带状疱疹急性期患者后遗神经痛的相关因素分析
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摘要
目的:分析带状疱疹(HZ)急性期患者后遗神经痛的相关因素。方法:65例HZ患者根据治愈3个月内是否发生遗留神经痛分为HZ后遗神经痛组(PHN组,n=30)及单纯HN组(HN组,n=35),选取同期健康体检者35例作为对照组;分别采集PHN组、HN组入院后急性期及对照组体检时空腹静脉血,采用酶联免疫吸附法(ELISA)测定其血清肿瘤坏死因子-α(TNF-α)、γ干扰素(IFN-γ)、神经元特异性烯醇化酶(NSE)、S100B蛋白(S100B)、白细胞介素-6(IL-6)、IL-17、β-内啡肽(β-EP)、降钙素基因相关肽(CGRP)、P物质(SP)、5羟色胺(5-HT)、神经生长因子诱导蛋白(VGF)及免疫球蛋白(IgA、IgG、IgM)水平,采用流式细胞分析仪测定其外周血T细胞亚群(CD_3~+、CD_4~+、CD_8~+)。结果:3组受试者血清TNF-α、IFN-γ、NSE、S100B、IL-6及IL-17、CGRP、SP、5-HT、VGF水平比较,PHN组> HN组>对照组,血清β-EP水平比较,PHN组 PHN组>对照组,差异有统计学意义(P <0. 05); HN组、PHN组患者CD_3~+、CD_4~+、CD_8~+显著低于对照组,CD_4~+/CD_8~+显著高于对照组(P <0. 05),但两患者组比较,差异无统计学意义(P> 0. 05)。结论:HZ急性期患者血清炎性因子、疼痛介质及机体免疫状态的异常,与PHN的发生有关。
Objective: To analyze the related factors of post-herpetic neuralgia in patients with herpes zoster( HZ) at the acute stage. Methods: Sixty-five patients with HZ were divided into HZ post-neuropathic pain group( PHN group,n = 30) and HN group( HN group,n = 35) according to whether they had residual neuralgia within 3 months of cure. Thirty-five healthy controls during the same period were collected as the control group. The fasting venous blood was collected from the control group at their medical examination,the PHN group and the HN group at the acute stage after admission. Protein specific Enzyme-linked immunosorbent assay( ELISA) kits were used to detect the serum tumor necrosis factor-α( TNF-α),interferon-gamma( IFN-γ),neuron-specific enolase( NSE),S100 B protein( S100 B),interleukin-6( IL-6),interleukin-17( IL-17),β-Endorphin( β-EP),calcitonin gene-related peptide( CGRP),substance P( SP),serotonin( 5-HT),nerve growth factor-inducing protein( VGF) and immunoglobulin( IgA,IgG,At the level of IgM),respectively. Peripheral blood T cell subsets( CD_3~+,CD_4~+,CD_8~+) were measured by flow cytometry. Results: The levels of serum TNF-α,IFN-γ,NSE,S100 B,IL-6 and IL-17,CGRP,SP,5-HT and VGF were in the order of PHN group > HN group > control group; serumβ-EP levels were in the order of PHN group < HN group PHN group > control group. The differences were statistically significant( P < 0. 05). The levels of CD_3~+T cells,CD_4~+T cells and CD_8~+T cells in HN group and PHN group were significantly lower than those in the control group,whereas the ratios of CD_4~+/CD_8~+in these two groups were significantly higher than that in the control group( P < 0. 05),but there was no significant difference between PHN group and HN groups( P > 0. 05). Conclusion: The abnormal levels of serum inflammatory factors,pain mediators and immune status in patients with HZ at the acute stage are associated with the occurrence of PHN.
Objective: To analyze the related factors of post-herpetic neuralgia in patients with herpes zoster( HZ) at the acute stage. Methods: Sixty-five patients with HZ were divided into HZ post-neuropathic pain group( PHN group,n = 30) and HN group( HN group,n = 35) according to whether they had residual neuralgia within 3 months of cure. Thirty-five healthy controls during the same period were collected as the control group. The fasting venous blood was collected from the control group at their medical examination,the PHN group and the HN group at the acute stage after admission. Protein specific Enzyme-linked immunosorbent assay( ELISA) kits were used to detect the serum tumor necrosis factor-α( TNF-α),interferon-gamma( IFN-γ),neuron-specific enolase( NSE),S100 B protein( S100 B),interleukin-6( IL-6),interleukin-17( IL-17),β-Endorphin( β-EP),calcitonin gene-related peptide( CGRP),substance P( SP),serotonin( 5-HT),nerve growth factor-inducing protein( VGF) and immunoglobulin( IgA,IgG,At the level of IgM),respectively. Peripheral blood T cell subsets( CD_3~+,CD_4~+,CD_8~+) were measured by flow cytometry. Results: The levels of serum TNF-α,IFN-γ,NSE,S100 B,IL-6 and IL-17,CGRP,SP,5-HT and VGF were in the order of PHN group > HN group > control group; serumβ-EP levels were in the order of PHN group < HN group
引文
[1]杜红.带状疱疹急性期皮神经阻滞对带状疱疹神经痛影响[J].现代仪器与医疗,2016,22(6):67-68; 71.
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[9]史海军,崔志强.带状疱疹急性期患者血清炎性因子、免疫球蛋白含量与后遗神经痛的相关性[J].海南医学院学报,2017,23(1):89-92.
[10]NIETO F R,CLARK A K,GRIST J,et al. Calcitonin gene-related peptide-expressing sensory neurons and spinal microglial reactivity contribute to pain states in collagen-induced arthritis[J]. Arthritis&Rheumatology,2015,67(6):1668-1677.
[11]CHIBA T,OKA Y,KAMBE T,et al. Paclitaxel-induced peripheralneuropathy increases substance P release in rat spinal cord[J]. Eur J Pharmacol,2016,5(770):46-51.
[12]王兴斌,李雪丽,郑雅男.干扰素联合更昔洛韦治疗带状疱疹疗效观察[J].临床合理用药杂志,2017,10(16):89-90.
[13]刘太华,唐丽君,周舟,等.血清降钙素基因相关肽、5-羟色胺浓度与带状疱疹疼痛程度相关性分析[J].实用皮肤病学杂志,2014,7(4):256-259.
[14]CHLIBEK R,PAUKSENS K,ROMBO L,et al. Long-term immunogenicityand safety of an investigational herpes zoster subunit vaccine in olderadults[J]. Vaccine,2016,34(6):863-868.
[15]薛萍,尤敏. T淋巴细胞亚群测定与带状疱疹后遗神经痛关系及指导干预的临床研究[J].中国社区医师,2016,32(17):142-143.
[16]JING L,LAING K J,DONG L,et al. Extensive CD4and CD8 T Cell Cross-Reactivity between Alphaherpesviruses[J]. J Immunol,2016,196(5):2205-2218.
[17]MARTINI R,WILLISON H. Neuroinflammation in the peripheral nerve:Cause,modulator,or bystander in peripheral neuropathies[J]. Glia,2016,64(4):475-486.
[2]孙冷冰,李志鸿.火针联合血府逐瘀胶囊治疗带状疱疹后遗神经痛的临床观察[J].中医药信息,2015,32(5):108-110.
[3]徐晓巍,王金忠.干扰素联合更昔洛韦治疗带状疱疹的临床疗效及对患者后遗神经痛及IL-6、IL-10的影响研究[J].中国生化药物杂志,2015,35(11):55-57.
[4] FRIESEN K J,FALK J,ALESSI-SEVERINI S,et al.Price of pain:population-based cohort burden of disease analysis of medication cost of herpes zoster and postherpetic neuralgia[J]. J Pain Res,2016,3(9):543-550.
[5]杨丽云,黄尧洲,郎娜.疏风解毒汤药对带状疱疹临床疗效、后遗神经痛及炎性细胞因子的影响[J].中国中医急症,2017,26(8):1457-1459.
[6]许洁,许纲.带状疱疹后遗神经痛与Th1/Th2细胞因子及血清炎性因子相关性探讨[J].标记免疫分析与临床,2017,24(6):666-669.
[7] LUCHTING B,RACHINGER-ADAM B,HEYN J,et al.Anti-inflammatoryT-cell shift in neuropathic pain[J]. J Neuroinflammation,2015,21(12):12.
[8]刘先岭,王静静,智明,等.泛昔洛韦对带状疱疹患者血清Th细胞因子、P物质水平的影响[J].山东医药,2016,56(42):88-90.
[9]史海军,崔志强.带状疱疹急性期患者血清炎性因子、免疫球蛋白含量与后遗神经痛的相关性[J].海南医学院学报,2017,23(1):89-92.
[10]NIETO F R,CLARK A K,GRIST J,et al. Calcitonin gene-related peptide-expressing sensory neurons and spinal microglial reactivity contribute to pain states in collagen-induced arthritis[J]. Arthritis&Rheumatology,2015,67(6):1668-1677.
[11]CHIBA T,OKA Y,KAMBE T,et al. Paclitaxel-induced peripheralneuropathy increases substance P release in rat spinal cord[J]. Eur J Pharmacol,2016,5(770):46-51.
[12]王兴斌,李雪丽,郑雅男.干扰素联合更昔洛韦治疗带状疱疹疗效观察[J].临床合理用药杂志,2017,10(16):89-90.
[13]刘太华,唐丽君,周舟,等.血清降钙素基因相关肽、5-羟色胺浓度与带状疱疹疼痛程度相关性分析[J].实用皮肤病学杂志,2014,7(4):256-259.
[14]CHLIBEK R,PAUKSENS K,ROMBO L,et al. Long-term immunogenicityand safety of an investigational herpes zoster subunit vaccine in olderadults[J]. Vaccine,2016,34(6):863-868.
[15]薛萍,尤敏. T淋巴细胞亚群测定与带状疱疹后遗神经痛关系及指导干预的临床研究[J].中国社区医师,2016,32(17):142-143.
[16]JING L,LAING K J,DONG L,et al. Extensive CD4and CD8 T Cell Cross-Reactivity between Alphaherpesviruses[J]. J Immunol,2016,196(5):2205-2218.
[17]MARTINI R,WILLISON H. Neuroinflammation in the peripheral nerve:Cause,modulator,or bystander in peripheral neuropathies[J]. Glia,2016,64(4):475-486.