高频重复经颅磁刺激治疗带状疱疹后遗神经痛疗效观察

High-frequency repetitive transcranial magnetic stimulation improves postherpetic neuralgia

目的:探讨高频重复经颅磁刺激(high-frequency repetitive transcranial magnetic stimulation, h-rTMS)对带状疱疹后遗神经痛(postherpetic neuralgia, PHN)的治疗效果。方法:49例PHN患者疼痛视觉模拟评分(visual analogue scale, VAS)≥4分,疼痛持续时间≥1个月,所有的患者均接受正规的药物治疗15 d以上,并且服药持续至治疗期间及随访的全过程。患者随机分为2组:真重复经颅磁刺激(real-rTMS)组和假重复经颅磁刺激(sham-rTMS)组。两组患者线圈的放置方向不同,shamrTMS组只产生声音,不产生刺激作用。测量第一次刺激开始前(T0)、每次刺激治疗后(T1~T10)、治疗后1个月(T11)、治疗后3个月(T12)VAS、生命质量评分(quality of life, QOL)、患者总体满意度的评分(patient global impression of change, PGIC)、用药的剂量调整(medication regulation, MR)以及并发症情况。结果:两组患者性别、年龄、病程、基础VAS评分等没有统计学差异(P>0.05)。与sham-rTMS组相比,real-rTMS组VAS从T2到T12各时间点下降(P<0.05),QOL评分在T12下降(P<0.05),PGIC在T10、T11和T12明显上升(P<0.05),MR在T5明显下降(P<0.05)。两组患者均没有发生磁刺激治疗相关的严重的不良反应。结论:h-rTMS对PHN患者是安全有效的治疗方法。

Objective： To study the efficacy of high-frequency repetitive transcranial magnetic stimulation （h-rTMS） for pos- therpetic neuralgia（PHN）. Methods： The enrollment criteria included ①VAS≥4, ②having pain for over 1 month, ③having been treated with a standardized regimen for over 15 days, and willing to continue throughout the study and follow-up. A to- tal of 49 PHN patients were randomly assigned into real-rTMS or sham-rTMS group. The directions of electrodes were in- stalled differently between these two groups. Sham-rTMS group only had a sound without stimulation. The primary outcome was pain intensity measured from TO to T12. Other outcomes included quality of life（QOL）, the patient global impression of change（PGIC）, medication regulation （MR） and adverse events. Results： Sex, age, duration of pain and baseline scores of VAS were similar between the sham-rTMS and real-rTMS groups. Compared with sham-rTMS group, real-rTMS group showed more reductions in VAS at all points from T2 to T12 （P〈0.05）, and the QOL score was significantly lower at T12 （P〈0.05）. But PGIC scores were significantly higher at T10, Tlland T12（P〈0.05, versus controls）. MR was significantly lower at TS（P〈 0.05, versus controls）. No serious adverse events related to rTMS occurred in either group. Conclusion： h-rTMS is an ef- fective and safe therapy for PHN.