定量温度觉检查用于神经病理性疼痛诊断的临床研究

The Clinical study of quantitative thermal threshold in the diagnosis of neuropathic pain

摘要:

目的：探讨定量温度觉检查(quantitative thermal threshold,QTT)用于神经病理性疼痛(neuropathic pain,NP)诊断的临床价值。方法：分别对462例临床诊断NP患者进行QTT检查,其中：带状疱疹(herpes zoster,HZ)120例、带状疱疹后神经痛(postherpetic neuralgia,PHN)65例、三叉神经痛(trigeminal neuralgia,TN)77例、腰椎间盘突出症(lumbar intervertebral disc herniation,LDH)伴神经根性疼痛200例。对全部患者患侧与健侧对称部位分别进行QTT检测,包括温觉阈值(warm sensory threshold,WST)、冷觉阈值(cold sensory threshold,CST)、热痛觉阈值(heat pain threshold,HPT)、冷痛觉阈值(cold pain threshold,CPT)。对全部患者患侧与健侧对应部位WST、CST、HPT、CPT检测结果分别进行统计学处理,并分析其与患者病程、NRS评分的关系。结果：HZ及PHN患者患侧较健侧CST及CPT降低,WST及HPT升高,差异有统计学意义(P＜0.01)。TN患者患侧较健侧CST及CPT表现为降低,WST表现为升高,差异有统计学意义(P＜0.05),HPT表现为升高,但差异无统计学意义(P＞0.05)。LDH伴神经根性疼痛患者患侧较健侧CST、WST、CPT、HPT差异无统计学意义(P＞0.05)。HZ、PHN、TN患者在病程不同阶段以及NRS评分不同等级中,患侧较健侧QTT结果均有统计学意义(P＜0.05)；其中,又以CST及CPT较为敏感,均表现为患侧较健侧降低。结论：QTT可以对NP进行早期诊断以及对NP患者神经损伤进行量化评估；可提高NP的诊断率,为临床诊断NP提供一种新的辅助诊断方法。

Abstract:

Objective: To explore the clinical value of quantitative thermal threshold in the diagnosis of neuropathic pain.Methods:462 patients with clinically diagnosed NP were examined by QTT, including 120 cases of herpes zoster (HZ), 65 cases of postherpetic neuralgia (PHN), 77 cases of trigeminal neuralgia (TN), and 200 cases of lumbar intervertebral disc herniation (LDH) with nerve root pain.The symmetrical parts of the healthy side and the affected side were detected by QTT, including warm sensory threshold (WST), cold sensory threshold (CST), heat pain threshold (HPT), cold pain threshold (CPT).The results of WST, CST, HPT and CPT in the affected side and healthy side of all patients were statistically processed, and the relationship between the results and the course of disease and NRS score was analyzed.Results:The CST and CPT in the affected side of HZ and PHN patients were lower than those in the healthy side, while WST and HPT were higher,there were significant difference(P < 0.01). CST and CPT in the affected side of TN patients were lower than those in the healthy side, WST was higher (P < 0.05), HPT was higher, but there was no significant difference (P > 0.05). There was no significant difference in CST, WST, CPT and HPT between the affected side and the healthy side in LDH patients with nerve root pain(P > 0.05). Among the patients with HZ, PHN and TN, there were significant differences in the results of QTT between the affected side and the healthy side (P < 0.05) in different stages of the course of disease and in different grades of NRS scores, and CST and CPT were more sensitive, showing that the affected side was lower than the healthy side.Conclusion: QTT can make early diagnosis of NP and quantitatively evaluate the nerve injury of NP patients. It can improve the diagnostic rate of NP and provide a new auxiliary diagnostic method for clinical diagnosis of NP.