短时程脊髓电刺激调控Th17/Treg水平治疗带状疱疹后神经痛的临床研究*

Clinical study on the regulation of Th 17 / Treg in the treatment of postherpetic neuralgia*

摘要:

摘要 目的：探究短时程脊髓电刺激 (short-term spinal cord stimulation, st-SCS) 治疗带状疱疹后神经痛(postherpetic neuralgia, PHN)的临床疗效，并检测Th17细胞、Treg细胞以及Th17/Treg细胞之间的平衡在治疗前后变化情况。方法：选取2023年9月1日至2024年12月30日就诊于青岛市市立医院疼痛科，确诊为带状疱疹后神经痛的患者60例，按随机数字法分为治疗组和对照组，每组30例。对照组入院后给予普瑞巴林进行基础治疗。治疗组患者在基础治疗的同时手术植入电极，进行短程脊髓电刺激7天。两组患者在入组后以及治疗后7天、1个月评估患者疼痛程度、睡眠质量及负性情绪的变化。使用视觉模拟评分法（visual analogue scale，VAS）评估患者疼痛程度，匹兹堡睡眠质量指数（Pittsburg sleep quality index, PSQI) 评估患者睡眠质量，焦虑自评量表（self-rating anxiety scale, SAS）评估患者负性情绪，在入组前及治疗7天后抽取外周血用于检测Th17 细胞和Treg 细胞，使用流式细胞术检测细胞含量。结果：对照组脱落3例，最终对照组27例，治疗组30例纳入研究。两组患者的疼痛程度、睡眠质量及负性情绪均有所改善 (P < 0.05)，治疗组较对照组改善更为明显（P＜0.05），经st-SCS治疗后Th17 细胞、Treg细胞及Th17/Treg比值较术前明显下降（P＜0.05）。而对照组未出现明显变化（P＞0.05）。治疗后治疗组Th17水平及Th17/Treg比值较对照组明显下降（P＜0.05），但Treg水平组间差异不明显（P＞0.05）。结论：st-SCS可有效治疗PHN，其发挥作用的机制可能与调控Th17/Treg细胞免疫平衡，抑制炎症反应有关，在疼痛缓解，睡眠质量改善及情绪改善方面显著优于常规治疗组。

Abstract:

Abstract Objective: To investigate the clinical efficacy of short-term spinal cord stimulation (ST-SCS) in treating postherpetic neuralgia (PHN), and to examine changes in the balance between Th17 cells, Treg cells, and their interactions before and after treatment. Methods: A total of 60 patients diagnosed with postherpetic neuralgia were enrolled in the study at the Department of Pain Medicine, Qingdao Municipal Hospital from September 1, 2023 to December 30,2024. These patients were randomly divided into treatment and control groups of 30 cases each. The control group received pregabalin as baseline therapy upon admission, while the treatment group underwent surgical implantation of electrodes and received short-term spinal cord stimulation (7 days) during treatment. Pain severity, sleep quality, and negative affect were assessed at baseline, 7 days post-treatment, and 1 month post-treatment. The visual analog scale (VAS) was used to evaluate pain intensity, Pittsburgh Sleep Quality Index (PSQI) for sleep quality, and Self-Rating Anxiety Scale (SAS) for negative affect. Peripheral blood samples were collected pre-enrollment and 7 days post-treatment for Th17 and Treg cell analysis using flow cytometry.. Results: Three cases in the control group dropped out, leaving 27 cases in the final control group and 30 in the treatment group. Both groups showed improvements in pain severity, sleep quality, and negative emotions (P <0.05), with more significant gains in the treatment group (P <0.05). St-SCS treatment significantly reduced Th17 cells, Treg cells, and the Th17/Treg ratio compared to pre-treatment levels (P <0.05), while no significant changes occurred in the control group (P> 0.05). Post-treatment, the treatment group demonstrated marked decreases in Th17 levels and Th17/Treg ratios (P <0.05), though no significant differences remained between groups in Treg levels (P> 0.05). Conclusion: St-SCS effectively treats postoperative pain neuropathy (PHN), possibly through regulating Th17/Treg immune balance and suppressing inflammatory responses. It demonstrated superior efficacy than conventional treatments in pain relief, sleep improvement, and emotional regulation.