背根节注射富血小板血浆改善带状疱疹后疼痛机制探究*

Mechanistic Study of Dorsal Root Ganglion Injection of Platelet-Rich Plasma in Alleviating Postherpetic Neuralgia

摘要:

目的：探讨背根神经节(dorsal root ganglion,DRG)注射富血小板血浆(platelet-rich plasma, PRP)改善带状疱疹后神经痛(postherpetic neuralgia ,PHN)疗效，并基于代谢组学方法探究其机制。方法：将40 例胸腰段 PHN 患者随机分为对照组(普瑞巴林)与PRP组(普瑞巴林联合 DRG 注射PRP)，比较两组数字疼痛评分(NRS)、睡眠质量、药物剂量及不良反应；采用非靶向代谢组学筛选差异代谢物，并进行代谢富集分析以提示其可能调控的生物学途径。结果：共 38 例患者完成临床研究(PRP组 18 例，对照组 20 例)。治疗后，PRP组 NRS降幅、睡眠改善及 28 天普瑞巴林减量均优于对照组(P＜0.05)，嗜睡发生率更低(P＜0.05)，其他不良反应无差异。代谢组学分析共纳入 18 例样本(PRP组 8 例，对照组 10 例)，筛选出苯甲酸、β- 精氨酸等差异代谢物，主要富集于苯丙氨酸、酪氨酸、色氨酸及谷胱甘肽代谢通路。结论：DRG注射PRP 可有效缓解 PHN、改善睡眠、减少药物用量及嗜睡反应；其机制可能与调节氧化应激、炎症反应及氨基酸代谢通路相关。

Abstract:

Objective:?To investigate the efficacy of dorsal root ganglion (DRG) injection of platelet-rich plasma (PRP) in improving postherpetic neuralgia (PHN) and to explore its mechanism using a metabolomics approach. Methods:?Forty patients with thoracolumbar PHN were randomly divided into a control group (pregabalin) and a PRP group (pregabalin combined with DRG injection of PRP). The two groups were compared regarding numerical rating scale (NRS) for pain, sleep quality, medication dosage, and adverse reactions. Non-targeted metabolomics was employed to screen for differential metabolites, and metabolic enrichment analysis was performed to identify potentially regulated biological pathways. Results:?A total of 38 patients completed the clinical study (18 in the PRP group, 20 in the control group). After treatment, the PRP group demonstrated superior outcomes compared to the control group in terms of NRS reduction, sleep improvement, and the 28-day pregabalin dose reduction (P < 0.05). The incidence of somnolence was lower in the PRP group (P < 0.05), with no significant differences in other adverse reactions. Metabolomics analysis included 18 samples (8 from the PRP group, 10 from the control group). Differential metabolites, including benzoic acid and β-arginine, were identified and were primarily enriched in the phenylalanine, tyrosine, tryptophan, and glutathione metabolic pathways. Conclusion:?DRG injection of PRP can effectively alleviate PHN, improve sleep, and reduce medication dosage and somnolence. The mechanism may be associated with the regulation of oxidative stress, inflammatory responses, and amino acid metabolic pathways.