高渗葡萄糖增殖疗法治疗带状疱疹后遗神经痛的效果和安全性

doi:10.3969/j.issn.1674-8115.2024.02.008

摘要/Abstract

摘要：

目的·探讨高渗葡萄糖增殖疗法（hypertonic dextrose prolotherapy，DPT）治疗带状疱疹后遗神经痛（postherpetic neuralgia，PHN）的效果和安全性。方法·选取2019年6月—2022年12月于徐州医科大学附属医院疼痛科就诊的PHN患者78例，将患者按照1∶1随机分配至对照组和研究组，每组各39例。对照组采用传统镇痛液治疗，研究组采用传统镇痛液联合DPT治疗。采用视觉模拟评分（visual analogue scale，VAS）评估患者治疗前后的疼痛程度，使用流式细胞仪测定患者T细胞亚群情况，使用酶联免疫吸附试验（enzyme-linked immunosorbent assay，ELISA）测定C反应蛋白（C-reactive protein，CRP）、白介素-6（interleukin-6，IL-6）及IL-10细胞因子水平。比较2组患者在治疗前，治疗后1、2、4、8及12周的VAS评分，治疗前和治疗2周后的CD4⁺/CD8⁺比值，CRP、IL-6、IL-10水平及不良反应发生情况。结果·2组患者的性别比例、年龄、病程差异无统计学意义。2组患者治疗后1、2、4、8及12周的疼痛评分均显著低于治疗前，差异均具有统计学意义（均P<0.05）。研究组治疗后1、2、4、8及12周的疼痛评分均显著低于对照组（均P<0.05）。2组患者治疗前CD4⁺/CD8⁺、CRP、IL-6及IL-10水平差异无统计学意义。治疗后研究组的IL-6、CRP水平低于对照组，差异有统计学意义（均P=0.000）；治疗后研究组的CD4⁺/CD8⁺、IL-10水平高于对照组，差异具有统计学意义（均P=0.000）。2组患者在治疗过程中均未发生局部神经损伤、硬膜外血肿、感染、气胸、过敏等不良反应。结论·DPT可以明显缓解PHN患者疼痛，改善患者T淋巴细胞亚群和细胞因子表达，可安全应用于临床。

关键词: 高渗葡萄糖增殖疗法, 带状疱疹后神经痛, T细胞计数, 细胞因子

Abstract:

Objective ·To investigate the efficacy and safety of hypertonic dextrose prolotherapy (DPT) in the treatment of postherpetic neuralgia. Methods ·Seventy-eight patients with postherpetic neuralgia who visited the Department of Pain of The Affiliated Hospital of Xuzhou Medical University from June 2019 to December 2022 were selected. The patients were randomly assigned to a control group and a research group in a 1∶1 ratio, with 39 patients in each group. The control group was treated with traditional analgesic solution, while the research group was treated with traditional analgesic solution combined with DPT. Visual analog scale (VAS) was used to evaluate the patients' pain level before and after treatment, flow cytometry was used to measure the patients' T-cell subsets, and enzyme-linked immunosorbent assay (ELISA) was used to measure the levels of C-reactive protein (CRP), interleukin-6 (IL-6), and IL-10 cytokines. The VAS scores were compared between the two groups of patients before and at 1, 2, 4, 8, and 12 weeks after treatment. CD4⁺/CD8⁺, CRP, IL-6, IL-10 levels, and the incidence of adverse reactions before and 2 weeks after treatment were compared between the two groups. Results ·There was no statistically significant difference in sex ratio, age, and disease duration between the two groups of patients. The VAS scores of the two groups of patients at 1, 2, 4, 8, and 12 weeks after treatment were significantly lower than those before treatment, and the differences were statistically significant (all P<0.05). The VAS scores of the research group at 1, 2, 4, 8, and 12 weeks after treatment were significantly lower than those of the control group (all P<0.05). There was no statistically significant difference in basal CD4⁺/CD8⁺, CRP, IL-6 and IL-10 levels between the two groups of patients. IL-6 and CRP levels in the research group were significantly lower after treatment than those in the control group, and the differences were statistically significant (all P=0.000). CD4⁺/CD8⁺ and IL-10 levels were significantly higher in the research group than those in the control group after treatment, and the difference was statistically significant (all P=0.000). No adverse reactions such as local nerve damage, epidural hematoma, infection, pneumothorax or allergy occurred in both groups of patients during the treatment. Conclusion ·DPT can significantly reduce the pain of PHN patients, improve patients' T lymphocyte subpopulations and cytokine expression, and can be safely applied to the clinic.

Key words: hypertonic dextrose prolotherapy (DPT), postherpetic neuralgia (PHN), T cell count, cytokine

中图分类号:

R752.12

殷琴, 陈立平, 许恒, 袁燕, 梁栋, 申文. 高渗葡萄糖增殖疗法治疗带状疱疹后遗神经痛的效果和安全性[J]. 上海交通大学学报（医学版）, 2024, 44(2): 223-227.

YIN Qin, CHEN Liping, XU Heng, YUAN Yan, LIANG Dong, SHEN Wen. Efficacy and safety of hypertonic dextrose prolotherapy for patients with post-herpetic neuralgia[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(2): 223-227.

图/表 3

参考文献 17

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Time	Control group	Research group	P_{group effect-simple}
Before treatment	7 (5, 8)	6 (6, 7)	0.591
1 week after treatment	4 (3, 4)	4 (3, 4)	0.002
2 weeks after treatment	4 (3, 4)	3 (3, 3)	0.000
4 weeks after treatment	4 (3, 4)	2 (2, 3)	0.000
8 weeks after treatment	4 (3, 4)	2 (2, 2)	0.000
12 weeks after treatment	4 (3, 4)	2 (2, 2)	0.000
P_{time effect-simple}	0.000	0.000	‒

Time	Control group	Research group	P_{group effect-simple}
Before treatment	7 (5, 8)	6 (6, 7)	0.591
1 week after treatment	4 (3, 4)	4 (3, 4)	0.002
2 weeks after treatment	4 (3, 4)	3 (3, 3)	0.000
4 weeks after treatment	4 (3, 4)	2 (2, 3)	0.000
8 weeks after treatment	4 (3, 4)	2 (2, 2)	0.000
12 weeks after treatment	4 (3, 4)	2 (2, 2)	0.000
P_{time effect-simple}	0.000	0.000	‒

Index	Control group	Research group	P value
CRP/(mg·mL^-1)
Before	25.80±3.46	26.10±3.85	0.725
After	10.30±1.57^①	4.70±0.85^②	0.000
IL-6/(pg·mL^-1)
Before	83.80±10.85	86.70±12.44	0.280
After	26.30±3.73^①	11.70±1.49^②	0.000
IL-10/(µg·mL^-1)
Before	0.84±0.16	0.79±0.13	0.115
After	3.90±0.55	11.60±1.50	0.000
CD4⁺/CD8⁺
Before	0.99±0.14	1.04±0.16	0.142
After	1.45±0.19	1.98±0.37	0.000

Index	Control group	Research group	P value
CRP/(mg·mL^-1)
Before	25.80±3.46	26.10±3.85	0.725
After	10.30±1.57^①	4.70±0.85^②	0.000
IL-6/(pg·mL^-1)
Before	83.80±10.85	86.70±12.44	0.280
After	26.30±3.73^①	11.70±1.49^②	0.000
IL-10/(µg·mL^-1)
Before	0.84±0.16	0.79±0.13	0.115
After	3.90±0.55	11.60±1.50	0.000
CD4⁺/CD8⁺
Before	0.99±0.14	1.04±0.16	0.142
After	1.45±0.19	1.98±0.37	0.000

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