重复经颅磁刺激治疗糖尿病性周围神经病理性疼痛的疗效观察

Repeated transcranial magnetic stimulation for the relief of diabetic peripheral neuropathic pain

目的观察重复经颅磁刺激(rTMS)治疗糖尿病性周围神经病理性疼痛(DPNP)的疗效。方法采用随机数字表法将86例2型糖尿病合并DPNP患者分为观察组及对照组,每组43例。2组患者均给予降糖、降压等常规治疗,观察组在此基础上辅以rTMS治疗,磁刺激部位选择非优势侧手对应的初级运动皮质区(M1区),磁刺激频率为10 Hz,每天治疗1次,每周治疗5 d;对照组则辅以假磁刺激治疗。于治疗前、治疗4周后分别采用疼痛视觉模拟量表(VAS)、患者整体印象变化量表(PGIC)对2组患者进行疗效评定,同时于上述时间点检测2组患者正中神经、腓总神经运动传导速度(MCV)及感觉传导速度(SCV)。结果治疗后观察组疼痛VAS评分[(3.05±0.48)分]、PGIC评分[(2.98±0.45)分]均较治疗前及对照组明显降低(P<0.05),并且观察组疼痛治疗有效率(79.07%)亦显著优于对照组水平(23.26%),组间差异均具有统计学意义(P<0.05)。治疗后观察组正中神经、腓总神经MCV[分别为(47.65±1.94)m/s和(46.98±3.26)m/s]均较治疗前及对照组明显增快,其差异均具有统计学意义(P<0.05)。结论在常规干预基础上辅以rTMS治疗,能显著缓解DPNP患者疼痛,加速受损神经功能恢复,对改善患者病情及生活质量具有重要意义。

Objective To observe any effect of repeated transcranial magnetic stimulation(rTMS)in the treatment of diabetic peripheral neuropathic pain(DPNP).Methods Eighty-six persons with type 2 diabetes mellitus and DPNP were randomly divided into an observation group and a control group,each of 43.Both groups were given basic treatment to control plasma glucose and blood pressure,while the observation group was additionally provided with daily 10Hz rTMS of the primary motor cortex(M1 area)of the non-dominant hand 5 days a week for 4 weeks.Before and after the treatment,pain in both groups was evaluated using a visual analog scale(VAS)and the Patient′s Global Impression Change scale(PGIC).The motor conduction velocity(MCV)and sensory conduction velocity of the median and the common peroneal nerves were also tested.Results After treatment,the average VAS pain rating and PGIC score of the observation group were significantly lower than the control group′s averages and those before treatment.The observation group′s treatment effectiveness rate(79.07%)was then much better than that of the control group(23.26%).After the treatment,the average MCV of the median and common peroneal nerves of the observation group(47.65±1.94 m/s and 46.98±3.26 m/s,respectively)were significantly faster than before treatment,and those of the control group.Conclusions rTMS based on routine intervention can significantly relieve DPNP and promote the recovery of injured nerves,bettering diabetics′physical condition and life quality.