不同强度超声波联合加巴喷丁治疗神经病理性疼痛的临床疗效及对miR-132和miR-34a表达的影响

Clinical efficacy of ultrasound with different intensities combined with gabapentin in treatment of neuropathic pain and its effect on the expression of miR-132 and miR-34a

摘要:

目的 探讨不同强度超声波联合加巴喷丁治疗神经病理性疼痛的临床疗效及对miR-132和miR-34a表达的影响。方法 选取2018年12月至2019年12月间河北大学附属医院收治的180例神经病理性疼痛患者，根据使用超声波强度的不同将其分为低、中、高强度超声波组，每组各60例。3组患者均在使用超声波的基础上联合加巴喷丁进行治疗，疗程为3个月。比较治疗前后3组的睡眠干扰、疼痛数字分级评分法评分、疼痛介质（前列腺素E2、5-羟色胺、内皮素1、P物质）水平、复发状况、临床疗效及miR-132和miR-34a的表达水平。结果 治疗前3组睡眠干扰评分、疼痛数字分级评分法评分、疼痛介质水平及miR-132和miR-34a表达水平比较，差异无统计学意义（P>0.05）。治疗后，3组上述检测数值与治疗前比较均有降低，差异有统计学意义（P<0.05）；高强度超声波组的检测数值低于中、低强度超声波组，差异有统计学意义（P<0.05）。高强度超声波组临床总有效率为98.3%，中强度超声波组为93.3%，低强度超声波组为86.7%，3组间比较差异具有统计学意义（P<0.05）。低强度超声波组、中强度超声波组、高强度超声波组不良反应发生率分别为8.3%、11.7%、13.3%，3组间比较差异无统计学意义（P>0.05）。随访调查表明，高强度超声波组、中强度超声波组、低强度超声波组复发率分别为0、5.0%、13.3%，3组间比较差异有统计学意义（P<0.05）。结论 不同强度超声波联合加巴喷丁治疗神经病理性疼痛效果显著；随着超声波强度的增加，联合治疗发挥的作用越明显；高强度超声波可有效提高其睡眠质量，显著降低miR-132、miR-34a表达水平，显著改善患者疼痛程度。国际神经病学神经外科学杂志, 2023, 50(2): 6-11]

Abstract:

Objective To investigate the clinical efficacy of ultrasound therapy with different intensities combined with gabapentin in the treatment of neuropathic pain and its effect on the expression of miR-132 and miR-34a.Methods A total of 180 patients with neuropathic pain who were admitted to Affiliated Hospital of Hebei University from December 2018 to December 2019 were enrolled. According to the intensity of ultrasound therapy， they were divided into low-， medium-， and high-intensity ultrasound groups， with 60 patients in each group. All three groups were given ultrasound therapy combined with gabapentin， with a course of treatment of 3 months. The three groups were compared in terms of sleep disturbance， Numerical Rating Scale （NRS） pain score， levels of pain mediators （prostaglandin E2， 5-hydroxytryptamine endothelin substance P）， recurrence， clinical outcome， and the expression levels of miR-132 and miR-34a before and after treatment.Results Before treatment， there were no significant differences among the three groups in sleep disturbance score， NRS pain score， the levels of pain mediators， and the expression levels of miR-132 and miR-34a （P>0.05）. After treatment， all three groups had significant reductions in the above indicators （P<0.05）， and the high-intensity ultrasound group had significantly lower values than the low- and medium-intensity ultrasound groups （P<0.05）. The overall response rate was 98.3% in the high-intensity ultrasound group， 93.3% in the medium-intensity ultrasound group， and 86.7% in the low-intensity ultrasound group， and there was a significant difference in overall response rate among the three groups （P<0.05）. The incidence rate of adverse events was 8.3% in the low-intensity ultrasound group， 11.7% in the medium-intensity ultrasound group， and 13.3% in the high-intensity ultrasound group， with no significant difference among the three groups （P>0.05）. Follow-up investigation showed a recurrence rate of 0% in the high-intensity ultrasound group， 5.0% in the medium-intensity ultrasound group， and 13.3% in the low-intensity ultrasound group （P<0.05）.Conclusions Ultrasound therapy with different intensities combined with gabapentitin has a marked therapeutic effect on neuropathic pain， and the effect of this combination treatment increases with the increase in the intensity of ultrasound. High-intensity ultrasound can effectively improve sleep quality， significantly reduce the expression levels of miR-132 and miR-34a expression， and significantly improve the degree of pain. ［Journal of International Neurology and Neurosurgery, 2023, 50(2): 6-11］