脊髓刺激治疗带状疱疹相关性疼痛患者脊髓背角的T2高信号强度区：一项回顾性病例对照研究

T2 high-signal-intensity zone of the spinal cord dorsal horn in patients treated with spinal cord stimulation for herpes zoster-associated pain: a retrospective case-control study.

作者信息

Arakawa Kyosuke, Nakagawa Masayuki, Abe Yoichiro, Morimatsu Hiroshi

机构信息

Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan.

Department of Pain Management Clinic, NTT Medical Center Tokyo, Tokyo, Japan.

出版信息

J Anesth. 2025 Apr;39(2):273-281. doi: 10.1007/s00540-025-03458-1. Epub 2025 Feb 20.

DOI:10.1007/s00540-025-03458-1

PMID:39976687

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11937087/

Abstract

PURPOSE

In patients with herpes zoster-associated pain (ZAP), magnetic resonance imaging (MRI) has revealed T2 high-signal intensity zones (MRI T2 HIZ) in the dorsal horn of the spinal cord, associated with postherpetic neuralgia (PHN). We retrospectively analyzed the relationship between PHN and MRI T2 HIZ in patients with refractory ZAP in the subacute phase who underwent temporary spinal cord stimulation therapy (tSCS).

METHODS

This single-center, case-control study included patients who underwent tSCS for refractory ZAP between 2010 and 2018. MRIs were re-assessed for the presence of T2 HIZ in the dorsal horn of the spinal cord. Patients were divided into T2 HIZ( +) and T2 HIZ(-) groups. Patients with a numerical rating score (NRS) ≥ 3 at the last visit were defined as PHN. The NRS values and the incidence rate of PHN were compared between the two groups.

RESULTS

Of the 67 cases extracted, 38 were included in the analysis: 22 in T2 HIZ( +) group and 16 in T2 HIZ(-) group. No significant differences were observed in background factors between the two groups. However, the T2 HIZ( +) group had a significantly higher NRS at the final visit (T2 HIZ( +):3.8 ± 2.1, T2 HIZ(-):1.4 ± 1.5; P < 0.05) and had significantly more patients with PHN than the T2 HIZ(-) group (T2 HIZ( +) vs. T2 HIZ(-), 15/22 (68%) vs. 3/16 (19%); odds ratio = 8.67; 95% confidence interval, 1.7-63.3).

CONCLUSION

T2HIZ is detected in more than half of refractory ZAP, and pain is more likely to remain after tSCS treatment in the T2HIZ( +) group.

摘要

目的

在带状疱疹相关性疼痛（ZAP）患者中，磁共振成像（MRI）显示脊髓背角存在T2高信号强度区（MRI T2 HIZ），与带状疱疹后神经痛（PHN）相关。我们回顾性分析了接受临时脊髓刺激治疗（tSCS）的亚急性期难治性ZAP患者中PHN与MRI T2 HIZ之间的关系。

方法

这项单中心病例对照研究纳入了2010年至2018年间因难治性ZAP接受tSCS治疗的患者。对MRI进行重新评估，以确定脊髓背角是否存在T2 HIZ。患者分为T2 HIZ(+)组和T2 HIZ(-)组。最后一次就诊时数字评分量表（NRS）≥3分的患者被定义为PHN。比较两组的NRS值和PHN发病率。

结果

在提取的67例病例中，38例纳入分析：T2 HIZ(+)组22例，T2 HIZ(-)组16例。两组间背景因素无显著差异。然而，T2 HIZ(+)组在最后一次就诊时的NRS显著更高（T2 HIZ(+)：3.8±2.1，T2 HIZ(-)：1.4±1.5；P<0.05），且PHN患者明显多于T2 HIZ(-)组（T2 HIZ(+)组与T2 HIZ(-)组，15/22（68%） vs. 3/16（19%）；优势比=8.67；95%置信区间，1.7 - 63.3）。