CT引导下脉冲射频联合神经阻滞治疗头面部带状疱疹后神经痛的临床效果

陆磊磊; 耿祝生

doi:10.16766/j.cnki.issn.1674-4152.003714

CT引导下脉冲射频联合神经阻滞治疗头面部带状疱疹后神经痛的临床效果

doi: 10.16766/j.cnki.issn.1674-4152.003714

陆磊磊,
耿祝生^,

连云港市第一人民医院/徐州医科大学附属连云港医院疼痛科，江苏连云港 222000

基金项目:

2021年江苏省卫健委科研项目 M2020105

详细信息

通讯作者:
耿祝生，E-mail: 1249934359@qq.com

中图分类号: R752.12
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- 文章访问数: 20
- HTML全文浏览量: 11
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- 被引次数: 0
出版历程
- 收稿日期: 2024-04-18
- 网络出版日期: 2024-12-28

The Clinical Effect of CT-guided Pulse Radiofrequency Combined with Nerve Block in the Treatment of Patients with Head and Face Postherpetic Neuralgia

LU Leilei,
GENG Zhusheng^,

Department of Pain, the First People ' s Hospital of Lianyungang/ The Affiliated Lianyungang Hospital of Xuzhou Medical University Lianyungang City, Lianyungang, Jiangsu 222000, China

摘要

摘要: 目的探究CT引导下脉冲射频(PRF)联合神经阻滞治疗头面部带状疱疹后神经痛(PHN)的疗效及可能机制。方法选择2021年2月—2023年8月连云港市第一人民医院收治的头面部PHN患者104例，采用随机数表法将其分为研究组(52例)与对照组(52例)。对照组给予神经阻滞治疗，研究组行CT引导下PRF联合神经阻滞治疗。治疗1个月后评价疗效及安全性，对比2组治疗前后疼痛视觉模拟评分(VAS)、匹兹堡睡眠质量指数(PSQI)、汉密尔顿焦虑/抑郁量表(HAMA/HAMD)评分，且治疗前后采血测定疼痛递质[β-内啡肽(β-EP)、P物质(SP)、降钙素基因相关肽(CGRP)、神经肽Y(NPY)]与炎症指标[白细胞介素(IL)-6、IL-26、CC趋化因子受体2(CCR2)]。结果治疗后，研究组总有效率高于对照组[90.38%(47/52) vs. 73.08%(38/52)，P＜0.05)]；研究组VAS评分为(2.21±0.64)分，低于对照组的(3.37±1.00)分(F=802.273, P＜0.001)，研究组PSQI、HAMA及HAMD评分、血清疼痛递质及炎症指标水平均低于对照组(P＜0.05)；2组不良反应发生率比较，差异无统计学意义(P＞0.05)。结论 CT引导下PRF联合神经阻滞治疗头面部PHN安全有效，能减轻患者疼痛，其机制可能与抑制疼痛介质、降低血清IL-6、IL-26、CCR2水平有关。
- 头面部带状疱疹后神经痛 /
- CT引导 /
- 脉冲射频 /
- 神经阻滞 /
- 疼痛 /
- 机制
Abstract: Objective To investigate the efficacy and possible mechanism of CT-guided pulse radiofrequency (PRF) combined with nerve block in the treatment of post-herpetic neuralgia (PHN) of the head and face. Methods A total of 104 patients with head and face PHN admitted to the First People ' s Hospital of Lianyungang from February 2021 to August 2023 were randomly divided into the study group (52 cases) and the control group (52 cases) using the random number table method. The control group underwent a nerve block procedure. The study group received CT-guided PRF combined nerve block treatment. Efficacy and safety were evaluated after 1 month of treatment, and changes in VAS, Pittsburgh sleep quality index (PSQI), Hamilton anxiety/depression scale (HAMA/HAMD) scores were compared between the two groups before and after treatment. Pain transmitters [β-endorphin (β-EP), substance P (SP), calcitonin gene-related peptide (CGRP), neuropeptide Y (NPY)] and inflammatory markers [interleukin-6, IL-26, CC chemokine receptor 2 (CCR2)] were measured in blood samples before and after treatment. Results Following treatment, the total effective rate in the study group was significantly higher [90.38% (47/52) vs. 73.08% (38/52), P < 0.05]; Additionally, the VAS score in the study group was (2.21±0.64) points, which was lower than that in the control group [(3.37±1.00) points, F=802.273, P < 0.001]. The PSQI, HAMA, HAMD scores, as well as serum pain transmitters and inflammatory marker levels, were significantly lower in the study group (P < 0.05). Conversely, there was no statistically significant difference in the incidence of adverse reactions (P>0.05). Conclusion CT-guided PRF combined with nerve block in the treatment of PHN of the head and face is safe and effective and can reduce pain in patients. The mechanism may be related to inhibition of pain mediators and reduction of serum levels of IL-6, IL-26 and CCR2.
- Head and face postherpetic neuralgia /
- CT-guided /
- Pulse radiofrequency /
- Nerve block /
- Pain /
- Mechanism

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表 1 2组头面部PHN患者临床资料比较

Table 1. Comparison of clinical data between two groups of patients with head and facial PHN

项目	研究组(n=52)	对照组(n=52)	统计量	P值
性别[例(%)]			0.160^a	0.689
男性	22(42.31)	20(38.46)
女性	30(57.69)	32(61.54)
年龄(x±s，岁)	52.14±8.02	53.08±7.86	0.604^b	0.547
疼痛持续时间(x±s，月)	2.20±0.45	2.15±0.43	0.579^b	0.564
BMI(x±s)	24.00±2.35	23.76±2.18	0.540^b	0.590
患侧[例(%)]			0.346^a	0.556
左侧	25(48.08)	28(53.85)
右侧	27(51.92)	24(46.15)
三叉神经累及情况[例(%)]			0.324^a	0.850
第1支	9(17.31)	7(13.46)
第1、2支	26(50.00)	28(53.85)
第2、3支	17(32.69)	17(32.69)
合并基础病[例(%)]
糖尿病	11(21.15)	13(25.00)	0.217^a	0.642
高血压	15(28.85)	14(26.92)	0.048^a	0.827
吸烟史[例(%)]			0.160^a	0.689
有	30(57.69)	32(61.54)
无	22(42.31)	20(38.46)
注：^a为χ²值，^b为t值。

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表 2 2组头面部PHN患者临床总有效率比较[例(%)]

Table 2. Comparison of efficacy between the two groups of patients with head and facial PHN[cases (%)]

组别	例数	显效	有效	无效	总有效
研究组	52	26(50.00)	21(40.38)	5(9.62)	47(90.38)
对照组	52	16(30.77)	22(42.31)	14(26.92)	38(73.08)

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表 3 2组头面部PHN患者各项评分比较(x±s，分)

Table 3. Changes of scores before and after treatment between the two groups of patients with head and facial PHN(x±s)

组别	例数	VAS评分		PSQI评分		HAMA评分		HAMD评分
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
研究组	52	7.26±1.34	2.21±0.64^b	17.23±2.75	10.12±3.00^b	15.38±3.06	8.53±2.14^b	16.24±3.58	10.15±2.96^b
对照组	52	7.32±1.43	3.37±1.00^b	17.35±2.80	12.64±3.15^b	15.43±3.10	10.26±2.38^b	16.30±3.62	12.43±3.05^b
统计量		0.221^a	802.273^c	0.220^a	511.650^c	0.083^a	257.142^a	0.085^a	3.868^c
P值		0.826	＜0.001	0.826	＜0.001	0.934	＜0.001	0.932	＜0.001
注：^a为t值，^c为F值；与同组治疗前比较，^bP＜0.05。

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表 4 2组头面部PHN患者血清疼痛介质相关指标变化比较(x±s)

Table 4. Changes of serum pain mediators related indexes before and after treatment between the two groups of patients with head and facial PHN(x±s)

组别	例数	β-EP(pg/mL)		SP(pg/mL)		CGRP(ng/mL)		NPY(pg/mL)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
研究组	52	462.25±48.37	312.04±41.30^b	135.46±16.37	84.24±12.19^b	336.75±40.16	200.47±29.14^b	271.23±33.27	187.65±26.04^b
对照组	52	465.01±50.40	350.18±42.63^b	136.00±16.75	100.12±14.25^b	338.16±41.08	240.35±36.12^b	272.19±35.10	220.34±30.15^b
统计量		0.285^a	434.710^c	0.166^a	438.234^c	0.177^a	522.442^c	0.143^a	242.930^c
P值		0.776	＜0.001	0.868	＜0.001	0.860	＜0.001	0.887	＜0.001
注：^a为t值，^c为F值；与同组治疗前比较，^bP＜0.05。

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表 5 2组头面部PHN患者血清IL-6、IL-26、CCR2水平变化比较(x±s)

Table 5. Changes of serum levels of IL-6, IL-26, and CCR2 in the two groups of patients with head and facial PHN before and after treatment(x±s)

组别	例数	IL-6(ng/mL)		IL-26(pg/mL)		CCR2(μg/L)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
研究组	52	100.34±22.73	64.25±14.38^b	15.60±2.01	8.54±1.13^b	72.86±13.15	38.26±10.02^b
对照组	52	102.18±23.24	75.36±16.07^b	15.74±2.16	11.12±1.75^b	73.17±13.48	45.93±11.25^b
统计量		0.408^a	135.243^c	0.342^a	543.800^c	0.119^a	341.922^c
P值		0.684	＜0.001	0.733	＜0.001	0.906	＜0.001
注：^a为t值，^c为F值；与同组治疗前比较，^bP＜0.05。

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参考文献(20)

[1]	WERNER R N, GHORESCHI K. Herpes zoster-prevention, diagnosis, and treatment[J]. Hautarzt, 2022, 73(6): 442-451. doi: 10.1007/s00105-022-04992-9
[2]	田俊斌, 罗斌, 赵静, 等. 不同频率分散式体外冲击波治疗带状疱疹后神经痛的临床疗效[J]. 西部医学, 2019, 31(10): 1605-1608. doi: 10.3969/j.issn.1672-3511.2019.10.025 TIAN J B, LUO B, ZHAO J, et al. The clinical affection of different frequency dispersed extracorporeal shock wave in the treatment of postherpetic neuralgia[J]. Medical Journal of West China, 2019, 31(10): 1605-1608. doi: 10.3969/j.issn.1672-3511.2019.10.025
[3]	李富波, 龚格格. 超声引导下肋间神经脉冲射频联合神经阻滞治疗带状疱疹后神经痛疗效分析[J]. 中国基层医药, 2023, 30(4): 557-560. doi: 10.3760/cma.j.cn341190-20210804-00881 LI F B, GONG G G. Efficacy of ultrasound guided intercostal nerve pulse radiofrequency combined with nerve block in the treatment of post-herpetic neuralgia[J]. Chinese Journal of Primary Medicine and Pharmacy, 2023, 30(4): 557-560. doi: 10.3760/cma.j.cn341190-20210804-00881
[4]	徐幼苗, 刘婷婷, 张志利, 等. CT引导下脉冲射频调节术联合胸椎旁神经阻滞对带状疱疹后神经痛患者疼痛程度及生活质量的影响[J]. 卒中与神经疾病, 2023, 30(1): 49-54. doi: 10.3969/j.issn.1007-0478.2023.01.008 XU Y M, LIU T T, ZHANG Z L, et al. Effects of CT-guided pulse radiofrequency ablation combined with thoracic paravertebral nerve block on pain degree and quality of life of patients with postherpetic neuralgia[J]. Stroke and Nervous Diseases, 2023, 30(1): 49-54. doi: 10.3969/j.issn.1007-0478.2023.01.008
[5]	侯靳, 郭安梅, 张少勇, 等. 脉冲射频治疗带状疱疹后神经痛临床效果的系统评价[J]. 中国疼痛医学杂志, 2018, 24(6): 421-428. doi: 10.3969/j.issn.1006-9852.2018.06.006 HOU J, GUO A M, ZHANG S Y, et al. Clinical effect of pulsed radiofrequency treatment on postherpetic neuralgia: a systematic review[J]. Chinese Journal of Pain Medicine, 2018, 24(6): 421-428. doi: 10.3969/j.issn.1006-9852.2018.06.006
[6]	中国医师协会皮肤科医师分会带状疱疹专家共识工作组. 带状疱疹中国专家共识[J]. 中华皮肤科杂志, 2018, 51(6): 403-408. doi: 10.3760/cma.j.issn.0412-4030.2018.06.001 Shingles Expert Consensus working Group of Dermatologist Branch of Chinese Medical Doctor Association. Herpes zoster Chinese expert consensus[J]. Chinese Journal of Dermatology, 2018, 51(6): 403-408. doi: 10.3760/cma.j.issn.0412-4030.2018.06.001
[7]	GROSS G E, EISERT L, DOERR H W, et al. S2k guidelines for the diagnosis and treatment of herpes zoster and postherpetic neuralgia[J]. J Dtsch Dermatol Ges, 2020, 18(1): 55-78.
[8]	严广斌. 视觉模拟评分法(VAS)[J]. 中华关节外科杂志(电子版), 2014, 8(2): 273. YAN G B. Visual analogue Scale (VAS)[J]. Chinese Journal of Joint Surgery (Electronic version), 2014, 8(2): 273.
[9]	路桃影, 李艳, 夏萍, 等. 匹兹堡睡眠质量指数的信度及效度分析[J]. 重庆医学, 2014, 43(3): 260-263. LU T Y, LI Y, XIA P, et al. Analysis on reliability and validity of the Pittsburgh sleep quality index[J]. Chongqing Medicine, 2014, 43(3): 260-263.
[10]	张作记. 行为医学量表手册[M]. 北京: 中华医学电子音像出版社出版, 2005: 214-215, 225-227. ZHANG Z J. Manual of Behavioral Medicine Scales[M]. Beijing: Published by China Medical Electronic Audio-Visual Publishing House, 2005: 214-215, 225-227.
[11]	MERCAN A, UZUN S T, KELES S, et al. Immunological mechanism of postherpetic neuralgia and effect of pregabalin treatment on the mechanism: a prospective single-arm observational study[J]. Korean J Pain, 2021, 34(4): 463-470. doi: 10.3344/kjp.2021.34.4.463
[12]	王一一, 李晓红, 刘鹏, 等. 超声引导下椎旁神经阻滞联合利多卡因凝胶贴膏治疗带状疱疹后神经痛疗效观察[J]. 中华全科医学, 2023, 21(3): 401-404, 497. doi: 10.16766/j.cnki.issn.1674-4152.002893 WANG Y Y, LI X H, LIU P, et al. Efficacy observation of ultrasound-guided paravertebral nerve block combined with lidocaine gel plaster in the treatment of postherpetic neuralgia[J]. Chinese Journal of General Practice, 2023, 21(3): 401-404, 497. doi: 10.16766/j.cnki.issn.1674-4152.002893
[13]	杨一玲, 黎月娥, 张俊峰, 等. 经颅磁刺激评估带状疱疹后遗神经痛患者皮层兴奋性变化的研究[J]. 中华全科医学, 2023, 21(7): 1113-1116. doi: 10.16766/j.cnki.issn.1674-4152.003062 YANG Y L, LI Y E, ZHANG J F, et al. Study on the changes of cortical excitability in patients with postherpetic neuralgia evaluated by transcranial magnetic stimulation[J]. Chinese Journal of General Practice, 2023, 21(7): 1113-1116. doi: 10.16766/j.cnki.issn.1674-4152.003062
[14]	李云泽, 王敬萱, 宋文阁, 等. 脉冲射频治疗急性期带状疱疹三叉神经痛疗效观察[J]. 中国疼痛医学杂志, 2020, 26(10): 789-791. LI Y Z, WANG J X, SONG W G, et al. Therapeutic effect of pulsed radiofrequency on acute herpes zoster trigeminal neuralgia[J]. Chinese Journal of Pain Medicine, 2020, 26(10): 789-791.
[15]	黄景妹, 王萍, 叶峻宏, 等. 背根神经节脉冲射频联合普瑞巴林治疗老年胸段带状疱疹后神经痛的疗效及对血清相关因子水平的影响[J]. 中国老年学杂志, 2023, 43(15): 3729-3732. HUANG J M, WANG P, YE J H, et al. Effect of dorsal root ganglion pulse combined with pregabalin on the treatment of senile thoracic postherpetic neuralgia and the level of serum related factors[J]. Chinese Journal of Gerontology, 2023, 43(15): 3729-3732.
[16]	FILA M, CHOJNACKI J, SOBCZUK P, et al. Nutrition and calcitonin gene related peptide (CGRP) in migraine[J]. Nutrients, 2023, 15(2): 289.
[17]	CHEN K, WANG M, LONG D, et al. Cerebrospinal fluid proteomic profiles in patients with postherpetic neuralgia[J]. J Proteome Res, 2023, 22(12): 3879-3892.
[18]	LIN D, ZHONG C, JIANG Q, et al. Serum interleukin-6 levels are increased in post-herpetic neuralgia: a single-center retrospective study[J]. An Bras Dermatol, 2023, 98(2): 202-207.
[19]	曹鑫意. 趋化因子CCL2在颅脑损伤后炎症反应中的作用[J]. 中国临床神经外科杂志, 2022, 27(3): 224-226. CAO X Y. The role of chemokine CCL2 in inflammatory response after craniocerebral injury[J]. Chinese Journal of Clinical Neurosurgery, 2022, 27(3): 224-226.
[20]	魏冉, 卢懿, 彭丽, 等. 带状疱疹患者血清CX3CR1、CCR2表达与带状疱疹后遗神经痛的相关性[J]. 疑难病杂志, 2022, 21(12): 1283-1287, 1292. WEI R, LU Y, PENG L, et al. Correlation between the expression of CX3CR1 and CCR2 in serum of patients with herpes zoster and postherpetic neuralgia[J]. Chinese Journal of Difficult and Complicated Cases, 2022, 21(12): 1283-1287, 1292.