火针联合刺络放血治疗带状疱疹的疗效及对外周血Thl7 Treg细胞比例及其相关细胞因子的影响

doi:10.3969/j.issn.1006-6233.2024.02.09

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摘要 目的: 探究火针联合刺络放血治疗带状疱疹(HZ)的疗效,分析其对外周血辅助性T细胞17(Thl7)、调节性T细胞(Treg)细胞比例及其相关细胞因子的影响。方法: 选取2019年1月至2020年12月本院HZ患者80例,依据随机单、双数分配原则分为对照组和研究组,每组各40例。对照组给予西医抗病毒治疗,研究组给予火针联合刺络放血+西医抗病毒治疗。比较两组治疗效果、康复进程、治疗前后HZ症状积分(红斑、水疱、皮损疼痛)、应用CytoFLEX流式细胞仪检测外周血Thl7、Treg细胞比例。采用ELISA法检测Thl7/Treg细胞相关细胞因子(IL-6、IL-17、TGF-βl)及神经疼痛因子[前列腺素E2(PGE2)、5-羟色胺(5-HT)]。比较两组治疗前后疼痛程度(VAS评分)。结果: 研究组治疗总有效率(97.50%)高于对照组的(80.00%)(P<0.05);研究组康复进程优于对照组(P<0.05);研究组治疗3d后红斑积分、水疱积分、皮损疼痛积分分别为(1.24±0.35)、(1.94±0.42)、(1.27±0.36)分,低于对照组的(1.71±0.42)、(2.30±0.45)、(1.74±0.39)分(P<0.05);研究组治疗7d后红斑积分、水疱积分、皮损疼痛积分分别为(0.82±0.24)、(0.94±0.30)、(0.68±0.22)分,低于对照组的(1.13±0.31)、(1.25±0.34)、(0.91±0.27)分(P<0.05);研究组治疗3d、7d后外周血Thl7细胞比例分别为(1.58±0.46)%、(1.05±0.33)%,Treg细胞比例分别为(4.21±0.95)%、(3.53±0.87)%,血清IL-6水平分别为(14.53±2.61)pg/mL、(10.12±2.14)pg/mL,IL-17水平分别为(22.68±3.86)pg/mL、(18.65±3.42)pg/mL,PGE2水平分别为(126.85±12.69)ng/L、(95.42±9.35)ng/L,5-HT水平分别为(65.32±14.19)ng/mL、(42.86±10.74)ng/mL,均低于对照组(P<0.05);研究组治疗3d、7d后TGF-βl水平分别为(0.48±0.05)pg/mL、(0.51±0.05)pg/mL,高于对照组的(0.44±0.06)pg/mL、(0.46±0.06)pg/mL(P<0.05);研究组治疗3d、7d后VAS评分分别为(3.15±0.82)、(1.87±0.59)分,低于对照组的(4.20±0.97)、(2.46±0.71)分(P<0.05)。结论: 火针联合刺络放血治疗HZ疗效确切,可改善临床症状,缩短康复进程,并可缓解疼痛,其作用机制可能与纠正Thl7/Treg细胞失衡有关。

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关键词 ：带状疱疹, 火针, 刺络放血, 拔罐, 辅助性T细胞17, 调节性T细胞

Abstract：Objective: To explore the efficacy of fire needle combined with blood-letting acupoint pricking in the treatment of herpes zoster (HZ) and analyze its impact on peripheral blood Th17, regulatory T (Treg) cell ratio, and related cytokines. Methods: Eighty patients with HZ admitted to our hospital from January 2019 to December 2020 were selected and divided into control group and study group according to the random single or double number allocation principle, with 40 cases in each group. The control group received western medicine antiviral treatment, while the study group received fire needle combined with blood-letting acupoint pricking plus western medicine antiviral treatment. The treatment effects, recovery process, pre and post-treatment HZ symptom scores (erythema, vesicles, skin lesion pain), peripheral blood Th17, Treg cell ratios were compared. The levels of Th17/Treg cell-related cytokines (IL-6, IL-17, TGF-β₁) and neural pain factors [prostaglandin E2 (PGE2), serotonin (5-HT)] were detected using CytoFLEX flow cytometry and ELISA, respectively. The pain levels (VAS scores) were compared before and after treatment. Results: The total effective rate in the study group 97.50% was higher than that in the control group 80.00% (P<0.05). The study group showed better recovery process than the control group (P<0.05). Three days after treatment, erythema score, vesicle score, and skin lesion pain score in the study group were (1.24±0.35), (1.94±0.42), and (1.27±0.36), respectively, lower than those in the control group (P<0.05). Seven days after treatment, erythema score, vesicle score, and skin lesion pain score in the study group were (0.82±0.24), (0.94±0.30), and (0.68±0.22), respectively, lower than those in the control group (P<0.05). Three and seven days after treatment, the Th17 cell ratios in peripheral blood were (1.58±0.46)% and (1.05±0.33)% in the study group, Treg cell ratios were (4.21±0.95)% and (3.53±0.87)%, serum IL-6 levels were (14.53±2.61) pg/mL and (10.12±2.14) pg/mL, IL-17 levels were (22.68±3.86) pg/mL and (18.65±3.42) pg/mL, PGE2 levels were (126.85±12.69) ng/L and (95.42±9.35) ng/L, 5-HT levels were (65.32±14.19) ng/mL and (42.86±10.74) ng/mL, all lower than those in the control group (P<0.05). Three and seven days after treatment, TGF-β1 levels were (0.48±0.05) pg/mL and (0.51±0.05) pg/mL in the study group, higher than those in the control group (P<0.05). Three and seven days after treatment, VAS scores in the study group were (3.15±0.82) and (1.87±0.59), respectively, lower than those in the control group (P<0.05). Conclusion: The treatment of herpes zoster with fire needle combined with blood-letting acupoint pricking is effective, improves clinical symptoms, shortens the recovery process, and relieves pain. The mechanism of action may be related to correcting the imbalance of Th17/Treg cells.

Key words： Herpes zoster Fire needle Blood-letting acupoint pricking Cupping Th17 Treg

基金资助:2019年度皖南医学院中青年科研基金立项,(编号:WK2019F38);国家重点研发计划,(编号:2018YFC1705301)

通讯作者: 秦晓明

引用本文:

谢兰清, 王建锋, 张虹亚, 秦晓明. 火针联合刺络放血治疗带状疱疹的疗效及对外周血Thl7 Treg细胞比例及其相关细胞因子的影响[J]. 河北医学, 2024, 30(2): 223-230.
XIE Lanqing, et al. Efficacy of Fire Needle Combined with Blood-letting Acupoint Pricking in the Treatment of Herpes Zoster and Its Impact on Peripheral Blood Th17 Treg Cell Ratio and Related Cytokines. HeBei Med, 2024, 30(2): 223-230.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2024.02.09 或 http://www.hbyxzzs.cn/CN/Y2024/V30/I2/223

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