早期脉冲射频治疗带状疱疹神经痛临床研究

Clinical study of early pulsed radiofrequency therapy for herpes zoster-related neuralgia

目的:回顾性分析早期脉冲射频(pulsed radiofrequency,PRF)治疗对带状疱疹神经痛(zoster related neuralgia,ZRN)临床疗效的影响,为提高ZRN临床疗效和预防带状疱疹后神经痛(postherpetic neuralgia,PHN)提供依据。方法:2019年6月至2020年6月在中日友好医院疼痛科初次接受PRF治疗的88名中重度疼痛的老年ZRN病人,按PRF干预时间分为早期治疗组(<3个月)和晚期治疗组(≥3个月),分别于术前、术后第1天、1、3、6个月对病人进行数字评分法(numerical rating scale,NRS)评分和匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)随访,并采用倾向性评分匹配法,对两组匹配后的样本进行临床疗效差异性分析。结果:在倾向性评分匹配之前,晚期治疗组中爆发痛病人比例高于早期治疗组,差异有统计学意义(P<0.05)。经匹配后除了PRF干预时间,其余特征组间差异无统计学意义。两组术后第1天、1、3、6个月的NRS评分均低于术前(P<0.001)。组间比较,早期治疗组术后1、3、6个月的NRS评分均低于晚期治疗组(P<0.01)。术后3、6个月,早期治疗组有效和完全缓解率均明显高于晚期治疗组(P<0.01)。术后3、6个月,早期治疗组中PHN发生率低于晚期治疗组(P<0.01)。术后6个月,早期治疗组PSQI评分低于晚期治疗组(P<0.01)。结论:对于50岁或50岁以上伴有中度至重度疼痛的ZRN病人,早期PRF治疗能够取得良好的短期和长期疗效,并可能预防急性带状疱疹神经痛向慢性疼痛的发展。

Objective:To retrospectively analyze the effect of early pulsed radiofrequency(PRF)treatment on the clinical outcome of herpes zosterrelated neuralgia(ZRN)and to provide a basis for improving the clinical efficacy of ZRN and preventing postherpetic neuralgia(PHN).Methods:A total of 88 elderly ZRN patients(50 years old)with moderate to severe pain who were initially treated with PRF in the pain department of China Japan Friendship Hospital from June 2019 to June 2020 were divided into early treatment(<3 months)and late treatment(3 months)groups according to PRF intervention time.The patients were followed up for numerical rating scale(NRS)scores,Pittsburgh sleep quality index(PSQI)scores,preoperatively and at 1 day,1,3 and 6 months postoperatively.After the propensity score matching,the difference of clinical efficacy between the two groups was analyzed.Results:Prior to propensity score matching,the proportion of patients with burst pain in the late treatment group was higher than that in the early treatment group,and the difference was statistically significant(P<0.05).After matching,there was no significant difference between groups in any of the characteristics except PRF intervention time.The NRS scores of the two groups at 1 day and 1,3 and 6 months after operation were lower than those before operation,and the difference was statistically significant(P<0.001).The NRS scores of the early treatment group were lower than those of the late treatment group at 1,3 and 6 months afrer operation(P<0.01).At 3 and 6 months afrer operation,the proportion of patients in effective and complete remission rates were significantly higher in the early treatment group than in the late treatment group(P<0.01)and the incidence of PHN was significantly lower in the early treatment group than in the late treatment group(P<0.01).Six months after operation,the PSQI score of the early treatment group were significantly lower than that of the late treatment group(P<0.01).Conclusion:For ZRN patients aged 50 years or older with moderate to severe pain,the early PRF treatment can achieve good short-term and long-term outcomes and may prevent the progression of acute herpes zoster-related neuralgia to chronic pain.