比较高电压和标准电压脉冲射频治疗带状疱疹相关性疼痛的有效性和安全性：基于随机对照试验的Meta分析*

Comparing the efficacy and safety of high-voltage and standard-voltage pulsed radiofrequency for the treatment of zoster-associated pain: a meta-analysis based on randomized controlled trials*

摘要:

目的：系统评价高电压和标准电压脉冲射频(Pulsed Radiofrequency,PRF)治疗带状疱疹相关性疼痛(Zoster-associated Pain,ZAP)的有效性和安全性,为临床实践提供理论依据。方法：对PubMed、Web Of Science、Cochrane Library、Embase、中国国家知识网络基础设施数据库(CNKI)、万方数据库、中国生物医学文献服务系统(Sinomed)、维普数据库等八大数据库进行全面检索,以获取比较高电压与标准电压PRF治疗ZAP的随机对照研究,时间截止为2022年6月,不设置语言限制。有2位研究者独立提取数据,文章质量评价,并交叉核对,采用RevMan软件进行Meta分析。主要结局指标为视觉模拟评分法或数字评分法评估疼痛改善的效果,次要结局指标为匹兹堡睡眠质量指数评估患者睡眠质量改善情况,安全指标为不良事件发生率。结果：共纳入10篇RCT研究,患者601例。Meta分析结果显示：在ZAP患者疼痛评分方面,高电压PRF治疗组低于标准电压PRF组(P< 0.00001)；在匹兹堡睡眠质量指数方面,高电压PRF治疗组也低于标准电压PRF组(P< 0.05)；在不良反应发生率方面,高电压PRF治疗组与标准电压PRF组相比无统计学意义(P=0.16)。

Abstract:

Objective: To compare the efficacy and safety between high-voltage and standard-voltage pulsed radiofrequency(PRF)in the treatment of zoster-associated pain. Methods: PubMed, Cochrane Library, Embase, Web Of Science, Wanfang Database, VIP Database, China National Knowledge Network Infrastructure Database (CNKI),and China Biomedical Documentation Service System (Sinomed) were searched for randomized controlled trials up to June 2022 that compared high-voltage and standard-voltage pulsed radiofrequency in the treatment of zoster-associated pain. No language restrictions were set. Two researchers independently extracted data, evaluated the quality of the articles, and cross-checked them. Then, a meta-analysis was performed by using RevMan software. The primary outcome was the visual analogue scale(VAS)or numerical rating scale(NRS)to assess the effect of pain , the secondary outcome was the Pittsburgh Sleep Quality Index to assess the improvement of patients sleep quality, and the safety outcomes was the incidence of adverse events. Results: Ten randomized controlled trials involving 601 patients were included. The meta-analysis showed that pain scores of ZAP patients in the high-voltage PRF group treatment group were lower than that in the standard voltage PRF group (P<0.00001); Pittsburgh Sleep Quality Index of ZAP patients in the high-voltage PRF group was also lower than that in the standard voltage PRF group (P < 0.05). However there was no significant difference between the two groups in the incidence of adverse reactions of ZAP patients (P=0.16). Conclusion: High-voltage PRF was superior to standard-voltage PRF in improving pain scores and sleep quality in ZAP patients. And high-voltage PRF didn’t increase the incidence of treatment-related adverse reactions of ZAP patients.