高电压和标准电压脉冲射频治疗带状疱疹相关性疼痛的有效性和安全性:随机对照试验的荟萃分析

Comparing the efficacy and safety of high-voltage and standard-voltage pulsed radiofrequency for the treatment of zoster-associated pain: a meta-analysis based on randomized controlled trials

目的:系统评价高电压和标准电压脉冲射频(pulsed radiofrequency, PRF)治疗带状疱疹相关性疼痛(zoster-associated pain, ZAP)的有效性和安全性,为临床实践提供理论依据。方法:对Pub Med、Web of Science、Cochrane Library、Embase、中国国家知识网络基础设施数据库(CNKI)、万方数据库、维普数据库、中国生物医学文献服务系统(Sinomed)等8个数据库进行全面检索,以获取比较高电压与标准电压PRF治疗ZAP的随机对照试验研究,时间截止为2022年6月,不设置语言限制。由两位研究者独立提取数据,进行文章质量评价,并交叉核对,采用Rev Man软件进行荟萃分析。主要结局指标为视觉模拟评分法(visual analogue scale, VAS)或数字评分法(numerical rating scale, NRS)评估疼痛改善的效果,次要结局指标为匹兹堡睡眠质量指数(Pittsburgh sleep quality index, PSQI)评估病人睡眠质量改善情况,安全指标为不良事件发生率。结果:共纳入10篇RCT研究,病人601例。荟萃分析结果显示:在ZAP病人疼痛评分方面,高电压PRF治疗组低于标准电压PRF组(P <0.00001);在匹兹堡睡眠质量指数方面,高电压PRF治疗组低于标准电压PRF组(P <0.05);在不良反应发生率方面,高电压PRF治疗组与标准电压PRF组相比差异无统计学意义(P=0.16)。结论:高电压PRF在改善ZAP病人的镇痛疗效和睡眠质量方面优于标准电压PRF,且并不增加ZAP病人治疗相关不良反应的发生率。

Objective: To compare the efficacy and safety between high-voltage and standard-voltage pulsed radiofrequency(PRF) in the treatment of zoster-associated pain. Methods: Pub Med, Web of Science, Cochrane Library, Embase, China National Knowledge Network Infrastructure Database(CNKI), Wanfang Database,VIP Database, and China Biomedical Documentation Service System(Sinomed) were searched for randomized controlled trials up to June 2022 that compared high-voltage and standard-voltage pulsed radiofrequency in the treatment of zoster-associated pain. No language restrictions were set. Two researchers independently extracted data, evaluated the quality of the articles, and cross-checked them. Then, a meta-analysis was performed by using RevMan software. The primary outcome was the visual analogue scale(VAS) or numerical rating scale(NRS) to assess the effect of pain, the secondary outcome was the Pittsburgh sleep quality index(PSQI) to assess the improvement of patients sleep quality, and the safety outcomes was the incidence of adverse events.Results: Ten randomized controlled trials involving 601 patients were included. The meta-analysis showed that pain scores of ZAP patients in the high-voltage PRF group were lower than that in the standard voltage PRF group(P < 0.00001);PSQI of ZAP patients in the high-voltage PRF group was also lower than that in the standard voltage PRF group(P < 0.05). However, there was no significant difference between the two groups in the incidence of adverse reactions of ZAP patients(P = 0.16). Conclusion: High-voltage PRF was superior to standard-voltage PRF in improving pain scores and sleep quality in ZAP patients. High-voltage PRF didn’t increase the incidence of treatment-related adverse reactions of ZAP patients.