广西医学

目的观察壮医莲花针拔罐逐瘀法治疗带状疱疹后神经痛（PHN）的临床效果，以及对瞬时受体电位阳离子通道亚家族Ⅴ成员1（TRPV1）的影响。方法将96例PHN患者随机分为观察组（n=32）、对照1组（n=32）、对照2组（n=32），分别给予壮医莲花针拔罐逐瘀法治疗、中医针灸围刺治疗、加巴喷丁胶囊口服治疗。治疗后第42天评价3组的临床疗效。在治疗前、治疗后第21天、治疗后第42天，评估3组患者的疼痛视觉模拟量表（VAS）评分，检测其静脉血和穴位血的TRPV1含量及TRPV1 mRNA表达水平。结果治疗后，观察组、对照1组、对照2组总有效率分别为93.75％（30/32）、 81.25%（26/32）和68.75％（22/32），观察组的总有效率高于对照2组（P<0.05）。3组患者的疼痛VAS评分随治疗时间的延长而降低（P<0.05），其中，治疗后第42天，对照2组、对照1组、观察组患者的疼痛VAS评分依次降低（P<0.05）。观察组和对照1组的静脉血和穴位血TRPV1含量及TRPV1 mRNA表达水平随着治疗时间延长而降低（P<0.05），其中，治疗后第21天、第42天，对照2组、对照1组、观察组静脉血和穴位血TRPV1含量及TRPV1 mRNA表达水平依次降低（P<0.05）。结论壮医莲花针拔罐逐瘀法治疗PHN疗效显著，镇痛效果优于中医针灸围刺及加巴喷丁胶囊口服治疗，其作用机制可能是通过下调TRPV1的表达来抑制炎症介质进一步释放，从而降低痛觉过敏，缓解疼痛。

Objective To observe the clinical effect of Zhuang Medicine lotus needle cupping and expelling stagnated blood method for the treatment of postherpetic neuralgia (PHN), and the influence on transient receptor potential cation channel subfamily Ⅴ member 1 (TRPV1). Methods A total of 96 PHN patients were randomly divided into observation group (n=32), control 1 group (n=32), or control 2 group (n=32), and Zhuang Medicine lotus needle cupping and expelling stagnated blood method, Traditional Chinese Medicine acupuncture and moxibustion surround needling therapy, and oral administration of Gabapentin Capsules were given to patients, respectively. The clinical efficacy of the 3 groups was evaluated on the 42th day after treatment. Visual Analogue Scale (VAS) score for pain of the 3 groups was evaluated before treatment, and on the 21st day and the 42th day after treatment. The content of TRPV1 and mRNA expression of TRPV1 in venous blood and acupoint blood were detected in the 3 groups. Results After treatment, the total effective rates of the observation group, control 1 group, and control 2 group were 93.75% (30/32), 81.25% (26/32), and 68.75% (22/32), respectively, and the observation group exhibited a higher total effective rate as compared with the control 2 group (P<0.05). VAS score for pain in the 3 groups decreased with the extension of treatment duration (P<0.05), therein on the 42th day after treatment, VAS score for pain in the control 2 group, control 1 group, and observation group were decreased successively (P<0.05). The content of TRPV1 and TRPV1 mRNA expression in venous blood and acupoint blood of the observation group and the control 1 group decreased with the extension of treatment duration (P<0.05), therein on the 21st day and the 42th day after treatment, the content of TRPV1 and TRPV1 mRNA expression in venous blood and acupoint blood of the control 2 group, control 1 group, and observation group were decreased successively (P<0.05). Conclusion Zhuang Medicine lotus needle cupping and expelling stagnated blood method for the treatment of PHN exerts significant efficacy, and its analgesic effect is superior to Traditional Chinese Medicine acupuncture and moxibustion surround needling and oral administration of Gabapentin Capsules. Its mechanism may be further inhibiting the releases of inflammatory mediators, thereby reducing hyperalgesia, and relieving pain through down-regulating TRPV1 expression.