与镇痛药相比，皮下注射肉毒杆菌毒素治疗中国带状疱疹后神经痛的疗效和安全性：随机对照试验的系统评价和荟萃分析

Efficacy and safety of subcutaneous injection of botulinum toxin in the treatment of Chinese postherpetic neuralgia compared to analgesics: a systematic review of randomized controlled trials and meta-analysis.

作者信息

Wang Hui, Lin Ping

机构信息

Department of Geriatrics, Hangzhou Third People's Hospital, Hangzhou, Zhejiang, China.

出版信息

Front Neurol. 2024 Oct 17;15:1479931. doi: 10.3389/fneur.2024.1479931. eCollection 2024.

DOI:10.3389/fneur.2024.1479931

PMID:39484052

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11524963/

Abstract

OBJECTIVE

The purpose of this meta-analysis is to investigate the efficacy and safety of a subcutaneous injection of botulinum toxin in the treatment of postherpetic neuralgia (PHN) compared to analgesics.

METHODS

We searched PubMed, Cochrane Library, Embase, Web of Science, Chinese National Knowledge Infrastructure (CNKI), and Wanfang for randomized controlled trials (RCTs) from inception to 10 September 2023. The primary clinical outcomes included visual analog scale (VAS) pain scores and clinical effective rates. The secondary clinical outcome included the adverse event rate during follow-up.

RESULTS

A total of 14 studies with 1,358 participants were included in the meta-analysis. Among the included patients, 670 participants received botulinum toxin A injections and 688 participants received other medication treatments. The botulinum toxin-A (BTX-A) group exhibited lower pain scores [week 2: Mean difference (MD): -1.91, 95% confidence interval (CI): -2.63 to -1.20, and < 0.00001; week 4: MD: -1.69, 95% CI: -2.69 to -0.68, and < 0.00001; week 8: MD: -1.66, 95% CI: -2.20 to -1.12, and < 0.00001; week 12:MD: -1.83, 95% CI: -2.70 to -0.96, and < 0.00001; and week 24: MD: -1.07, 95% CI: -1.16 to -0.99, and < 0.00001]. The effective rate was significantly higher in patients who received BTX-A for postherpetic neuralgia compared to those who received lidocaine or gabapentin (lidocaine: MD: -1.55, 95% CI: -2.84 to -0.27, and = 0.02 and gabapentin: MD: -1.57, 95% CI: -2.12 to -1.02; and < 0.00001). There was no difference in the incidence of adverse events between the treatment groups [odds ratio (OR): 1.25, 95% CI: 0.43 to 3.61, and = 0.69].

CONCLUSION

Our meta-analysis showed that BTX-A has certain advantages in relieving postherpetic neuralgia compared to analgesics. In addition, BTX-A is safe for treating postherpetic neuralgia, with no notable side effects.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/, identifier CRD42021289813.

摘要

目的

本荟萃分析旨在研究皮下注射肉毒杆菌毒素与镇痛药相比治疗带状疱疹后神经痛（PHN）的疗效和安全性。

方法

我们检索了PubMed、Cochrane图书馆、Embase、科学网、中国知网（CNKI）和万方数据库，查找从数据库建立至2023年9月10日的随机对照试验（RCT）。主要临床结局包括视觉模拟量表（VAS）疼痛评分和临床有效率。次要临床结局包括随访期间的不良事件发生率。

结果

本荟萃分析共纳入14项研究，1358名参与者。在纳入的患者中，670名参与者接受了A型肉毒杆菌毒素注射，688名参与者接受了其他药物治疗。A型肉毒杆菌毒素（BTX-A）组的疼痛评分较低[第2周：平均差（MD）：-1.91，95%置信区间（CI）：-2.63至-1.20，P＜0.00001；第4周：MD：-1.69，95%CI：-2.69至-0.68，P＜0.00001；第8周：MD：-1.66，95%CI：-2.20至-1.12，P＜0.00001；第12周：MD：-1.83，95%CI：-2.70至-0.96，P＜0.00001；第24周：MD：-1.07，95%CI：-1.16至-0.99，P＜0.00001]。与接受利多卡因或加巴喷丁治疗的患者相比，接受BTX-A治疗带状疱疹后神经痛的患者有效率显著更高（利多卡因：MD：-1.55，95%CI：-2.84至-0.27，P = 0.02；加巴喷丁：MD：-1.57，95%CI：-2.12至-1.02，P＜0.00001）。治疗组之间不良事件发生率无差异[比值比（OR）：1.25，95%CI：0.43至3.61，P = 0.69]。