度洛西汀添加治疗亚急性带状疱疹神经痛的疗效和安全性观察Efficacy and safety of doloxetine in the treatment of subacute herpes zoster neuralgia
唐毅;王冬;陈剑豪;郑伟;郑智楷;
摘要(Abstract):
目的探索度洛西汀治疗亚急性带状疱疹神经痛(subacute herpes zoster neuralgia)的临床疗效及安全性。方法 43例病程1个月以上的亚急性带状疱疹神经痛患者,随机分为度洛西汀组(doloxitine group)及对照组(control Group),对照组口服加巴喷丁、普瑞巴林治疗,度洛西汀组在对照组用药的基础上加用度洛西汀治疗;比较治疗前、治疗后1个月及3个月2组疼痛视觉模拟评分法(VAS)、抑郁自评量表(SDS)及焦虑自评量表评分(SAS)、普瑞巴林和加巴喷丁剂量及不良反应。结果度洛西汀组VAS评分较对照组显著降低(P<0.01);2组普瑞巴林剂量无明显变化,而度洛西汀组加巴喷丁剂量较对照组减少(P<0.05);3个月后,加巴喷丁的剂量无显着差异,而普瑞巴林的剂量则显著降低(P<0.05)。抑郁自评量表评分(SDS)、焦虑自评量表评分(SAS)2组无显著性差异;2组不良反应发生率差异无统计学意义(P>0.05)。结论度洛西汀可显著改善带状疱疹后遗神经痛的疗效及生活质量,且临床安全性较好。
关键词(KeyWords): 度洛西汀;亚急性带状疱疹神经痛;疼痛视觉模拟评分法;抑郁自评量表;焦虑自评量表
基金项目(Foundation): 福建省卫健委中青年骨干人才培养项目(编号:2019-ZQNB-6)
作者(Authors): 唐毅;王冬;陈剑豪;郑伟;郑智楷;
参考文献(References):
- [1] DING Y,LI H,HONG T,et al.Efficacy and Safety of Computed Tomography-Guided Pulsed Radiofrequency Modulation of Thoracic Dorsal Root Ganglion on Herpes Zoster Neuralgia[J].Neuromodulation,2019,22(1):108-114.
- [2] SACKS G M.Unmet need in the treatment of postherpetic neuralgia[J].Am J Manag Care,2013,19(1):S207-S213.
- [3] YAWN B P,SADDIER P,WOLLAN P C,St Sauver JL,Kurland MJ,Sy LS.A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction[J].Mayo Clin Proc,2007,82(11):1341-1349.
- [4] BRUCKENTHAL P,BARKIN R L.Options for treating postherpetic neuralgia in the medically complicated patient[J].Ther Clin Risk Manag,2013,9:329-340.
- [5] FORBES H J,BHASKARAN K,THOMAS S L,et al.Quantification of risk factors for postherpetic neuralgia in herpes zoster patients,a cohort study[J].Neurology,2016,87(1):94-102.
- [6] VARGHESE L,STANDAERT B,OLIVIERI A,et al.The temporal impact of aging on the burden of herpes zoster[J].BMC Geriatr,2017,17(1):30.
- [7] NILSSON J,CASSEL T,LINDQUIST L.Burden of herpes zoster and post-herpetic neuralgia in Sweden[J].BMC Infect Dis,2015,15:215.
- [8] ZHU Q,ZHENG H,QU H et al.Epidemiology of herpes zoster among adults aged 50 and above in Guangdong,China[J].Hum Vaccin Immunother,2015(11):2113-2118.
- [9] DONG D S,YU X,WAN C,et al.Efficacy of Short-Term Spinal Cord Stimulation in Acute/Subacute Zoster-Related Pain:A Retrospective Study[J].Pain Physician,2017,20(5):572-577.
- [10] QATO D M,ALEXANDER G C,CONTI R M,et al.Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States[J].JAMA,2008,300(24):2867-2878.
- [11] PRESKORN S H,SILKEY B,SHAH R,et al.Complexity of medication use in the Veterans Affairs healthcare system:Part I:Outpatient use in relation to age and number of prescribers[J].J Psychiatr Pract.,2005,11(1):5-15.
- [12] FARQUHAR-SMITH P.Chemotherapy-induced neuropathicpain[J].Curr Opin Support Palliat Care,2013,5(1):1-7.
- [13] 李明浩.药物配合神经阻滞治疗带状疱疹后遗神经痛的疗效分析[J].中国实用神经疾病杂,2016,19(6):109-110.
- [14] WAN C,DONG DS,SONG T.High-Voltage,Long-Duration Pulsed Radiofrequency onGasserian Ganglion Improves Acute/Subacute Zoster-Related Trigeminal Neuralgia:A Randomized,Double-Blinded,Controlled Trial[J].Pain Physician,2019,22(4):361-368.
- [15] ASADA H.VZV-specific cell-mediated immunity,but not humoral immunity,correlates inversely with the incidence of herpes zoster and the severity of skin symptoms and zoster-associated pain:The SHEZ study[J].Vaccine,2019,37(44):6776-6781.DOI:10.1016/j.vaccine.2019.09.031.31543415.
- [16] DING Y,LI H,HONG T,et al.Efficacy and Safety of ComputedTomography-Guided Pulsed Radiofrequency Modulation of Thoracic Dorsal RootGanglion on Herpes Zoster Neuralgia.Neuromodulation,2019,22(1):108-114.
- [17] DONG D S,YU X,WAN C F,et al.Efficacyof Short-Term Spinal Cord Stimulation in Acute/Subacute Zoster-Related Pain:ARetrospective Study[J].Pain Physician,2017,20(5):E633-E645.
- [18] ASADA H,NAGAYAMA K,OKAZAKI A,et al.An inverse correlation of VZV skin-test reaction,but not antibody,with severity of herpes zoster skin symptoms and zoster-associated pain[J].J Dermatol Sci,2013,69(3):243-249.
- [19] TULNER L R,FRANKFORT S V,GIJSEN G J,et al.Drug-drug interactions in a geriatric outpatient cohort:prevalence and relevance[J].Drugs Aging,2008,25(4):343-355.
- [20] AMRITA R JOHN,DAVID H.Canaday.Herpes Zoster in the Older Adult[J].Infect Dis Clin N Am,2017,31(4):811-826.
- [21] DWORKIN R H,O’CONNOR A B,AUDETTE J,et al.Recommendations for the pharmacological management of neuropathic pain:an overview and literature update[J].Mayo Clin Proc.,2010,85(Suppl 3):3-14.
- [22] ARGOFF C E.Review of current guidelines on the care of postherpetic neuralgia[J].Postgrad Med,2011,123(5):134-142.
- [23] AZIZ M T,GOOD B L,LOWE D K.Serotonin-norepinephrine reuptake inhibitors for the management of chemotherapy-induced peripheral neuropathy[J].Ann Pharmacother,2014:48(5):626-632
- [24] FINNERUP N B,ATTAL N,HAROUTOUNIAN S,et al.Pharmacotherapy for neuropathic pain in adults:a systematic review and meta-analysis[J].Lancet Neurol,2015,14(2):162-173.
- [25] 李保华.超声透皮给药联合普瑞巴林治疗带状疱疹后神经痛效果观察[J].中国实用神经疾病杂志,2018,21(22):2523-2528.
- [26] GARRISON C J,DOUGHERTY P M,KAJANDER K C,et al.Staining of glial fibrillary acidicprotein (GFAP) in lumbar spinal cord increases following a sciatic nerve constriction injury[J].Brain Res,1991565(1):1-7.
- [27] AZIZ M T,GOOD B L,LOWE D K.Serotonin-norepinephrine reuptake inhibitors for the management of chemotherapy-induced peripheral neuropathy[J].Ann Pharmacother,2014,48(5):626-632
- [28] HICKMAN S E,ALLISON E K,KHOURY J E.Microglial Dysfunction and Defective β-Amyloid Clearance Pathways in Aging Alzheimer’s Disease Mice[J].J Neurosci,2008,28(33):8354-8360.
- [29] HANDA J,SEKIGUCHI M,KRUPKOVA O,et al.The effect of serotonin-noradrenaline reuptake inhibitor duloxetine on the intervertebral disk-related radiculopathy in rats[J].Eur Spine J,2016,25(3):877-887.
- [30] WANG L,CHOPP M,SZALAD A,et al.Tadalafil Promotes the Recovery of Peripheral Neuropathy in Type II Diabetic Mice[J].PLoS One,2016,11(7):e0159665.
- [31] JI R R,KAWASAKI Y,ZHUANG Z Y,et al.Possible role of spinal astrocytes in maintaining chronic pain sensitization:review of current evidence with focus on bFGF/JNK pathway[J].Neuron Glia Biol,2006,2(4):259-269.
- [32] YAMASHITA T,YAMAMOTO S,ZHANG J,et al.Duloxetine Inhibits Microglial P2X4 Receptor Function and Alleviates Neuropathic Pain after Peripheral Nerve Injury[J].PLoS One,2016,11(10):e0165189.