JAMA子刊:高频(10khz)脊髓刺激对疼痛性糖尿病神经病变患者的影响

2021-04-11 MedSci原创 MedSci原创

循证治疗指南应考虑10 kHz SCS在连续护理中的定位。在实践中,对常规治疗反应不足的PDN患者应考虑使用10khz SCS。

据世界卫生组织估计,全世界共有4.22亿成年人患有糖尿病,其患病率(8.5%)在过去40年里几乎翻了一番。糖尿病可引起系统性损害,对健康相关的生活质量产生深远影响,并可能威胁生命。糖尿病周围神经病变是一种常见的并发症,表现为疼痛和其他感觉障碍,包括麻木、灼烧或刺痛。大约20%的糖尿病患者会发展为疼痛性糖尿病神经病变(PDN),这是一种进行性的、潜在的使人衰弱的慢性神经性疼痛状况。

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目前的PDN治疗包括神经性疼痛药物,如加巴喷素、5 -羟色胺-去甲肾上腺素再吸收抑制剂、三环抗抑郁药、阿片类药物和外用解决方案。高质量的随机临床试验(RCT)表明,这些药物的疗效有限,不良反应发生率高。加巴喷丁类药物可能增加呼吸抑制的风险,这是服用阿片类药物或有潜在呼吸障碍的患者严重关注的问题。

1996年首次报道了用脊髓刺激(SCS)设备进行非药理学PDN治疗。观察数据表明,高频(10-kHz) SCS为PDN患者提供了实质性的疼痛缓解,而不会产生其他类型SCS所需要的感觉异常。基于此,有研究者研究了10khz脊髓刺激(SCS)是否能改善难治性疼痛性糖尿病神经病变(PDN)患者的预后。该研究结果近日发表在JAMA Neurol杂志上。

这项前瞻性、多中心、开放标签的SENZA-PDN随机临床试验比较了传统医疗管理(CMM)和10 kHz SCS+CMM。纳入服用加巴喷丁类药物1年或1年以上的PDN患者和至少1个其他镇痛级别的患者,下肢疼痛强度为5cm或10cm视觉模拟评分(VAS)以上,体重指数(以千克体重除以身高平方米计算)为45或以下,糖化血红蛋白(HbA1c)为10%或以下,并在医学上适用于该手术。参与者于2017年8月至2019年8月期间从美国多个地点注册,包括学术中心和社区疼痛诊所,随访6个月,6个月时可选交叉。对430名患者进行筛查,214名患者被排除或拒绝参与,216名患者被随机分组。在6个月的随访中,对187名患者进行了评估。

用10cm视觉模拟评分(VAS)测量随时间的疼痛缓解

预先设定的主要终点是3个月时VAS疼痛缓解50%或以上且基线神经功能缺损未恶化的参与者百分比。按照分析计划中的预先规定,对次要终点进行分层测试。测量包括疼痛VAS、神经系统检查、健康相关生活质量(EuroQol五维度问卷)和6个月以上的HbA1c。

216例随机患者中,136例(63.0%)为男性,平均年龄为60.8(10.7)岁。此外,糖尿病和周围神经病变的中位持续时间分别为10.9(6.3-16.4)年和5.6(3.0-10.1)年。CMM组94例患者中有5例(5%)达到意向治疗人群的主要终点,10 kHz SCS+CMM组95例患者中有75例。10khz SCS+CMM组有2例患者发生感染,感染率为2%。对于CMM组,疼痛VAS评分在基线时为7.0cm,6个月时为6.9cm。对于10kHz SCS+CMM组,基线检查时疼痛VAS评分平均为7.6cm,6个月时疼痛VAS评分平均为1.7cm。研究人员观察到6个月时,CMM组92名患者中有3名、10 kHz SCS+CMM组84名患者中有52名(62%)的神经系统检查改善。

神经评估和疼痛质量的改变

无论病因如何,慢性疼痛都会对睡眠质量产生负面影响。对于症状在夜间明显恶化的PDN患者尤其如此。这项研究表明,10khzscs能显著改善PDN患者的睡眠。此外,患者在各种与健康相关的生活质量指标上都有所改善,表明这种治疗对患者的生活有广泛的影响。

总之,用高频(10khz)SCS可以安全有效地治疗PDN难治的患者。循证治疗指南应考虑10 kHz SCS在连续护理中的定位。在实践中,对常规治疗反应不足的PDN患者应考虑使用10khz SCS。

参考文献:Petersen EA, Stauss TG, Scowcroft JA, et al. Effect of High-frequency (10-kHz) Spinal Cord Stimulation in Patients With Painful Diabetic NeuropathyA Randomized Clinical TrialJAMA Neurol. Published online April 05, 2021. doi:10.1001/jamaneurol.2021.0538

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    2022-02-15 云云玉玉

    学习

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    2021-04-19 ZJYYY7

    总之,用高频(10khz)SCS可以安全有效地治疗PDN难治的患者。

    0

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    2021-04-13 axin012
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    2021-04-12 ms2000000793218325

    不错

    0

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    2021-04-12 zb666111

    学习

    0

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    2021-04-11 wxl882001

    了解

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1193609, encodeId=cf77119360964, content=学习 , beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9a075617739, createdName=云云玉玉, createdTime=Tue Feb 15 14:12:21 CST 2022, time=2022-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=958188, encodeId=14ee95818872, content=总之,用高频(10khz)SCS可以安全有效地治疗PDN难治的患者。, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201214/b3170121d995432ea306ae3a7809cc05/2cfb236f361b4d3c80ef8fdef4301832.jpg, createdBy=8ad35400531, createdName=ZJYYY7, createdTime=Mon Apr 19 01:15:35 CST 2021, time=2021-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1322554, encodeId=16db132255475, content=<a href='/topic/show?id=c204e6750f7' target=_blank style='color:#2F92EE;'>#糖尿病神经病变#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76750, encryptionId=c204e6750f7, topicName=糖尿病神经病变)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=03e7496, createdName=楚钟, createdTime=Tue Apr 13 10:25:18 CST 2021, time=2021-04-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1491399, encodeId=b39514913995e, content=<a href='/topic/show?id=5316e4387aa' target=_blank style='color:#2F92EE;'>#神经病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74387, encryptionId=5316e4387aa, topicName=神经病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1ab48885684, createdName=axin012, createdTime=Tue Apr 13 10:25:18 CST 2021, time=2021-04-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1500416, encodeId=e5b21500416ae, content=<a href='/topic/show?id=ecdfe438970' target=_blank style='color:#2F92EE;'>#神经病变#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74389, encryptionId=ecdfe438970, topicName=神经病变)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=21015, createdName=heli0118, createdTime=Tue Apr 13 10:25:18 CST 2021, time=2021-04-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=956295, encodeId=08e0956295f5, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=82795476587, createdName=ms2000000793218325, createdTime=Mon Apr 12 20:31:09 CST 2021, time=2021-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=956070, encodeId=b02d9560e023, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=496c73396, createdName=zb666111, createdTime=Mon Apr 12 08:17:44 CST 2021, time=2021-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=956037, encodeId=7ee095603e18, content=了解, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuOgo3iaicb1Imgk1yIfnvr6oXzibcAFB6puAyNJXbzWhNuLqaFYBVRWjh7rghkvFLPxMAfD5ib3nXwVD/0, createdBy=bed21972958, createdName=wxl882001, createdTime=Sun Apr 11 22:47:13 CST 2021, time=2021-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036571, encodeId=5f1f10365e1d6, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Sun Apr 11 22:25:18 CST 2021, time=2021-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1043570, encodeId=a5d310435e0e4, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Sun Apr 11 22:25:18 CST 2021, time=2021-04-11, status=1, ipAttribution=)]
    2021-04-11 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

  10. [GetPortalCommentsPageByObjectIdResponse(id=1193609, encodeId=cf77119360964, content=学习 , beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9a075617739, createdName=云云玉玉, createdTime=Tue Feb 15 14:12:21 CST 2022, time=2022-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=958188, encodeId=14ee95818872, content=总之,用高频(10khz)SCS可以安全有效地治疗PDN难治的患者。, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201214/b3170121d995432ea306ae3a7809cc05/2cfb236f361b4d3c80ef8fdef4301832.jpg, createdBy=8ad35400531, createdName=ZJYYY7, createdTime=Mon Apr 19 01:15:35 CST 2021, time=2021-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1322554, encodeId=16db132255475, content=<a href='/topic/show?id=c204e6750f7' target=_blank style='color:#2F92EE;'>#糖尿病神经病变#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76750, encryptionId=c204e6750f7, topicName=糖尿病神经病变)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=03e7496, createdName=楚钟, createdTime=Tue Apr 13 10:25:18 CST 2021, time=2021-04-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1491399, encodeId=b39514913995e, content=<a href='/topic/show?id=5316e4387aa' target=_blank style='color:#2F92EE;'>#神经病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74387, encryptionId=5316e4387aa, topicName=神经病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1ab48885684, createdName=axin012, createdTime=Tue Apr 13 10:25:18 CST 2021, time=2021-04-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1500416, encodeId=e5b21500416ae, content=<a href='/topic/show?id=ecdfe438970' target=_blank style='color:#2F92EE;'>#神经病变#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74389, encryptionId=ecdfe438970, topicName=神经病变)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=21015, createdName=heli0118, createdTime=Tue Apr 13 10:25:18 CST 2021, time=2021-04-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=956295, encodeId=08e0956295f5, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=82795476587, createdName=ms2000000793218325, createdTime=Mon Apr 12 20:31:09 CST 2021, time=2021-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=956070, encodeId=b02d9560e023, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=496c73396, createdName=zb666111, createdTime=Mon Apr 12 08:17:44 CST 2021, time=2021-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=956037, encodeId=7ee095603e18, content=了解, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuOgo3iaicb1Imgk1yIfnvr6oXzibcAFB6puAyNJXbzWhNuLqaFYBVRWjh7rghkvFLPxMAfD5ib3nXwVD/0, createdBy=bed21972958, createdName=wxl882001, createdTime=Sun Apr 11 22:47:13 CST 2021, time=2021-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036571, encodeId=5f1f10365e1d6, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Sun Apr 11 22:25:18 CST 2021, time=2021-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1043570, encodeId=a5d310435e0e4, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Sun Apr 11 22:25:18 CST 2021, time=2021-04-11, status=1, ipAttribution=)]
    2021-04-11 misszhang

    谢谢MedSci提供最新的资讯

    0

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那么说到这,睡觉手麻到底有哪些原因引起的呢?可能提示哪些疾病?让我们来看一看——首先,姿势不良确实是很大的原因。通过某种姿势长时间对肢体神经施加压力,会造成体位性的感觉异常,但这种麻木感在改变体位后就会消失,如果长期发生这种现象,就要注意了。

Nat Commun:疼痛性糖尿病神经病变是如何发生的?

研究人员报告了糖尿病感觉神经元中POMC介导的抗痛觉功能障碍。在链脲佐菌素诱导的糖尿病小鼠中,由于NF-kB p50亚基结合增加,Pomc启动子被抑制,导致外周神经中基础POMC水平的丧失。

Diabetologia:基于人工智能的深度学习算法诊断糖尿病神经病变

角膜共聚焦显微镜是一种快速的非侵入性眼科成像技术,可鉴别周围和中枢神经退行性疾病。

Diabetologia:间质基质细胞来源的外泌体可改善糖尿病小鼠周围神经病变

糖尿病周围神经病变(DPN)是糖尿病的主要并发症之一,对糖尿病的发病率和死亡率有很大的影响。目前还没有有效的治疗方法。外泌体是细胞来源的纳米囊泡,在细胞间通讯中起着重要作用。

Diabetes Care:痛性糖尿病神经病变与夜间血压升高有关

一项来自意大利的小规模研究显示,有痛性糖尿病多发神经病变(PDPN)的患者夜间收缩压水平较高。因此,研究者认为,PDPN应被视作心血管高危因素。(Diabetes Care. 2014年6月26日在线版)该研究纳入113例糖尿病患者,其中34例有PDPN,33例伴无痛DPN,46例无DPN。研究者发现,伴PDPN的患者夜间收缩压水平明显高于其他两组受试者,而日间和夜间收缩压差较小,舒张压水平较低。