CT引导下脉冲射频治疗带状疱疹后神经痛患者疗效及相关因素分析  

Curative Effect of CT-Guided Pulsed Radiofrequency and Its Related Factors in Patients with Postherpetic Neuralgia

作　　者：刘冰 李琳[1] 高谦[1] LIU Bing;LI Lin;GAO Qian(Pain Department,Hengshui People's Hospital(Harrison International Peace Hospital))

机构地区：[1]河北省衡水市人民医院(哈励逊国际和平医院)疼痛科

出　　处：《中国医学计算机成像杂志》2024年第5期604-609,共6页Chinese Computed Medical Imaging

基　　金：河北省卫生厅科研基金项目(20232176)。

摘　　要：目的:探究CT引导下脉冲射频治疗带状疱疹后神经痛患者疗效及相关因素。方法:纳入2020年9月至2022年11月入院治疗的带状疱疹后神经痛患者135例,均接受CT引导下脉冲射频治疗,对比手术前后视觉模拟评分法(VAS)评分、皮损区与对应健侧区域皮肤的温差(△T)、血清疼痛介质及炎症因子水平,统计并发症情况。以术后1年为观察终点,根据疗效分为有效组和无效组,分别有84例和51例,对比2组临床资料,分析CT引导下脉冲射频治疗带状疱疹后神经痛患者疗效的影响因素,构建预测模型并验证。结果:与术前比较,患者术后1、3、7dVAS评分和△T明显降低,术后7d血清前列腺素E2(PGE2)、白细胞介素(IL)-6和IL-10水平明显降低,β-内咖啡肽(β-EP)水平明显升高(P<0.05)。无效组年龄>65岁、糖尿病、病程>6个月占比高于有效组,接受抗病毒治疗占比低于有效组(P<0.05);而2组性别、体重指数、高血压等其他资料分布的比较,差异无统计学意义(P>0.05)。年龄>65岁、合并糖尿病、病程6个月是影响疗效的独立危险因素(P<0.05)。构建CT引导下脉冲射频治疗后1年疗效的风险预测模型,Logit(P)=-4.751+1.723×(年龄)+1.637×(糖尿病)+1.853×(病程)。Hosmer-Lemeshow拟合优度检验显示,该模型的预测概率与实际发生率的差异无统计学意义(χ^(2)=4.251,P=0.851),受试者工作特征(ROC)曲线结果显示,模型预测CT引导下脉冲射频治疗后1年疗效(无效)的曲线下面积(AUC)为0.856(95%CI 0.783~0.930)。结论:CT引导下脉冲射频治疗可明显减轻带状疱疹后神经痛患者疼痛程度,年龄>65岁、合并糖尿病、病程>6个月是影响术后1年疗效的影响因素。Purpose:To explore the curative effect of CT-guided pulsed radiofrequency and its related factors in patients with postherpetic neuralgia.Methods:A total of 135 patients with postherpetic neuralgia undergoing CT-guided pulsed radiofrequency in the hospital were enrolled between September 2020 and November 2022.The scores of visual analogue scale(VAS),skin temperature difference(△T)between skin lesion area and the corresponding healthy area,levels of serum pain mediators and inflammatory factors were compared before and after surgery,and the complications were analyzed.According to curative effect,the above research subjects were divided into effective group(84 cases)and ineffective group(51 cases),and clinical data in the two groups were compared.The factors influencing curative effect of CT-guided pulsed radiofrequency in patients with postherpetic neuralgia were analyzed.The prediction model was constructed for verification.Results:At 1 d,3 d and 7 d after surgery,VAS scores and△T were significantly decreased(P<0.05).At 7 d after surgery,levels of serum prostaglandin E2(PGE2),interleukin(IL)-6 and IL-10 were significantly decreased,while level ofβ-endorphin(β-EP)was significantly increased(P<0.05).The proportions of age>65 years,diabetes mellitus and disease course>6 months were higher in ineffective group than those of effective group,while proportion of antiviral treatment was lower in ineffective group(P<0.05).The difference in gender,body mass index,hypertension and the other data between the two groups was with no statistical significance(P>0.05).Age>65 years,diabetes mellitus and disease course>6 months were independent influencing factors of curative effect(P<0.05).The risk prediction model for curative effect was as follow:Logit(P)=4.751+1.723x(age)+1.637×(diabetes mellitus)+1.853x(disease course).Hosmer-Lemeshow goodness of fit test showed that the difference in predicted probability between the model and actual detection was with no statistical significance(χ^(2)=4.251,P=0.851).Receiver operat

关 键 词：带状疱疹后神经痛 脉冲射频 疗效 影响因素 预测模型 

分 类 号：R752.12[医药卫生—皮肤病学与性病学]