小剂量糖皮质激素联合治疗对带状疱疹临床疗效和T细胞亚群的影响

发布时间：2018-05-11 19:00

本文选题：带状疱疹 + 糖皮质激素　；参考：《西南医科大学》2017年硕士论文

【摘要】：目的:带状疱疹(Herpes zoster,HZ)是由潜伏在感觉神经节内的水痘带状疱疹病毒(Varicella-zoster virus,VZV)再激活引起的一种常见的感染性疾病,90%的HZ患者伴有剧烈的神经痛。临床研究发现早期小剂量短疗程的糖皮质激素(Glucocorticoid,GC)联合常规治疗可以促进HZ患者皮损的早期愈合,减轻急性期疼痛的严重程度、缩短疼痛的持续时间。但小剂量短疗程GC联合常规治疗HZ是否会造成病毒感染扩散,加重神经损害,加重病情等一直存在争议,其焦点在于这种联合治疗是否会影响HZ患者机体的免疫功能。本研究拟通过观察小剂量短疗程GC联合常规治疗HZ患者的临床疗效、外周血VZV DNA载量、血浆S100β蛋白浓度及T细胞亚群变化情况,探讨该治疗对HZ患者的临床疗效及T细胞亚群的影响,为小剂量短疗程GC联合常规治疗HZ提供一定的理论依据。方法1.收集急性期HZ患者100例作为HZ组,健康正常对照组40例作为C组;将HZ组患者按其治疗期间使用GC与否分为GC组(52例)与非GC组(48例),记录HZ患者的止疱时间、止痛时间、结痂时间,治疗前及治疗1、2周后的疼痛视觉模拟评分(Visual analogue scale,VAS)及病情评分,随访出院1月后PHN的发生率;并于治疗前、治疗2周后分别抽取外周血采用实时荧光定量PCR法检测VZV DNA载量,酶联免疫法(ELISA法)检测血浆中神经损伤因子S100β蛋白的浓度,采用SPSS17.0软件进行数据分析,比较GC组与非GC组HZ患者的临床疗效、外周血VZV DNA载量、神经损伤标志物S100β蛋白变化情况。2.随机选取上述HZ患者50名作为HZT组(其中GC组选取25例作为GC_T组,非GC组选取25例作为非GC_T组)以及健康正常对照组20例作为CT组,分别于治疗前及治疗2周后抽取外周血采用流式细胞仪检测患者T细胞亚群(CD3~+T、CD4~+T、CD8~+T、CD4~+CD25~+Treg、CD4~+CD25~+Foxp3~+Treg、CD4~+CD25~+GITR~+Treg的百分比)。采用SPSS17.0软件分析比较GC_T组与非GC_T组T细胞亚群的变化情况。结果:1.治疗后GC组止疱时间、止痛时间、结痂时间及治疗1周后的病情评分、VAS均低于非GC组,差异具有显著的统计学意(P0.05);GC组与非GC组治疗2周后病情评分、VAS、S100β蛋白水平、外周血VZV DNA载量比较差异无统计学意义(P0.05);治疗结束1月后电话随访带状疱疹后遗神经痛(Postherpetic neuralgia,PHN)发生率差异无统计学意义(P0.05)。2.治疗前及治疗2周后HZT组T细胞亚群(CD3~+T、CD4~+T、CD8~+T百分比及CD4~+T/CD8~+T比值)均较CT组显著降低(P0.01);CD4~+CD25~+Treg、CD4~+CD25~+TFoxp3~+Treg、CD4~+CD25~+GITR~+Treg百分数均较CT组升高(P0.01)。3.HZT组治疗前及治疗2周后比较,T细胞亚群中CD3~+T、CD4~+T、CD8~+T、CD4~+CD25~+T、CD4~+CD25~+TFoxp3~+Treg、CD4~+CD25~+GITR~+Treg百分数及CD4~+T/CD8~+T比值均具有明显的差异性(P0.05)。4.治疗2周后GC_T组与非GC_T组比较,T细胞亚群(CD3~+T、CD4~+T、CD8~+T、CD4~+CD25~+T、CD4~+CD25~+TFoxp3~+Treg、CD4~+CD25~+GITR~+Treg百分比及CD4~+T/CD8~+T比值)比较均无统计学差异(P0.05)。结论:1.小剂量短疗程GC联合常规治疗急性期HZ患者有助于减轻患者的症状及体征,但对外周血VZV DNA载量、血浆S100β无影响;2.小剂量短疗程GC联合常规治疗急性期HZ对患者的T细胞亚群无明显影响;3.小剂量短疗程GC联合常规治疗急性期HZ是安全有效的治疗方案。
[Abstract]:Objective: Herpes zoster (HZ) is a common infectious disease caused by the reactivation of varicella zoster virus (Varicella-zoster virus, VZV) latent in the sensory ganglia, and 90% of HZ patients are accompanied by severe neuropathic pain. Clinical studies have found a combination of early small dose and short course of Glucocorticoid (Glucocorticoid, GC). Routine treatment can promote the early healing of the skin lesions of HZ patients, reduce the severity of acute pain and shorten the duration of pain. However, the small dose short course of GC combined with routine treatment of HZ will cause the spread of virus infection, aggravation of the nerve damage, and the aggravation of the disease. The focus is whether this combination of treatment will affect HZ. The purpose of this study is to observe the clinical efficacy of the small dose short course GC combined with routine treatment of HZ patients, the VZV DNA load in peripheral blood, the concentration of S100 beta protein in plasma and the changes of T cell subsets, and to explore the effect of the treatment on the clinical efficacy and the subsets of T cells in HZ patients, and for the small dose and short course GC combined with routine treatment of H. Z provided a certain theoretical basis. Method 1. 100 cases of acute HZ patients were collected as HZ group and 40 healthy normal control group were used as group C. The patients in group HZ were divided into GC group (52 cases) and non GC group (48 cases) according to their treatment during the period of treatment. The time of stop blister, time of pain stopping, scab time, pain visual model before and after 1,2 weeks after the treatment were recorded. The Visual analogue scale (VAS) and the disease score were followed up and the incidence of PHN was followed up after January; and before the treatment, 2 weeks after treatment, the peripheral blood was extracted by real-time fluorescence quantitative PCR method to detect VZV DNA load, and the enzyme linked immunosorbent assay (ELISA method) was used to detect the concentration of S100 beta protein of nerve damage factor in plasma, and the data were carried out by SPSS17.0 software. To compare the clinical efficacy of GC and non GC group HZ patients, VZV DNA load in peripheral blood and the change of S100 beta protein of nerve damage marker,.2. randomly selected 50 of the above HZ patients as HZT group (among which 25 were selected as GC_T group, 25 in non GC group) and 20 in normal control group as group, respectively. T cell subgroups (CD3~+T, CD4~+T, CD8~+T, CD4~+CD25~+Treg, CD4~+CD25~+Foxp3~+Treg, CD4~+CD25~+GITR~+Treg) were detected by flow cytometry before and after 2 weeks of treatment. The changes in the T cell subgroup of the GC_T group and non GC_T group were compared with the SPSS17.0 software. Results: 1. after the treatment, the time of the blisters and the pain in the GC group were relieved. Time, time of scab and 1 weeks after treatment, VAS was lower than non GC group, and the difference had significant statistical meaning (P0.05), and there was no statistical difference between GC and non GC group after 2 weeks of treatment, and the level of VAS, S100 beta protein and VZV DNA load in peripheral blood (P0.05); after the end of January, the follow-up of herpes zoster sequela (Po) neuralgia (Po) There was no significant difference in the incidence of stherpetic neuralgia, PHN) (P0.05), before.2. treatment and 2 weeks after treatment, the T cell subgroups of HZT group (CD3~+T, CD4~+T, CD8~+T percentage and CD4~+T/CD8~+T ratio) were significantly lower than those of the CT group. Before and after 2 weeks of treatment, CD3~+T, CD4~+T, CD8~+T, CD4~+CD25~+T, CD4~+CD25~+TFoxp3~+Treg, CD4~+CD25~+GITR~+Treg percentage and CD4~+T/CD8~+T ratio in the subsets of T cells were significantly different (P0.05) and CD4~+T/CD8~+T ratio (P0.05) for 2 weeks, the GC_T group was compared with the non GC_T group. 3~+Treg, CD4~+CD25~+GITR~+Treg percentage and CD4~+T/CD8~+T ratio were not statistically different (P0.05). Conclusion: 1. small dose and short course GC combined with routine treatment of acute HZ patients can help to reduce the symptoms and signs of patients, but there is no effect on VZV DNA load in peripheral blood and S100 beta in plasma; 2. small dose short course GC combined with routine treatment of acute treatment. Phase HZ had no significant effect on T cell subsets of patients. 3. small dose of short course GC combined with routine treatment of acute HZ is a safe and effective treatment.

【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R752.12

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