射频干预时间对不同阶段带状疱疹相关性疼痛临床疗效的影响

TIMING OF RADIOFREQUENCY INTERVENTION IS ASSOCIATED WITH THE CLINICAL EFFICACY IN DIFFERENT STAGES OF HERPES ZOSTER RELATED PAIN

摘要:

目的：回顾性分析射频干预时间对不同阶段带状疱疹相关性疼痛(Zoster Related Pain, ZRP)临床疗效的影响。方法：2019年6月至2020年5月在中日友好医院疼痛科初次接受脉冲射频(Pulsed Radiofrequency, PRF)/热凝射频(Thermocoagulation Radiofrequency, TRF)治疗的99名中重度疼痛的老年ZRP患者,采用单因素和多因素逻辑回归分析以确定ZRP临床疗效相关独立影响因素。从皮疹发作到初次接受射频治疗(PRF/TRF)之间的时间定义为射频干预时间。将射频干预时间按不同ZRP阶段分为急性期、亚急性期和慢性期,并进行分层分析。术后6个月数字评分法(Numerical rating scale, NRS)评分下降程度作为临床结局,并分为A组(与术前相比术后6个月NRS评分下降≥50%)和B组(与术前相比术后6个月NRS评分下降＜50%)。结果：根据单因素分析发现性别、术前NRS评分、合并自身免疫性疾病和射频干预时间与ZRP临床疗效相关(P＜0.10)。多因素逻辑回归分析发现,与慢性期相比,急性期获得ZRP有效缓解的优势比是46.447(95% CI 3.750-575.340),亚急性期获得ZRP有效缓解的优势比是17.294(95% CI 5.101-58.629)。结论：对于50岁或50岁以上有中度至重度疼痛的ZRP患者,射频干预时间与疼痛有效缓解相关,在疾病早期使用射频治疗可能会提高ZRP临床疗效。

Abstract:

Objective: To retrospectively analyze the effect of the timing of radiofrequency intervention on the clinical efficacy in different stages of herpes zoster related pain (ZRP). Methods：A total of 99 elderly ZRP patients with moderate to severe pain, who were initially treated with pulsed radiofrequency (PRF) or thermocoagulated radiofrequency (TRF) from June 2019 to may 2020 at the pain department of China Japan Friendship Hospital, were analyzed using univariate and multivariate logistic regression to identify the independent influencing factors associated with clinical efficacy of patients with ZRP. Timing of radiofrequency intervention was defined as the time between the onset of rash and the initial RF treatment (PRF / TRF). The timing of radiofrequency intervention was divided into acute, subacute, and chronic phases by different ZRP stages, and stratified analysis was performed. The degree of decrease in numerical rating scale (NRS) scores at 6 months after surgery was used as the clinical outcome and was divided into group A (≥ 50% decrease in NRS score at 6 months after surgery compared with before surgery) and group B (< 50% decrease in NRS score at 6 months after surgery compared with before surgery). Results: According to univariate analysis, gender, preoperative NRS score, comorbid autoimmune diseases and the timing of RF intervention were found to be associated with ZRP clinical efficacy (P < 0.10), while multivariate logistic regression analysis found that compared with the chronic phase, the odds ratio of obtaining ZRP effective remission was 46.447 (95% CI 3.750-575.340) in the acute phase and 17.294 (95% CI 5.101-58.629) in the subacute phase. Conclusion: For ZRP patients aged 50 years or older with moderate to severe pain, the timing of radiofrequency intervention was correlated with the effective remission of pain, and the use of radiofrequency treatment in the early stage of the disease might improve the clinical efficacy.