急性、慢性疼痛病人的痛阈及焦虑状态的比较

COMPARISON OF PAIN THRESHOLD AND ANXIETY STATUS IN PATIENTS WITH ACUTE OR CHRONIC PAIN

目的:观察急性骨折、慢性骨关节炎、癌痛病人痛阈、焦虑评分及血清炎性因子的变化,研究疼痛类型和焦虑状态对于痛阈的影响。方法:选择120例病人,性别不限,年龄40~70岁,BMI18~24 kg/m2,ASA分级II-III级。根据病人疼痛的类型不同分4组(n=30):急性骨折组(A组)、慢性骨关节炎组(B组)、癌痛组(C组)及健康对照组(D组),测定病人压力性痛阈(pressure pain threshold,PPT)、焦虑评分及血清中CRP、IL-6、IL-17的浓度。结果:与D组比较,A、B、C三组PPT降低,而焦虑得分升高,二者的相关系数r 2=0.661,回归系数b=-1.691。B、C组的血清CRP、IL-6、IL-17浓度高于对照组D(P<0.05),以C组升高更为明显;对于IL-6,B、C和A、C组间比较有差异;对于CRP,四组间两两比较均有差别;对于IL-17,B、C组高于D组。结论:急性骨折、慢性骨关节炎及癌性疼痛三种疼痛类型及病人焦虑状态可以影响痛阈,相关机制可能与血清中相应的炎性因子浓度改变有关。

Objective： To evaluate the effects of pain types and anxiety state on pain threshold of patients with acute fracture or chronic osteoarthritis or cancerous pain by observing changes of pressure pain threshold（PPT）, anxiety scores（SAS） and serum levels of inflammation factors. Methods： We prospectively enrolled 120 patients of both sexes, aged 40-70 years with body mass index of 18-24 kg/m2, II to III grades of American Society of Anesthesiologists physical status. They were divided into 4 groups（n = 30 each） according to pain type ： acute fracture（A）; chronic osteoarthritis（B）; cancer pain（C） and control group（D）. We assessed PPT with electric Von Frey test, and evaluated anxiety state by the Zung anxiety self-rating scale. The blood sample was taken to measure CRP, IL-6, IL-17. Results： Compared with group D, the PPT in group A, B and C decreased（P 0.05）, while anxiety scores increased with r 2 = 0.661, b =-1.691. The concentrations of serum CRP, IL-6, IL-17 of group B and C were higher than that of group D, and group C was the highest. There were significant difference among group A, B and C in IL-6, and among the four groups in CRP. The IL-17 in group B and C were higher than that in group D. Conclusion： Three types of pain and anxiety status in patients with acute fracture or chronic osteoarthritis or cancerous pain can affect pain threshold and the underlying mechanism may be related to the change of serum level of inflammation factors.