中药封包联合蜡疗治疗奥沙利铂诱导的轻中度癌性神经病理性疼痛的疗效研究

背景　奥沙利铂诱导的癌性神经病理性疼痛的发病率高，病程持续时间长，西药治疗疗效不佳且不良反应较大，目前传统中药治疗方法为研究热点。目的　观察中药封包联合蜡疗治疗奥沙利铂诱导的轻中度癌性神经病理性疼痛的临床疗效。方法　收集2018年2月-2019年2月辽宁省肿瘤医院中西医结合科门诊、住院部患者中明确诊断为奥沙利铂诱导的轻中度癌性神经病理性疼痛患者65例。按照就诊顺序及电脑随机数字表法，以1∶1比例随机分为试验组32例和对照组33例。试验组给予中药封包配合蜡疗联合盐酸度洛西汀口服，对照组给予盐酸度洛西汀口服，均治疗21 d。观察比较治疗前后两组疼痛数字评价量表（NRS）评分、疼痛缓解情况、周围神经毒性分级情况、肌电图指标、中医症状评分及血清肿瘤坏死因子α（TNF-α）、白介素1β（IL-1β）水平。结果　治疗后试验组NRS评分低于对照组，试验组疼痛缓解情况优于对照组（P<0.05）。治疗后试验组周围神经毒性分级低于对照组（P<0.05）。试验组胫神经和正中神经的运动传导速度（MCV）、感觉传导速度（SCV）快于对照组（P<0.05）。治疗后试验组疼痛、麻木、畏寒肢冷、乏力、遇冷加重评分低于对照组（P<0.05）。治疗后，试验组TNF-α、IL-1β水平低于对照组（P<0.05）。结论　中药封包联合蜡疗治疗奥沙利铂诱导的轻中度癌性神经病理性疼痛疗效确切，可有效缓解疼痛，改善周围神经毒性分级，提高胫神经和正中神经的MCV、SCV，降低中医症状评分及TNF-α、IL-1β水平，且安全性良好。

Clinical Study of Encapsulated Chinese Medicine Combined with Wax Therapy on Oxaliplatin-induced Mild-to-moderate Cancerous Neuropathic Pain

Background　Oxaliplatin-induced cancerous neuropathic pain has a high incidence and long duration.Treatment with western medicine is assessed to be ineffective for it with evident adverse reactions，but traditional Chinese medicine treatment is a research hotspot at present.Objective　To observe and evaluate the clinical efficacy of oxaliplatin-induced mild-to-moderate cancerous neuropathic pain treated by encapsulated Chinese medicine with wax therapy.Methods　65 outpatients and inpatients with oxaliplatin chemotherapy-induced mild-to-moderate cancerous neuropathic pain from Integrated TCM & Western Medicine Department，Liaoning Cancer Hospital were enrolled from February 2018 to February 2019，and were divided into the experimental group（n=32） and control group（n=33） by the order of admission and computer-generated random numbers，receiving encapsulated Chinese medicine，wax therapy and duloxetine hydrochloride enteric-coated tablets，and duloxetine hydrochloride enteric-coated tablets，respectively.The treatment for all cases lasted for 21 days.The treatment outcome was evaluated by pain relief status assessed by NRS score，and VRS score，peripheral neurotoxicity severity assessed by NCI-CTCAE v3.0.2，EMG parameters，TCM symptom score，serum TNF-α and IL-1β levels at the end of treatment.Results　After treatment，compared with the control group，the experimental group showed a lower mean NRS score，better pain relief status，and lower peripheral neurotoxicity grade（P<0.05）.Moreover，the experimental group demonstrated rapider MCV and SCV of tibial nerve and median nerve（P<0.05）.The mean evaluation scores for pain，numbness，aversion to cold，cold extremities，fatigue，and cold-induced exacerbations of symptoms were lower in the experimental group（P<0.05）.The mean TNF-α and IL-1βlevels were also lower in the experimental group（P<0.05）.Conclusion　Encapsulated Chinese medicine with wax therapy showed good effects on oxaliplatin-induced mild-to-moderate cancerous neuropathic pain by relieving pain，improving peripheral neurotoxicity，MCV and SCV of tibial nerve and median nerve，and TNF-α and IL-1β levels，as well as reducing TCM symptoms.Moreover，it also demonstrated good safety.