,按入院序号分成观察组和对照组1、2,每组40例,观察组采用皮下注射肉毒素A联合口服加巴喷丁片治疗;对照组1采用皮下注射肉毒素A治疗;对照组2采用口服加巴喷丁片治疗,观察三组患者的临床疗效、治疗前后疼痛评分及药物不良反应。结果观察治疗后2 w、1个月及3个月后三组患者VAS评分情况,三组患者治疗后VAS评分均有明显改善,有统计学意义(<0.05)。结论皮下注射肉毒素A联合口服加巴喷丁片在治疗带状疱疹后神经痛不仅能够有效缓解患者剧烈疼痛等临床症状,还能提高患者生存质量,且治疗过程未见明显不良反应,达到了安全又有效的目标。     

针推颈夹脊穴为主结合牵引治疗神经根型颈椎病的临床观察

目的 比较针灸推拿颈夹脊穴为主结合牵引和单纯针灸治疗神经根型颈椎病的疗效.方法将60例神经根型颈椎病患者按就诊顺序分为治疗组和对照组,观察不同的治疗方法对神经根型颈椎病的影响.结果在疗效方面,治疗组疗效优于对照组(P＜0.05);与对照组相比较,治疗组镇痛效果更显著(P＜0.05).结论 针灸推拿颈夹脊穴为主结合牵引和单纯针灸治疗神经根型颈椎病都有一定的疗效,针灸推拿颈夹脊穴为主结合牵引在治疗效果和镇痛方面效果优于单纯针灸治疗.     

褪黑素对带状疱疹后遗神经痛大鼠T细胞亚群及IL-2、TNF-α表达的影响

目的 分析褪黑素分泌减少对带状疱疹后遗神经痛(PHN)大鼠T细胞亚群及IL-2、TNF-α表达的影响.方法 雄性SD大鼠40只,根据随机数字表分为4组,每组10只,分别为空白对照组,该组大鼠不造模亦不采取任何治疗措施;假手术组,该组大鼠仅暴露松果体;非治疗组,该组大鼠去松果体并接种HSV-1病毒;治疗组,该组大鼠去除松果体+接种HSV-1病毒+腹腔注射外源性褪黑素120mg/(kg.d).接种病毒前以及接种后1、14、30d对各组大鼠进行机械痛觉评分(MPRS)并记录非治疗组与治疗组组大鼠PHN发病情况;采用ELISA法检测接种病毒前、接种后1、14、30d各组大鼠外周血褪黑素水平改变;采用流式细胞技术于接种病毒后30d检测各组大鼠外周血T细胞亚群水平改变.结果 接种病毒后14d以及30d,各组大鼠褪黑素水平表现为非治疗组显著低于治疗组和空白组,差异有统计学意义(P＜0.05).接种病毒30d,CD3+,CD4+细胞数以及CD4+/CD8+均表现非治疗组显著低于治疗组和空白组,差异有统计学意义(P均＜0.05);CD8+细胞数表现为非治疗组显著高于治疗组和空白组,差异有统计学意义(P均＜0.05).接种病毒30d,IL-2、TNF-α水平均表现为非治疗组显著低于治疗组和空白组,差异有统计学意义(P均＜0.05).结论 褪黑素减少会导致带状疱疹后遗神经痛大鼠T细胞亚群失衡,影响机体免疫功能的发挥,同时会降低多种细胞因子的水平,降低免疫炎症反应;外源褪黑素能显著改善上述改变,提示褪黑素可能存在对PHN的免疫治疗作用.     

Acute herpes zoster and postherpetic neuralgia: effects of acyclovir and outcome of treatment with amitriptyline.

This retrospective study was designed to assess the effects of acyclovir treatment of acute herpes zoster on subsequent postherpetic neuralgia, and to examine the effects of amitriptyline in the treatment of postherpetic neuralgia. Eighty seven patients with postherpetic neuralgia of three or more months' duration were studied: 24 of them had had their herpes zoster treated with oral acyclovir. At first presentation, only 25% of the 24 patients who had had their herpes zoster treated with acyclovir selected the word group containing burning on the McGill pain questionnaire compared with 76% of the 63 patients who had not received acyclovir. A higher proportion of patients who had had acyclovir than had not selected the word group which contains the word aching (63% versus 49%). Acyclovir thus appears to change the nature of postherpetic neuralgia. Postherpetic neuralgia was treated with amitriptyline, alone or in combination with distigmine and/or sodium valproate. There was a strong correlation between pain relief and the interval between the occurrence of herpes zoster and the initiation of treatment with amitriptyline--early treatment is almost twice as likely to be successful as late. Since conventional analgesics and sympatholytic drugs are of no benefit in the treatment of established postherpetic neuralgia, the sequelae of herpes zoster must, therefore, be recognized and treated with amitriptyline as soon as possible.     

Association of human leukocyte antigen with postherpetic neuralgia in Koreans

Postherpetic neuralgia (PHN), the most frequent complication of varicella‐zoster virus reactivation, is characterized by pain that persists for more than 3 months, often for years after healing of zoster rash. A few studies revealing the association of human leukocyte antigen (HLA) with PHN have been reported, but only in the Japanese. The aim of this study was to investigate the primary HLA locus associated with PHN susceptibility in Koreans. We compared HLA‐A, ‐B, ‐C, and DRB1 genotypes of 66 PHN patients with those of 54 herpes zoster (HZ) patients without developing PHN and 235 healthy controls. Frequencies of HLA‐B*13, B*44, B*15 (B75), DRB1*10:01, and DRB1*12:02 were increased, and those of HLA‐C*01, C*12, and DRB1*01:01 were decreased in PHN patients compared to those in controls (each, p < 0.05). Among these alleles, only the frequency of HLA‐B*44 was significantly increased in PHN patients compared to that in HZ patients and the change was due to HLA‐B*44:03 (PHN vs controls, p = 0.043; PHN vs HZ, p = 0.012). The results suggest that HLA‐B*44:03 or other closely linked gene of the major histocompatibility complex is associated with susceptibility to the development of PHN after HZ, but not with the onset of HZ.     

A double-blind, placebo-controlled study of oral acyclovir in postherpetic neuralgia

Twenty-one patients with postherpetic neuralgia of two- to 84-months duration participated in a double-blind, placebo-controlled study of oral acyclovir. Pain perception was assessed with the Melzack Pain Questionnaire at baseline and at two-to six-week intervals during the ensuing six months. Clinically significant pain reduction occurred in eight patients: four received acyclovir, and four received a placebo. Several treatment strategies have been advocated for relief of postherpetic neuralgia. Results of the present study demonstrate the need for a double-blind, placebo-controlled paradigm to substantiate the efficacy of new clinical approaches. The same caveat applies to the more common syndromes encountered in psychiatric practice.     

A study of shingles and the development of postherpetic neuralgia in East London

The incidence of post-herpetic neuralgia following shingles and the factors that are known to predict it were examined in a prospective observational community study of patients with acute shingles presenting to their family doctors. The detection of viral DNA in the blood at presentation as a prognostic indicator for pain was also evaluated. Patients were followed for one year and the persistence of pain following rash assessed. Among 165 patients who had completed 6 months, and 139 one-year follow-up, the prevalence of post herpetic neuralgia was 30% at 6 weeks 27% at 12 weeks, 15.9% at 6 months, and 9% at one year. Age and severity of pain were significantly associated with the persistence of pain beyond 3 months. Viremia at presentation was detected in 66% of patients and was significantly associated with the presence of pain at six months or beyond. Antiviral agents were administered to only 50% of those at highest risk of post-herpetic neuralgia (PHN) mainly because of presentation longer than 72 hours after the onset of rash. Few patients were prescribed the more potent prodrugs, Valaciclovir and Famciclovir. In conclusion, treatment of acute shingles in this observational community-based study was suboptimal in 50% of cases. More accurate prediction of which subset of elderly patients are most at risk of PHN may enable targeted prescribing of the most potent drugs to those most likely to benefit.     

Metformin use and the risks of herpes zoster and postherpetic neuralgia in patients with type 2 diabetes

Herpes zoster and postherpetic neuralgia cause substantial pain in patients. Persons with type 2 diabetes (T2D) are prone to zoster infection and postherpetic neuralgia due to compromised immunity. We conducted this study to evaluate the risks of herpes zoster and postherpetic neuralgia between metformin users and nonusers. Propensity score matching was utilized to select 47 472 pairs of metformin users and nonusers from Taiwan's National Health Insurance Research Database between January 1, 2000, and December 31, 2017. The Cox proportional hazards models were used for comparing the risks of herpes zoster and postherpetic neuralgia between metformin users and nonusers in patients with T2D. Compared with no-use of metformin, the adjusted hazard ratios (95% confidence interval) for metformin use in herpes zoster and postherpetic neuralgia were 0.70 (0.66, 0.75) and 0.510 (0.39, 0.68), respectively. A higher cumulative dose of metformin had further lower risks of herpes zoster and postherpetic neuralgia than metformin no-use. This nationwide cohort study demonstrated that metformin use was associated with a significantly lower risk of herpes zoster and postherpetic neuralgia than metformin no-use. Moreover, a higher cumulative dose of metformin was associated with further lower risks of these outcomes.     

Local immune responses and systemic cytokine responses in zoster: relationship to the development of postherpetic neuralgia

Varicella zoster virus (VZV) causes varicella (chickenpox) as the primary infection and zoster (shingles) on reactivation from latency, often many years later. One of the most common and most severe sequela of zoster is postherpetic neuralgia (PHN). Apart from age, factors which predispose towards PHN are unknown. In the present study, the concentration of a variety of Th1 and Th2 cytokines in the serum of 30 zoster patients at the time of the acute disease were correlated with the subsequent development of PHN in nine of these patients, but no association was found. In addition, although some cytokines such as IFN-gamma, IL-6 and IL-8 were slightly raised in the zoster group compared with a group of normal healthy subjects of a similar age distribution, these differences only verged on significance. Antibody titres to VZV were raised in the zoster group compared with the controls but these did not differ between the patients who developed PHN and those who did not. Biopsies of zoster lesions were collected from nine patients. There were significantly fewer infiltrating lymphocytes in the lesions of the three patients who subsequently developed PHN compared with the six who did not, although the expression of the neuropeptide, substance P, did not differ between the two groups. It is possible that the poor inflammatory response at the time of the acute zoster may result in less effective containment of the VZV and more damage in the dermatome, thus contributing to the persistence of the neuralgia.     

玉屏风颗粒联合常规对症治疗儿童反复呼吸道感染的meta分析

目的：评价玉屏风颗粒联合常规对症治疗对于儿童反复呼吸道感染的疗效。方法：计算机检索CNKI、VIP、WANFANG DATA、Sinomed以及PubMed、EMBASE、the Cochrane Library等,收集玉屏风颗粒对儿童反复呼吸道感染的疗效和免疫功能影响的随机对照研究,检索时限截止至2016年5月。由2位研究者按照纳入与排除标准筛选文献,提取数据和评价纳入研究的方法学质量后,采用RevMan 5.3软件进行meta分析。结果：共纳入18个研究,1845例患者。与对照组(常规对症治疗)相比,治疗组(常规对症治疗+玉屏风颗粒)在提升总有效率、抗体水平和T细胞水平上具有明显优势。结论：玉屏风颗粒联合常规对症治疗儿童反复呼吸道感染的总体疗效优于单纯常规对症治疗。但是由于文献的质量不高,仍需要大样本双盲随机试验的理论支持。