中国针灸

目的：观察腕踝针治疗带状疱疹后神经痛（PHN）的临床疗效及对患者血清电压门控钠通道1.7(NaV1.7)、降钙素基因相关肽（CGRP）含量的影响。方法：将90例PHN患者随机分为腕踝针组（45例，脱落2例）和西药组（45例，脱落1例，中止1例）。西药组予局部外用5%利多卡因凝胶贴膏；腕踝针组予腕踝针治疗，每次30 min，每日1次，连续5 d为一疗程，疗程间休息2 d。两组均治疗4周。分别于治疗前、治疗2周后、治疗4周后及治疗结束后4周随访观察两组患者疼痛视觉模拟量表（VAS）、匹兹堡睡眠质量指数（PSQI）、焦虑自评量表（SAS）和抑郁自评量表（SDS）评分，于治疗前、治疗4周后检测两组患者血清NaV1.7、CGRP含量，记录两组患者试验期间应急用药及不良反应发生情况，并于治疗4周后评定临床疗效。结果：两组患者治疗2、4周后及随访期疼痛VAS、PSQI、SAS、SDS评分均较治疗前降低（P<0.05）；治疗4周后、随访时，腕踝针组患者上述评分低于西药组（P<0.05）。治疗4周后，两组患者血清NaV1.7、CGRP含量均较治疗前降低（P<0.05），且腕踝针组低于西药组（P<0.05）。试验期间腕踝针组服用应急镇痛药物5例，西药组服用应急镇痛药物11例，两组比较差异无统计学意义（P>0.05）；腕踝针组患者不良反应发生率为9.3%，低于西药组的27.9%(P<0.05)。腕踝针组总有效率为90.7%(39/43)，西药组总有效率为83.7%(36/43)，两组总有效率比较差异无统计学意义（P>0.05）。结论：腕踝针可有效治疗PHN，降低患者疼痛程度、改善睡眠质量及负性情绪，其机制可能与下调血清NaV1.7、CGRP含量有关。

Objective To observe the clinical efficacy of wrist-ankle acupuncture for postherpetic neuralgia(PHN) and its effects on serum levels of voltage-gated sodium channel 1.7(Na V1.7) and calcitonin gene-related peptide(CGRP). Methods A total of 90 PHN patients were randomized into a wrist-ankle acupuncture group(45 cases, 2 cases dropped out) and a western medication group(45 cases, 1 case dropped out, 1 case was discontinued). In the western medication group, the topical 5% lidocaine gel plaster was used locally. In the wrist-ankle acupuncture group, wrist-ankle acupuncture was applied 30 min each time, once a day, 5-day treatment was as one course, with 2-day interval between courses. The treatments lasted for 4 weeks in both groups. The scores of visual analogue scale(VAS), Pittsburgh sleep quality index(PSQI), self-rating anxiety scale(SAS), and self-rating depression scale(SDS) were observed before treatment, after 2 and 4 weeks of treatment, and in the follow-up of 4 weeks after treatment completion. The serum levels of NaV1.7 and CGRP were measured before and after 4 weeks of treatment. The use of rescue analgesics and the occurrence of adverse reactions were recorded, and the clinical efficacy was evaluated after 4 weeks of treatment. Results Compared with those before treatment, the scores of VAS, PSQI, SAS and SDS were decreased after 2 and 4 weeks of treatment, and in follow-up(P<0.05). After 4 weeks of treatment and in follow-up, the above scores in the wrist-ankle acupuncture group were lower than those in the western medication group(P<0.05). After 4 weeks of treatment, the serum levels of NaV1.7 and CGRP were decreased compared with those before treatment(P<0.05), and the serum levels of NaV1.7 and CGRP in the wrist-ankle acupuncture group were lower than those in the western medication group(P<0.05). During the trial, 5 cases in the wrist-ankle acupuncture group and 11 cases in the western medication group required rescue analgesics, with no statistical difference between the two groups(P>0.05). The incidence of adverse reactions was 9.3% in the wrist-ankle acupuncture group, which was lower than 27.9% in the western medication group(P<0.05). The total effective rate in the wrist-ankle acupuncture group was 90.7%(39/43), that of the western medication group was 83.7%(36/43), there was no statistical difference between the two groups(P>0.05). Conclusion Wrist-ankle acupuncture can effectively treat PHN, reduce pain, improve sleep quality and relieve negative emotions. Its mechanism may relate to the down-regulation of serum NaV1.7 and CGRP levels.