Effect of dorsal root ganglion pulsed radiofrequency combined with gabapentin in treating postherpetic neuralgia
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摘要:目的
观察背根神经节(DRG)脉冲射频联合加巴喷丁对带状疱疹后神经痛(PHN)的治疗效果。
方法选取102例PHN患者, 随机分成加巴喷丁组(常规药物+加巴喷丁)和加巴喷丁+射频组(在加巴喷丁组基础上联合DRG脉冲射频)，每组51例。比较2组疗效、疼痛状况、睡眠状况、血清P物质(SP)水平、神经激肽-1(NK-1)水平和不良反应发生情况。
结果加巴喷丁+射频组总有效率为94.12%, 高于加巴喷丁组的76.47%, 差异有统计学意义(P < 0.05)。治疗2、4周后, 2组患者疼痛数字评价量表(NRS)评分、睡眠干扰评分(SIS)均较治疗前降低，且加巴喷丁+射频组均低于加巴喷丁组，差异有统计学意义(P < 0.05)。治疗4周后, 2组血清SP、NK-1水平均低于治疗前，且加巴喷丁+射频组低于加巴喷丁组，差异有统计学意义(P < 0.05)。加巴喷丁+射频组、加巴喷丁组不良反应总发生率分别为9.80%、5.88%, 差异无统计学意义(P>0.05)。
结论DRG脉冲射频联合加巴喷丁对PHN患者的治疗效果较好，可有效下调血清SP、NK-1水平，减轻疼痛，改善睡眠状况，且不良反应少。
Abstract:ObjectiveTo observe the effect of radiofrequency pulse of dorsal root ganglion(DRG) combined with gabapentin in treating postherpetic neuralgia (PHN).
MethodsA total of 102 patients with PHN were selected as study objects, and were randomly divided into gabapentin group (n=51, conventional drug and gabapentin) and gabapentin combined with radiofrequency group (n=51, adding DRG pulse radiofrequency on the basis of gabapentin group). The curative effect, pain status, sleep status, serum substance P (SP) and neurokinin-1 (NK-1) levels and occurrence of adverse reactions were compared between the two groups.
ResultsThe total effective rate of the gabapentin and radiofrequency group was higher than that of the gabapentin group (94.12% versus 76.47%, P < 0.05); after 2 and 4 weeks of treatment, the pain scores of Numerical Evaluation Scale (NRS) and Sleep Interference Score (SIS) in two groups were lower than before treatment, and were lower in the gabapentin combined with radiofrequency group than those in the gabapentin group (P < 0.05). After 4 weeks of treatment, serum SP and NK-1 levels in two groups were lower than before treatment, and were lower in the gabapentin combined with radiofrequency group than the gabapentin group (P < 0.05). There was no difference in the incidence of adverse reactions between gabapentin combined with radiofrequency group (9.80%) and the gabapentin group (5.88%) (P>0.05).
ConclusionDRG pulsed radiofrequency combined with gabapentin has good effects in PHN patients, which can effectively reduce the levels of serum SP and NK-1, relieve pain, improve sleep condition, and has fewer adverse reactions.
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Keywords:
- dorsal root ganglion /
- pulse radiofrequency /
- gabapentin /
- post-herpetic neuralgia /
- substance P /
- neurokinin-1
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表 1 2组患者一般资料比较(x±s)[n(%)]
组别 n 性别 年龄/岁 病程/月 体质量指数/(kg/m2) 皮疹部位 男 女 腰腹部 胸背部 头面部 其他 加巴喷丁+射频组 51 29(56.86) 22(43.14) 56.27±6.54 15.75±4.02 23.46±2.38 11(21.57) 18(35.29) 13(25.49) 9(17.65) 加巴喷丁组 51 27(52.94) 24(47.06) 57.19±7.03 16.83±5.21 23.28±2.15 13(25.49) 16(31.37) 15(29.41) 7(13.73) 
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表 2 2组患者疗效比较[n(%)]
组别 n 显效 有效 无效 总有效 加巴喷丁组 51 22(43.14) 17(33.33) 12(23.53) 39(76.47) 加巴喷丁+射频组 51 29(56.86) 19(37.26) 3(5.88) 48(94.12)* 与加巴喷丁组比较, *P < 0.05。
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表 3 2组不同时点NRS评分、SIS比较(x±s)
分 组别 n NRS评分 SIS 治疗前 治疗2周后 治疗4周后 治疗前 治疗2周后 治疗4周后 加巴喷丁组 51 7.08±1.38 4.34±1.12* 2.96±0.83* 7.33±1.79 3.76±1.21* 2.82±0.78* 加巴喷丁+射频组 51 7.36±1.59 3.28±0.94*# 1.81±0.60*# 7.81±1.82 2.53±0.87*# 1.78±0.52*# NRS: 疼痛数字评价量表; SIS: 睡眠干扰评分。与治疗前比较, *P < 0.05; 与加巴喷丁组比较, #P < 0.05。
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表 4 2组治疗前后血清SP、NK-1水平比较(x±s)
pg/mL 组别 n SP NK-1 治疗前 治疗4周后 治疗前 治疗4周后 加巴喷丁组 51 1 981.29±276.85 261.46±54.58* 13.15±3.72 3.89±1.16* 加巴喷丁+射频组 51 1 989.51±279.32 183.31±41.12*# 13.36±4.14 2.75±0.81*# SP: P物质; NK-1: 神经激肽-1。与治疗前比较, *P < 0.05; 与加巴喷丁组比较, #P < 0.05。
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表 5 2组不良反应发生情况比较[n(%)]
组别 n 嗜睡 头晕 呕吐 合计 加巴喷丁组 51 1(1.96) 0 2(3.92) 3(5.88) 加巴喷丁+射频组 51 2(3.92) 1(1.96) 2(3.92) 5(9.80)
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