Δ通信作者 樊碧发 [e-mail]

CLINICAL OBSERVATION OF PREGABALIN IN THE TREATMENT OF POSTHERPETIC NEURALGIA BASED ON BLOOD CONCENTRATION MONITORING*

摘要:

目的: 探讨血药浓度监测在普瑞巴林治疗带状疱疹后神经痛(PHN)中的作用。方法: 选择2018年12月至2020年12月就诊于中日友好医院疼痛科的带状疱疹后神经痛(postherpetic neuralgia,PHN)患者149例。所有患者进行疼痛量化评分后,进入第一阶段治疗。给予口服普瑞巴林150mg,每日 2 次。14天后,进行疼痛量化评估,记录药物不良反应,同时测定普瑞巴林的血药浓度。并根据NRS评分情况将患者分为三个组进行第二阶段治疗：将NRS评分≤3分的患者归入常规药物组(R组,Group R,66例)；NRS评分>3分的患者(83例)再按照患者意愿分为两组：增强药物组(P组,Group P,37例)和射频治疗组(F组,Group F,46例)。R组患者继续原治疗方案。P组将普瑞巴林治疗量增加100%(每日2次,每次600mg)；F组在原治疗方案的基础上,行选择性神经根脉冲射频。治疗14天后,再次进行疼痛量化评估,测定普瑞巴林的血药浓度。结果: 收治患者治疗前的NRS评分为6.81±1.12,经过第一阶段治疗后,NRS评分降至3.85±1.27(p<0.01)。其中,NRS>3分患者的普瑞巴林血药浓度为2252.33±1308.91μg/L,明显低于NRS≤3分患者的血药浓度(p<0.01)。第二阶段治疗后,P组患者NRS降至2.81±0.52,F组降至2.68±0.74。F组NRS评分3分以下的患者占入组患者的87.0%,明显高于P组(p<0.05)。P组总体的普瑞巴林血药浓度上升至2759.55±1810.88μg/L,明显高于治疗前(p<0.05),R组和P组普瑞巴林血药浓度高于F组患者,差异具有统计学意义(p<0.05)。研究的不良反应主要是恶心、头晕和嗜睡。其中,F组的不良反应发生率最低。结论: 普瑞巴林可以有效缓解带状疱疹后神经痛,其效果与血药浓度呈现一定的相关性。血药浓度偏低的患者采用脉冲射频与普瑞巴林的联合治疗,具有良好的有效性和安全性。

Abstract:

Objective: To explore the role of plasma drug concentration monitoring in the treatment of postherpetic neuralgia (PHN) with pregabalin. Methods: One hundred and forty-nine patients with postherpetic neuralgia (PHN) treated in the pain department of China Japan Friendship Hospital from December 2018 to December 2020 were selected. All patients entered the first stage of treatment. Pregabalin 150mg was given orally twice a day. After treatment for 14 days, NRS score and adverse reactions were recorded, and the plasma concentration of pregabalin was measured. Then according to the NRS score, the patients were divided into three groups for the second stage of treatment: Patients with NRS score ≤ 3 were classified into routine drug group (Group R, 66 cases); Patients with NRS score > 3 (83 cases) were divided into two groups according to the wishes of patients: enhancement drug group (group P, 37 cases) and radiofrequency treatment group (Group F, 46 cases). Patients in Group R continued the original treatment regimen. Group P increased the amount of pregabalin treatment by 100% (600 mg twice a day); Group F received selective nerve root pulse radiofrequency on the basis of the original treatment scheme. After 14 days of treatment in the second stage, the pain was quantitatively evaluated again and the blood concentration of pregabalin was measured. Results: The NRS score before treatment was 6.81 ± 1.12. After the first stage of treatment, the NRS score decreased to 3.85 ± 1.27 (P < 0.01). The plasma concentration of pregabalin in patients with NRS > 3 was 2252.33 ± 1308.91μg/ L, which was significantly lower than that in patients with NRs ≤ 3 (P < 0.01).. After the second stage of treatment, NRS score decreased to 2.81 ± 0.52 in group P and 2.68 ± 0.74 in group F. The patients with NRS ≤ 3 in group F accounted for 87.0% of the patients in the group, which was significantly higher than that in group P (P < 0.05). The plasma concentration of pregabalin in group P increased to 2759.55 ± 1810.88 μg/ L, which was significantly higher than that before treatment (P < 0.05). The plasma concentration of pregabalin in Group R and group P was higher than that in group F (P < 0.05). The main adverse reactions in the study were nausea, dizziness and drowsiness. Among them, the incidence of adverse reactions in group F was lowest. Conclusion: Pregabalin can effectively alleviate postherpetic neuralgia, and its effect is related to the blood concentration. The combination of pulsed radiofrequency and pregabalin in the treatment of patients with low blood drug concentration has good efficacy and safety.