The Effectiveness And Safety Of Epidural Block Combined With Stellate Ganglion Block Therapy In Treatment Of Psoriasis

Objective: To investigate the effectiveness and safety of epidural block combined with stellate ganglion block(SGB)therapy in treatment of psoriasis,and to explore the mechanism of epidural block combined with SGB therapy in immuno system and microcirculation.The mechanism was explored to further improve the clinical effectiveness and safety of epidural block combined with stellate ganglion block in the treatment of psoriasis.Methods: 19 patients with psoriasis were enrolled and treated with epidural block combined with stellate ganglion block therapy.Before treatment,PASI and sPGA scores were used to assess the severity of psoriasis,EQ-5D and DL-QI scales were used to evaluate the quality of life,HAD scale was used to evaluate the mood state and the blood samples were collected for the research of immunologic mechanism.During the treatment,the side-stream dark field technique was used for evaluating the sublingual microcirculation.Before the second time treatment in the 4 weeks,the patient's psoriasis severity,quality of life,mood state,side effects,results oflaboratory examinations were evaluated again,and the patient's blood samples were retained to evaluate the patient's immune function.The microcirculatory function was also evaluated during the treatment.Patients were followed up after 6 weeks and the severity of psoriasis and adverse effects were evaluated.Results: Epidural block combined combined with SGB therapy can significantly reduced the PASI scores(baseline vs.4 weeks after treatment:22.62±13.16 vs.17.06±8.95,p=0.008).In the various parts of whole body,the PASI score of lower limb can be significantly decreased than that before treatment(baseline vs.4 weeks after treatment: 11.43±7.26 vs.7.99±4.52,p=0.011),while the rest parts showed no statistically significant difference.4weeks after treatment,there was no statistically significant difference in the quality of life evaluated by scales.During the course of treatment,the overall rate of adverse events is 43.8%,and no serious adverse events occurred.After4 weeks,the serum concentrations of IL-6,IL-17 A,IL-23,and TNF-? were not significantly changed.Epidural block combined with SGB therapy can significantly improve the function of microcirculation in a short term.During the treatment,at 3 hours post treatment,TVD,PVD of all kinds of vessels has increased significantly(baseline vs.3 hours after treatment: 13.87±2.17 vs.14.80±1.55,p=0.006).The MFI was significantly improved(baseline vs.3 hours after treatment: 3(3-3.25)vs.3.5(3.25-3.75),p <0.001)and the maximum flow velocity of small vessels was significantly higher than that before treatment(baseline vs.3 hours after treatment: 384.2 ± 92.67 vs547.97±128.87,p < 0.001).Conclusions: Epidural block combined with stellate ganglion block therapy can effectively decreased the PASI score within 6 weeks,but has no significant effect on the patient's quality of life score in a short term.Epidural block combined with SGB therapy can effectively treat psoriasis through the microcirculatory mechanism.