上肢周围神经损伤所致神经病理性疼痛的临床亚型分析  

Clinical subtype analysis of neuropathic pain caused by peripheral nerve injury of upper extremity

作　　者：彭蔚骢 劳杰 周英杰[1,2,3] 芮晶 Peng Weicong;Lao Jie;Zhou Yingjie;Rui Jing(Department of Hand Surgery,Huashan Hospital,Fudan University,Shanghai 200040,China;Key Laboratory of Hand Reconstruction,Ministry of Health,Shanghai 200032,China;Shanghai Key Laboratory of Peripheral Nerve and Microsurgery,Shanghai 200032,China)

机构地区：[1]复旦大学附属华山医院手外科,上海200040 [2]卫生部手功能重建重点实验室,上海200032 [3]上海市周围神经显微外科重点实验室,上海200032

出　　处：《中华手外科杂志》2021年第6期434-439,共6页Chinese Journal of Hand Surgery

基　　金：国家自然科学基金面上项目(81972122, 81971150);上海市临床重点专科项目(shslczdzk05601)。

摘　　要：目的分析上肢周围神经损伤继发神经病理性疼痛患者的临床表现,依据临床表现特征将患者分为不同亚型。方法横断面分析自2019年11月至2021年2月我科收治的105例上肢周围神经损伤患者资料,以分级诊断标准确诊神经病理性疼痛,以NPSI量表采集其临床表现特征,以K均值聚类进行统计分析。结果符合入选标准105例,根据其临床特征成功分为三类:聚类一"深部痛",主要表现为显著深部痛及阵发痛缺失;聚类二"感觉异常",主要表现为显著感觉异常及深部痛缺失;聚类三"轻阵发痛",主要表现为略明显的阵发痛及深部痛和感觉异常缺失。结论上肢周围神经损伤继发神经病理性疼痛患者可根据临床特征分为三类,作为今后药物随机对照试验的分组依据。该分类方法有潜力指导临床个体化用药,提高该病临床缓解率。Objective To analyze clinical manifestations of patients with neuropathic pain secondary to peripheral nerve injury of upper limb and divide the patients into different subtypes based on features of clinical manifestations.Methods The cross-sectional study included the data of 105 patients with upper limb peripheral nerve injuries treated in our department from November 2019 to February 2021.The neuropathic pain was diagnosed by hierarchical diagnostic criteria.Its clinical manifestations were collected by NPSI questionnaire,and statistically analyzed by K-means clustering.Results A total of 105 patients met the inclusion criteria and were successfully divided into three categories according to their clinical characteristics:Cluster 1,deep pain,mainly manifested as significant deep pain and lack of intermittent pain;Cluster 2,sensory abnormalities,mainly manifested as significant sensory abnormalities and loss of deep pain;Cluster 3,mild intermittent pain,mainly manifested as slightly obvious intermittent pain,deep pain and loss of paresthesia.Conclusion The patients with neuropathic pain secondary to peripheral nerve injury of upper limb can be divided into three categories according to clinical characteristics,which can be used as the grouping basis for drug randomized controlled trials in the future.This classification method has the potential to guide clinical practice of individualized analgesics choices for better prognosis.

关 键 词：上肢 周围神经 神经病理性疼痛 临床分类 

分 类 号：R688[医药卫生—骨科学]