摘要目的:评估高频重复经颅磁刺激（hrTMS）治疗带状疱疹神经痛（PHN）的有效性及安全性。方法:采用前瞻性随机对照试验设计，纳入自2024年6月至2025年3月于安庆市立医院神经内科与皮肤性病科收治的63例PHN患者，采用随机序列实施分组，其中32例hrTMS组患者使用hrTMS刺激健侧初级运动皮层（M1区）（频率：10 Hz、总脉冲：2 400个、强度：90%运动阈值），31例假刺激组患者使用不产生刺激的8字形线圈进行伪刺激。分别于治疗前及治疗1、2、3、4周后收集2组患者的简易McGill问卷各项目评分[包括疼痛分级指数（PRI）总评分、感觉项总分及情感项总分，视觉模拟评分（VAS），现在疼痛状况（PPI）评分]及N100波幅情况，同时记录不良反应发生情况。结果:治疗2周后，hrTMS组患者的PRI总评分、VAS评分及N100波幅与假刺激组同时间点的差异均有统计学意义（ P<0.05）；治疗3、4周后，hrTMS组患者的简易McGill问卷各项目评分及N100波幅与假刺激组同时间点的差异均有统计学意义（ P<0.05）[3周时，PRI总评分：（8.59±1.13）分比（9.61±1.20）分，PRI感觉项总分：（5.34±0.79）分比（5.90±0.94）分，PRI情感项总分：（3.25±0.57）分比（3.71±0.46）分，VAS评分：（5.78±0.66）分比（6.42±0.92）分，PPI评分：（2.16±0.37）分比（2.55±0.51）分，N100波幅：（2.53±0.51）μV比（2.13±0.34）μV；4周时，PRI总评分：（7.53±0.92）分比（9.68±1.35）分，PRI感觉项总分：（4.94±0.62）分比（6.00±1.07）分，PRI情感项总分：（2.59±0.56）分比（3.68±0.60）分，VAS评分：（5.06±0.67）分比（6.23±1.06）分，PPI评分：（1.97±0.17）分比（2.52±0.51）分，N100波幅：（2.81±0.40）μV比（2.16±0.52）μV]。hrTMS组患者治疗2、3、4周后的简易McGill问卷各项目评分及N100波幅与治疗前的差异均有统计学意义（ P<0.05）。2组患者头痛头晕、耳鸣等不良反应发生率的差异均无统计学意义（ P>0.05）。 结论:hrTMS作用于健侧M1区治疗PHN能显著减轻患者的疼痛程度并调节其负性情绪状态，同时安全性也较高。

abstractsObjective:To evaluate the efficacy and safety of high-frequency repetitive transcranial magnetic stimulation (hrTMS) in postherpetic neuralgia (PHN).Methods:A prospective randomized controlled trial was performed; 63 PHN patients treated in Department of Neurology and Department of Dermatology and Venereology of Anqing Municipal Hospital from June 2024 to March 2025 were enrolled; they were randomly assigned to 2 groups: an hrTMS group ( n=32) received hrTMS (frequency: 10 Hz; total pulses: 2,400; intensity: 90% of resting motor threshold) to the contralateral primary motor cortex (M1), and a sham stimulation group ( n=31) received sham stimulation using a sham figure-of-eight coil generating no actual magnetic field. Scores of short-form McGill pain questionnaires (pain rating index [PRI] total score, PRI sensory subscore, PRI affective subscore, visual analogue scale [VAS] score, present pain intensity [PPI] score) and N100 amplitude were collected before treatment and at 1, 2, 3, and 4 weeks after treatment. Adverse events during treatment were recorded. Results:At 2 weeks after treatment, significant difference was observed between the hrTMS group and sham stimulation group in PRI total score, VAS score, and N100 amplitude ( P<0.05). At 3 and 4 weeks after treatment, significant differences were found between the two groups in PRI total score, PRI sensory subscore, PRI affective subscore, VAS score, PPI score and N100 amplitude (3 weeks after treatment: 8.59±1.13 vs. 9.61±1.20, 5.34±0.79 vs. 5.90±0.94, 3.25±0.57 vs. 3.71±0.46, 5.78±0.66 vs. 6.42±0.92, 2.16±0.37 vs. 2.55±0.51, and [2.53±0.51] μV vs. [2.13±0.34] μV; 4 weeks after treatment: 7.53±0.92 vs. 9.68±1.35, 4.94±0.62 vs. 6.00±1.07, 2.59±0.56 vs. 3.68±0.60, 5.06±0.67 vs. 6.23±1.06, 1.97±0.17 vs. 2.52±0.51, and [2.81±0.40] μV vs. [2.16±0.52] μV, P<0.05). In the hrTMS group, PRI total score, PRI sensory subscore, PRI affective subscore, VAS score, PPI score and N100 amplitude were significantly different at 2, 3, and 4 weeks after treatment compared with those before treatment ( P<0.05). Incidence of adverse events (headache, dizziness or tinnitus) did not differ significantly between the two groups ( P>0.05). Conclusion:The hrTMS applied to the M1 region in PHN patients is effective by obviously reducing pain intensity and improving negative emotional states, with favorable safety profile.