CT引导背根节射频治疗胸腹部带状疱疹后神经痛影响因素分析

Analysis of influencing factor of CT-guided dorsal root ganglion radiofrequency thermocoagulation for treating postherpetic neuralgia in thorax and abdomen

目的分析胸腹部的带状疱疹后神经痛(postherpetic neuralgia,PHN)射频热凝治疗疗效的影响因素,构建列线图疗效预测模型。方法选取2013年6月-2018年9月期间,在嘉兴学院附属医院疼痛科接受CT引导下背根神经节(dorsal root ganglion,DRG)射频热凝治疗的胸腹部PHN患者109例,采用疼痛数字评分(numeric rating scales,NRS)评价疗效,以NRS较术前基线下降≥50%作为有效标准,以术后1年为观察点,通过单因素分析和多因素logistic回归分析研究其独立影响因素,R软件绘制列线图疗效预测模型,并进行验证。结果术后1年,有效68例,无效41例;单因素分析显示,年龄>65岁、病程>3个月、有无神经治疗史和单双极射频方式与射频热凝疗效相关(均P<0.05);多因素logistic回归分析显示,年龄>65岁(OR=0.234,95%CI:0.078~0.703)、病程>3个月(OR=0.382,95%CI:0.161~0.908)以及双极射频(OR=5.727,95%CI:1.437~22.827)是疗效的独立影响因素。内部验证:列线图受试者工作曲线下面积为0.725、Hosmer-Lemeshow检验P=0.937,显示具有良好准确度。结论高龄(>65岁)和病程长(>3个月)的胸腹部PHN患者行射频热凝治疗可能效果不佳,治疗时需把握人群,谨慎对待,双极射频可能疗效更好。

Objective To analyze the influencing factors of CT-guided radiofrequency thermocoagulation for treating postherpetic neuralgia(PHN) in thorax and abdomen, and to construct a nomogram efficacy prediction model. Methods Total 109 patients with PHN in thorax and abdomen, who accepted CT-guided radiofrequency thermocoagulation on dorsal root ganglion(DRG) in pain management department of Affiliated Hospital of Jiaxing College from June 2013 to September 2018 were selected. The efficacy was evaluated by numerical rating scales(NRS). The effective standard was that NRS decreased more than 50% compared with baseline before operation, and the observation point was 1 year after operation. Univariate analysis and multivariate logistic regression were used to identify independent influencing factors. The nomogram was constructed by R software and validated to predict the efficacy. Results The number of valid patients were 68 while the invalid were 41 at one year after the operation. The univariate analysis showed that age >65 years, disease course >3 months, whether had nerve treatment, and radiofrequency mode were correlated with the efficacy of radiofrequency thermocoagulation(all P<0.05). The multivariate logistic regression revealed that age >65 years(OR=0.234, 95%CI:0.078-0.703), disease course >3 months(OR=0.382, 95%CI: 0.016-0.908) and bipolar radiofrequency(OR=5.727, 95%CI:1.437-22.827) were independent factors. For validation of the nomogram, area under receiver operating curve was 0.725 and Hosmer-Lemeshow test was P=0.937, which demonstrated that the model had good accuracy. Conclusion For patients of old age( >65 years) and long duration(course >3 months) with PHN in thorax and abdomen, the effect of radiofrequency thermocoagulation may be poor. We should evaluate carefully before treating. Bipolar radiofrequency may be more effective.