带状疱疹后遗神经痛相关因素的临床研究

发布时间：2019-05-28 19:01

【摘要】：目的通过临床流行病学方法,研究带状疱疹后遗神经痛(postherpetic neuralgia, PHN)发生的相关因素,为临床预防PHN提供参考依据。研究发生亚急性带状疱疹神经痛的带状疱疹患者的临床特点,探讨带状疱疹急性痛、亚急性带状疱疹神经痛和PHN之间的关系。方法本研究收集2010年1-10月份在我院就诊的门诊及住院的带状疱疹患者174例,记录年龄、性别、是否伴发热、有无前驱痛、受累神经部位、皮损类型、皮损面积、急性期疼痛程度、初治时间、治疗方式、合并内科疾病等情况。随访出疹后30天及4个月时的疼痛情况。出疹4个月后仍有持续性疼痛者判定为PHN；出疹30天后仍有持续性疼痛,但在出疹4个月后己无疼痛者判定为亚急性带状疱疹神经痛。对上述诸因素与PHN是否存在相关性进行单因素分析。就所得出的与PHN发生相关的临床因素,对发生亚急性带状疱疹神经痛的患者与发生PHN的患者和仅发生急性痛的患者进行比较,分析发生亚急性带状疱疹神经痛的患者的临床特征。所有数据应用SPSS 11.5统计软件进行统计学分析。结果 PHN相关因素分析结果显示,年龄,前驱痛,皮损类型,急性期疼痛程度,初治时间,合并糖尿病,PHN组和未发生PHN组比较,差异有统计学意义(P0.05)。而性别,发热,受累神经,皮损面积,应用抗病毒药物的种类,应用糖皮质激素,合并心脑血管疾病、消化系统疾病、呼吸系统疾病、恶性肿瘤、结缔组织病,PHN组和未发生PHN组比较,差异无统计学意义(P0.05)。发生亚急性带状疱疹神经痛者与发生PHN者相比,患者年龄和急性期疼痛的严重程度的差别有统计学意义(P0.05)。发生亚急性带状疱疹神经痛者与仅发生急性痛者相比,皮损类型的差别有统计学意义(P0.05)。结论年龄、有无前驱痛、皮损类型,急性期疼痛程度、初治时间、合并糖尿病与PHN的发生有关。而性别、发热、受累神经部位、皮损面积、抗病毒药物种类、应用糖皮质激素、合并心脑血管疾病、消化系统疾病、呼吸系统疾病、恶性肿瘤、结缔组织病与PHN的发生无关。老年,出现前驱痛,严重型皮损,急性期疼痛严重,初治时间较晚,合并糖尿病,则PHN的发生率增加。提示对年龄大,有前驱痛,皮损严重,急性期疼痛剧烈,或合并糖尿病的带状疱疹患者应予以关注,早期积极有效的给予治疗,减少PHN发生的机率。发生亚急性带状疱疹神经痛者比发生PHN者年轻,急性期疼痛程度较轻。发生亚急性带状疱疹神经痛者与仅发生急性痛者相比,皮损类型更严重。提示亚急性带状疱疹神经痛并不仅仅是带状疱疹急性痛和PHN之间时间上的过渡,三者之间可能存在更为复杂的关系。
[Abstract]:Objective to study the related factors of (postherpetic neuralgia, PHN) in postherpetic neuropain by clinical epidemiological method, and to provide reference for clinical prevention of PHN. To study the clinical characteristics of patients with subacute herpes zoster neuropain and to explore the relationship between acute herpes zoster pain, subacute herpes zoster neuropain and PHN. Methods 174 outpatients and inpatients with herpes zoster were collected from January to October 2010. The age, sex, fever, precursor pain, nerve site, skin lesion type and skin lesion area were recorded. The degree of pain in acute stage, the time of initial treatment, the treatment method, the combination of medical diseases and so on. The pain was followed up for 30 days and 4 months after rash. Patients with persistent pain after 4 months of rash were judged to have persistent pain after 30 days of PHN; rash, but those who had no pain after 4 months of rash were judged to be subacute herpes zoster neuropain. The correlation between the above factors and PHN was analyzed by single factor analysis. According to the clinical factors related to the occurrence of PHN, the patients with subacute herpes zoster neuropain were compared with those with PHN and patients with only acute pain. To analyze the clinical characteristics of patients with subacute herpes zoster neuropain. All the data were analyzed by SPSS 11.5 statistical software. Results the results of PHN related factors analysis showed that there were significant differences in age, prodromal pain, skin lesion type, acute pain degree, initial treatment time, diabetes mellitus, PHN group and non-PHN group (P 0.05). Sex, fever, nerve involvement, skin lesion area, types of antiviral drugs, glucocorticoids, cardiovascular and cerebrovascular diseases, digestive system diseases, respiratory diseases, malignant tumors, connective tissue diseases, There was no significant difference between PHN group and non-PHN group (P 0.05). There were significant differences in age and severity of acute pain between patients with subacute herpes zoster neuropain and those with PHN (P 0.05). There was significant difference in the type of skin lesions between patients with subacute herpes zoster neuropain and those with only acute pain (P 0.05). Conclusion Age, prodromal pain, skin lesion type, acute pain degree, initial treatment time and diabetes mellitus are related to the occurrence of PHN. Sex, fever, nerve involvement, skin lesion area, antiviral drugs, glucocorticoid, cardiovascular and cerebrovascular diseases, digestive system diseases, respiratory diseases, malignant tumors and connective tissue diseases were not related to the occurrence of PHN. In the elderly, with prodromal pain, severe skin lesions, severe acute pain, late initial treatment and diabetes mellitus, the incidence of PHN increased. It is suggested that patients with herpes zoster who are older, have prodromal pain, serious skin lesions, severe acute pain, or complicated with diabetes should be paid attention to, and early active and effective treatment should be given to reduce the incidence of PHN. The incidence of subacute herpes zoster neuropain was younger than that of PHN, and the degree of pain in acute phase was mild. The type of skin lesion was more serious in patients with subacute herpes zoster neuropain than in patients with only acute pain. It is suggested that subacute herpes zoster neuropain is not only the time transition between acute herpes zoster pain and PHN, but also a more complex relationship between the three.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R752.12

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