CT引导下阿霉素治疗原发性三叉神经痛定量感觉分析

Quantitative sensory testing analysis on idiopathic trigeminal neuralgia treated by adriamycin under the guidance of CT

目的评价原发性三叉神经痛患者阿霉素治疗后疼痛程度和感觉功能变化,并探讨二者的相关性。方法于CT引导下阿霉素治疗23例原发性三叉神经痛患者,分别于治疗前以及治疗后1 d、7 d、1个月、3个月、6个月、12个月采用视觉模拟评分(VAS)评价疼痛程度,定量感觉检测(QST)测定患侧下颏冷觉、温觉、冷痛觉、热痛觉阈值。结果与治疗前相比,治疗后1 d、7 d、1个月、3个月、6个月和12个月VAS评分降低(均P=0.000);治疗后1、3、6和12个月患侧下颏冷觉(P=0.003,0.000,0.000,0.000)和冷痛觉(P=0.022,0.000,0.000,0.013)阈值降低,温觉(P=0.004,0.002,0.000,0.000)和热痛觉(P=0.004,0.002,0.000,0.000)阈值升高。Pearson相关分析显示,阿霉素治疗后VAS评分与患侧下颏冷觉(r=0.703,P=0.000)和冷痛觉(r=0.679,P=0.002)阈值呈正相关,与温觉(r=-0.782,P=0.000)和热痛觉(r=-0.726,P=0.001)阈值呈负相关。结论 QST检测是一种无创性、简便的感觉功能评价方法,可以定量测定感觉神经损害,成为评价三叉神经毁损术治疗效果的有价值指标。

Objective To evaluate the changes of pain and sensory function in patients with idiopathic trigeminal neuralgia（ITN）treated by adriamycin interventional treatment,and to explore their correlation.Methods A total of 23 patients with ITN were treated by adriamycin interventional treatment guided via CT.Visual Analogue Scale（VAS）was used to evaluate the degree of pain before treatment and1 d,7 d,1 month,3 months,6 months,12 months after treatment.Quantitative Sensory Testing（QST）was used to measure cold sensation（CS）,warm sensation（WS）,cold pain（CP）and hot pain（HP）threshold value of chin at the affected side.Results Compared with before treatment,VAS scores decreased at 1 d,7 d,1 month,3 months,6 months and 12 months after treatment（P=0.000,for all）.One month,3 months,6 months and 12 months after treatment,CS（P=0.003,0.000,0.000,0.000）and CP（P=0.022,0.000,0.000,0.013）decreased,while WS（P=0.004,0.002,0.000,0.000）and HP（P=0.004,0.002,0.000,0.000）increased.Pearson correlation analysis showed VAS scores were positively correlated with CS（r=0.703,P=0.000）and CP（r=0.679,P=0.002）,and negatively correlated with WS（r=-0.782,P=0.000）and HP（r=-0.726,P=0.001）after adriamycin interventional treatment.ConclusionsQST was confirmed as noninvasive,simple and objective measurement.It could be used to quantificationally analyze the damage of sensory nervous function and could be a valuable index in evaluating the curative effect of trigeminal nerve destruction.