摘要
目的观察经皮耳迷走神经电刺激(TaVNS)辅助治疗对带状疱疹后神经痛的疗效,并探讨其对带状疱疹后神经痛患者外周血T细胞活化状态以及炎性因子表达水平的影响。方法收集2018年11月至2019年7月于山东大学附属省立医院疼痛科就诊并确诊为带状疱疹后神经痛患者20例,采用数字表法随机分为迷走神经组(n=10)和非迷走神经组(n=10)。全部患者在给予普瑞巴林口服(75 mg/次,2次/d)基础上,迷走神经组给予耳甲艇处TaVNS,非迷走神经组于患侧耳垂处给予经皮非迷走神经电刺激,2次/d,30 min/次,共治疗1周。记录患者每日治疗后NRS评分,取患者治疗前后外周血,用流式细胞术检测CD4+T细胞中CD71及nAChRα7的表达,用ELISA检测其炎性因子TNF-α、IL-1β的表达。结果迷走神经组治疗后NRS评分较治疗前下降[(2.9±1.2)比(5.4±0.8),P<0.05],非迷走神经组较治疗前下降,但差异无统计学意义[(4.3±1.2)比(5.1±0.9),P>0.05];迷走神经组治疗5 d后NRS评分较非迷走神经组下降明显(P<0.05)。迷走神经组治疗后外周血CD4+T细胞中CD71表达较治疗前及非迷走神经组明显下降(P<0.05),nAChRα7表达无明显变化(P>0.05);非迷走神经组治疗后外周血CD4+T细胞中CD71与nAChRα7表达较治疗前均无明显变化(P均>0.05)。迷走神经组外周血中TNF-α与IL-1β表达较治疗前下降(P均<0.05),非迷走神经组外周血中TNF-α与IL-1β表达较治疗前均无明显变化(P均>0.05);治疗后迷走神经组IL-1β表达较非迷走神经组下降(P<0.05),TNF-α表达较非迷走神经组无明显变化(P>0.05)。结论TaVNS对于辅助治疗带状疱疹后神经痛能提高疗效,其机制可能与抑制CD4+T细胞活性、降低炎性因子表达有关。
Objective To observe the efficacy of transcutaneous auricular vagus nerve stimulation(TaVNS)on complementary treatment for postherpetic neuralgia and investigate its effect on the activation of T cells and expression of pro-inflammatory mediators in peripheral blood of patients with postherpetic neuralgia.Methods Twenty patients with postherpetic neuralgia,diagnosed as postherpetic neuralgia in the Shandong Provincial Hospital Affiliated to Shandong University from November 2018 to July 2019,were randomly divided into vagal group(n=10)and non-vagal group(n=10).On the basis of daily oral pregabalin(75 mg bid),the patients in vagal group were given TaVNS twice a day for 30 minutes each time,and the patients in non-vagal group were given percutaneous non-vagus nerve(the affected ear lobe)electrical stimulation.The treatment lasted for 1 week,and the patients'NRS was recorded after the treatment.Peripheral blood was taken,and the expressions of CD71 and nAChRα7 in CD4+T cells were detected by flow cytometry.The expressions of inflammatory factors TNF-αand IL-1βwere detected by ELISA.Results After the treatment,the NRS was lower in the vagal group than that before the treatment[(2.9±1.2)vs.(5.4±0.8),P<0.05],but there was no significant change in the non-vagal group[(4.3±1.2)vs.(5.1±0.9),P>0.05].The NRS was lower in the vagal group than that in the non-vagal group after 5 days of the treatment(P<0.05).The expression of CD71 in peripheral blood CD4+T cells decreased in the vagal group,compared with that before treatment and that in the non-vagal group(P<0.05),and there was no significant change in the expression of nAChRα7(P>0.05).The expressions of CD71 and nAChRα7 in peripheral blood CD4+T cells had no significant difference in the non-vagal group(all P>0.05).The expressions of TNF-αand IL-1βin the peripheral blood decreased in the vagal group,compared with that before the treatment(all P<0.05),and the expressions of TNF-αand IL-1βin the peripheral blood had no significant difference in the non-vagal group(all P>0.05).The expression of IL-1βwas lower in the vagal group than that in the non-vagal group after treatment(P<0.05),while the expression of TNF-αwas of no significant change,compared with that in the non-vagal group(P>0.05).Conclusion TaVNS is of complementary effect as an adjuvant therapy on treatment of postherpetic neuralgia,which may be related to its inhibition of CD4+T cell activity and reduction of inflammatory factor expression.
作者
陈阳
杨聪娴
王胜涛
Chen Yang;Yang Congxian;Wang Shengtao(Department of Pain Management,Shandong Provincial Hospital(Shandong Provinvial Hospital Affiliated to Shandong First Medical University),Jinan City,Shandong Province 250021,China)
出处
《中华疼痛学杂志》
2020年第3期197-203,共7页
Chinese Journal Of Painology
基金
山东省医药卫生科技发展计划项目(2017WS197)。
关键词
神经痛
带状疱疹后
迷走神经
经皮神经电刺激
Neuralgia
postherpetic
Vagus nerve
Transcutaneous electric nerve stimulation
