肉毒毒素A治疗疱疹后神经痛的临床研究

THERAPEUTIC EFFECT OF BOTULINUM TOXIN A IN THE TREATMENT OF POSTHERPETIC NEURALGIA BY SUBCUTANEOUS INJECTION

目的:探讨肉毒毒素A皮下注射对疱疹后神经痛的治疗效果。方法:选择疱疹后神经痛的患者60例,随机分为A、B和C三组,各20例,每组病人在服用少量药物的基础上均行皮损区域的皮下注射治疗,注射药物是:A组:100单位肉毒毒素A的生理盐水20亳升;B组:含100毫克利多卡因的生理盐水20亳升;C组:0.9%生理盐水20亳升;采用病人和评估人双肓的方法,在注射前及术后1天,出院时及出院后3个月4个时间点对患者的疼痛(VAS评分法)、痛觉过敏或超敏以及睡眠时间进行观察,同时记录实验中因疗效不佳增服阿片类药物。结果:三组患者出院时及出院后3个月VAS评分均较术前显著下降(P<0.01),A组VAS下降最明显,B组与C组其次,A组与B组或A组与C组之间差异显著(P<0.01);出院时患者的痛觉过敏或超敏以及睡眠障碍等症状均有改善,A组与C组相比,差别有显著意义(P<0.01);另外,每一组病例中术后因疼痛加用阿片类药物的百分比不等,A组为21.1%,B组为52.6%,C组为66.7%,A组与C组相比,差异最大(P<0.01),A组与B组相比,差别有显著意义(P<0.05),结论:皮下注射肉毒毒素A能有效减轻疱疹后神经痛,注射后约7天疗效明显,同时对患者的痛觉过敏或超敏以及睡眠障碍等症状均有改善,也能减少患者对阿片类药物的使用。

Objective ： To explore the effect of botulinum toxin A （BTA） in the treatment of postherpetic neuralgia by subcutaneous injection. Methods：60 patients of postherpetic neuralgia were randomly divided into group A（20cases）, group B（20cases） and group C （20cases）. All patients were treated by subcutaneous injection in the affected area,0.9% saline affected dermatomere in group A, 0.9% saline with 100u BTA was administrated to the surface of the with 100mg lidocaine was administrated in the group B and 0. 9% saline alone was injected in group C. Clinical assessments were made by observe-blind, between-patient comparisons. VAS evaluation was taken before therapy, one day after therapy, discharge day （usually 7-10 days after therapy） and 3 months after therapy. Hyperalgesia or allodynia, disfunction of sleep and the usage of opioids were observed before and after injection. Results：Compared with pretreatment, the value of VAS decreased significantly at discharged and 3 months after therapy in three groups （P 〈 0.01 ） ;The value of VAS in group A reduced more significantly as compared with that in group B and group C at discharged and 3 months after therapy in three groups （P 〈 0.01 ） ;The symptoms of hyperalgesia or allodynia, sleep dysfunction had improved as compared with pretreatment, but the effect in group A was best, the effect in group B was better as compared with the effecet in group C. The differential was significant between group A and group C（P 〈0.01 ）. It＇s the lowest usage of opioids in group A（21.1% ） compared with group B（52.6% ） and group C（66.7% ）. The difference was significant between group A and group B （ P 〈 0.05 ）, between group A and group C （ P 〈 0.01 ）. Conclusion ： The intractable pain of postherpetic neuralgia could be relieved significantly by the subcutaneous injection with BTA, the effect was more significantly on the seventh days after therapy. It is helpful in relieving the hyperalgesia, allodynia and sleep dysfunction, while reducing the usage of opioids.