短时程脊髓电刺激治疗带状疱疹相关性神经痛预后分析

The prognostic analysis based on the Lasso-Logistic regression of spinal cord stimulation treatment for herpes zoster-associated neuralgia

目的:评估短时程脊髓电刺激(short-term spinal cord stimulation,st-SCS)治疗带状疱疹相关性神经痛(zoster-associated neuralgia,ZAN)的临床疗效,并分析影响治疗效果的危险因素。方法:收集2019年1月1日至2021年9月31日就诊于山东大学附属省立医院疼痛科,确诊为ZAN并接受短时程脊髓电刺激治疗病人的临床资料,回顾性分析其临床疗效,并使用Lasso回归筛选可能影响疗效的因素,应用Logistic回归建立预测模型,通过ROC曲线、C指数评估模型。结果:共纳入91例病人,st-SCS治疗后,疼痛数字分级评分法(numerical rating scale,NRS)评分显著减低,病人睡眠质量改善,普瑞巴林及加巴喷丁的平均用量较治疗前明显减少(P<0.05)。多因素Logistic回归结果表明长病程(course,OR 7.0232,95%CI 1.2551-39.299,P=0.0265)、高嗜酸性粒细胞百分比(EOP,OR 1.6808,95%CI 1.0513-2.6874,P=0.0301)、合并冠心病(OR 4.089,95%CI 1.1238-14.9440,P=0.0326)是影响短时程电刺激治疗ZAN效果的独立危险因素。结论:St-SCS可以缓解难治性ZAN病人的疼痛,减少镇痛药物的平均用量,改善睡眠质量,且并发症少、安全性高。长病程(course)、合并冠心病、高嗜酸性粒细胞百分比(eosinophil percentage,EOP)是影响st-SCS治疗效果的独立危险因素。计算C指数为0.767,ROC曲线下面积为0.767,说明本研究所制模型准确性较高。

Objective:To evaluate the clinical efficacy of short-term spinal cord stimulation(st-SCS)in the treatment of herpes zoster-associated neuralgia(ZAN)and to analyze the risk factors affecting the outcome.Methods:The patients who were diagnosed as herpes zoster-associated neuralgia and received short-course spinal cord electrical stimulation from January 1,2019,to September 31,2021 in the Department of Pain in Shandong Provincial Hospital were included and their clinical data were collected and analyzed retrospectively.All patients were followed for 6 months to retrospectively analyze clinical efficacy.Lasso regression was executed to screen factors.Logistic regression was applied to establish a prediction model.The model was evaluated by C index,ROC curve(receiver operating characteristic curve),calibration curve,and clinical decision analysis curve(DCA curve).Results:A total of 91 patients were included,and after st-SCS treatment,numerical rating scale(NRS)scores were significantly reduced,patients'sleep quality was improved,and the mean consumption of pregabalin and gabapentin was significantly reduced compared with that before st-SCS(P<0.05).Logistic regression models were developed,and the results showed that long course of ZAN(course,OR 7.0232,95%CI 1.2551-39.299,P=0.0265),high eosinophil percentage(EOP,OR 1.6808,95%CI 1.0513-2.6874,P=0.0301),and comorbid coronary artery disease(OR 4.089,95%CI 1.1238-14.9440,P=0.0326)were independent risk factors for the poor effect of short-term electrical stimulation treatment.Conclusion:St-SCS can significantly relieve pain of patients with refractory ZAN,reduce the average dosage of analgesic drugs,and improve sleep quality with few complications and high safety.Long disease duration(course),combined coronary artery disease,and high eosinophil percentage(EOP)were independent risk factors for the treatment effect of st-SCS.The area under the ROC curve was 0.767,indicated that the accuracy of the model developed in this study was high.