Association of Transthyretin and Retinol-Binding Protein 4 With Risk of Classical Trigeminal Neuralgia: A Case-Control Study.

We conducted a case-control study with longitudinal postoperative follow-up analysis in surgical subgroups to comprehensively investigate the potential correlation between transthyretin (TTR) and retinol-binding protein 4 (RBP4) concentrations and classical trigeminal neuralgia (TN) onset. This case-control study enrolled 162 participants, stratified into two cohorts: T group: patients diagnosed with classical TN according to the International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria, confirmed by MRI demonstrating neurovascular compression and C group: healthy volunteers without neuropathic pain. To evaluate the association between protein levels and classical TN while adjusting for potential confounders, a multivariable logistic regression model was constructed. In addition, a linear mixed-effects model (LMM) was employed to analyze the longitudinal changes in protein levels from preoperative to postoperative time points. In the unadjusted model, TTR and RBP4 serum concentrations showed significant associations with classical TN incidence (TTR: OR = 1.306, 95% CI 1.195-1.427; RBP4: 1.065[1.036-1.094] (P < 0.001)). Upon adjusting for all covariates, TTR remained significantly associated with an increased risk of TN (adjusted OR = 133.025 per 10-unit increase, 95% CI 4.472-3956.624, P = 0.005), while RBP4 did not exhibit a significant association with TN morbidity. Furthermore, TTR and RBP4 serum concentrations decreased after MVD and PBC. Higher concentrations of TTR were linked to an augmented risk of classical TN. In contrast, concentrations of RBP4 showed no association with classical TN. Furthermore, patients experiencing complete pain relief following MVD and PBC surgery exhibited decreased serum concentrations of TTR and RBP4, suggesting their potential as prognostic indicators for TN outcomes. The research was registered on the Chinese clinical trial registry on March 14, 2024 (ChiCTR2400081867).