艾灸联合抗组胺药治疗EGFR-TKI引发的慢性瘙痒疗效及作用机制  

Clinical Effect and Mechanism of Moxibustion Combined with Antihistamines in Treatment of Chronic Pruritus Induced by Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors

作　　者：刘佳保 张鹏程 伍健平 刘畅 张浩 刘新如 周美启 吴生兵 祝永福[5] LIU Jiabao;ZHANG Pengcheng;WU Jianping;LIU Chang;ZHANG Hao;LIU Xinru;ZHOU Meiqi;WU Shengbing;ZHU Yongfu(The First Clinical Medical College of Anhui University of Chinese Medicine,Anhui Hefei 230031,China;The First Clinical Medical College of Zhejiang Chinese Medical University,Zhejiang Hangzhou310002,China;Bozhou Vocational and Technical College,Anhui Bozhou 236800,China;Anhui Province Key Laboratory of Meridian Viscera Correlationship,Anhui Hefei 230038,China;The First Affiliated Hospital of Anhui University of Chinese Medicine,Anhui Hefei230031,China)

机构地区：[1]安徽中医药大学第一临床医学院,安徽合肥230031 [2]浙江中医药大学附属第一临床医学院,浙江杭州310002 [3]亳州职业技术学院,安徽亳州236800 [4]经脉脏腑相关安徽省重点实验室,安徽合肥230038 [5]安徽中医药大学第一附属医院,安徽合肥230031

出　　处：《安徽中医药大学学报》2025年第2期59-63,共5页Journal of Anhui University of Chinese Medicine

基　　金：安徽省卫生健康科研项目(AHWJ2022b053);亳州职业技术学院“医疗服务与保障能力提升补助”专项课题(YLFW2304);浙江省中医药科技项目(2023ZL467)。

摘　　要：目的观察艾灸肺经腧穴联合抗组胺药治疗表皮生长因子受体酪氨酸激酶抑制剂(epidermal growth factor receptor-tyrosine kinase inhibitors,EGFR-TKI)诱导的慢性瘙痒的疗效,并探讨其可能的作用机制。方法将62例口服EGFR-TKI致慢性瘙痒的非小细胞肺癌患者采用随机信封法分为观察组和对照组,每组31例。对照组予盐酸左西替利嗪片口服治疗,观察组在对照组治疗基础上予温和灸治疗。采用改良Duo氏瘙痒评分、瘙痒视觉模拟量表(visual analogue scale,VAS)评分评估患者瘙痒程度,比较两组患者治疗前后血清瞬时受体电位香草酸亚型1(transient receptor potential vanilloid subtype 1,TRPV1)、蛋白激酶C(protein kinase C,PKC)、P物质(substance P,SP)、前列腺素E 2(prostaglandin E 2,PGE 2)水平,并进行安全性评价。结果治疗后观察组Duo氏瘙痒评分、瘙痒VAS评分均显著低于对照组(P<0.05),且临床疗效优于对照组(P<0.05);与治疗前比较,两组患者治疗后血清TRPV1、PKC、SP、PGE 2水平均显著降低(P<0.05),且观察组降低幅度更显著(P<0.05)。结论艾灸肺经腧穴联合抗组胺药物治疗EGFR-TKI诱导的慢性瘙痒疗效显著,其作用机制可能与调控TRPV1通路相关。Objective To investigate the clinical effect and possible mechanism of moxibustion at acupoints of the lung meridian combined with antihistamines in the treatment of chronic pruritus induced by epidermal growth factor receptor tyrosine kinase inhibitors(EGFR-TKIs).Methods A total of 62 patients with non-small cell lung cancer who experienced chronic pruritus induced by EGFR-TKIs were enrolled and randomly divided into observation group and control group,with 31 patients in each group.The patients in the control group were treated with oral administration of levocetirizine hydrochloride tablets,and those in the observation group were treated with mild-warm moxibustion in addition to the treatment in the control group.The modified Duo’s pruritus score and Visual Analogue Scale(VAS)pruritus score were used to evaluate the degree of pruritus,and the two groups were compared in terms of the serum levels of transient receptor potential vanilloid subtype 1(TRPV1),protein kinase C(PKC),substance P(SP),and prostaglandin E 2(PGE 2)before and after treatment.Safety evaluation was also performed.Results After treatment,compared with the control group,the observation group had significantly lower Duo’s pruritus score and VAS pruritus score(P<0.05)and a significantly better clinical outcome(P<0.05).After treatment,both groups had significant reductions in the serum levels of TRPV1,PKC,SP,and PGE 2(P<0.05),and the observation group had significantly greater reductions than the control group(P<0.05).Conclusion Moxibustion at acupoints of the lung meridian combined with antihistamines has a marked clinical effect in the treatment of chronic pruritus induced by EGFR-TKIs,possibly by regulating the TRPV1 pathway.

关 键 词：艾灸 非小细胞肺癌 表皮生长因子受体 酪氨酸激酶抑制剂 慢性瘙痒 瞬时受体电位香草酸亚型1 

分 类 号：R758.31[医药卫生—皮肤病学与性病学]