牛痘疫苗接种家兔炎症皮肤提取物治疗脊髓损伤后神经病理性疼痛的定量感觉检查研究

TREATMENT OF NEUROPATHIC PAIN AFTER SPINAL CORD INJURY WITH NEUROTROPIN:QUANTITATIVE SENSORY TESTING AT THE LEVEL OF HUMAN SPINAL CORD INJURY

目的:分析脊髓损伤(spinal cord injury,SCI)后神经病理性疼痛患者损伤平面的皮肤感觉阈值变化与差异,推测牛痘疫苗接种家兔炎症皮肤提取物(神经妥乐平)治疗SCI后神经病理性疼痛的作用机制。方法:39例SCI患者根据神经病理性疼痛的视觉模拟量表评分及使用神经妥乐平的不同情况分为轻、中、重3组,应用定量感觉检查(Quantitative sensory testing,QST)的方法,测试损伤平面皮肤的单丝触觉、冷觉阈值、热觉阈值以及冷痛觉阈值、热痛觉阈值,并与20例正常健康者进行比较。结果:与正常健康者相比,SCI患者损伤平面的单丝触觉阈、热觉阈均明显提高,冷觉阈明显降低。与无明显疼痛者比较,中、重度神经病理性疼痛者的单丝触觉阈、冷痛阈和热痛阈值间的差异存在统计学意义;神经妥乐平治疗有效者与无效者比较,冷痛阈、热痛阈间差异均存在统计学意义。结论:神经妥乐平治疗SCI后的神经病理性疼痛具有其特定的解剖生理学基础。通过QST筛查,有利于对SCI后的神经病理性疼痛进行早期干预。

Objective： To analyze the thermal thresholds in patients with neuropathic pain after spinal cord injury （SCI） and speculate the pain relieving mechanism of Neurotropin on neuropathic pain after SCI. Methods： Clinical assessments and quantitative sensory testing （QST） were carried out on 39 patients with thoracic complete SCI. Pain was recorded with visual analog scale. According to different pain situations, 39 patients were divided into three groups （mild, middle and heavy group）. The thresholds of tactile （Semmes-Weinstein monofilaments）, thermal （cool, warm）, and pain （cold pain, hot pain） sensations at the neurological level of lesion were measured. A total of 20 healthy subjects used as controls. Results： At the level of lesion perceptual thresholds to monofilaments, warm thresholds were significantly raised, while cool thresholds were significantly reduced. Compared with no obvious pain, moderate and severe neuropathy pain of SCI patients have the differences in perceptual thresholds to monofilaments, cold pain and heat pain thresholds. With Neurotropin treatment, there were statistically significant differences on cold pain and heat pain thresholds between effective and non-effective patients. Conclusion： Treatment of neuropathic pain after SCI with Neurotropin own its specific physiological basis. Through the QST, it can be helpful for early intervention of neuropathic pain following SCI.