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带状疱疹后神经痛的危险因素和预防

2016-05-26 张毅韬 华山医院神经内科

在出疹前就出现疼痛,可能是带状疱疹后遗神经痛的危险因素(Pooled effect estimate 2.29, 95%CI=1.42~3.69)。  2. 尽管不同文献对“剧烈疼痛”的定义不同,但带状疱疹时的严重的疼痛与之后罹患疱疹后遗神经痛的风险有非常明确的相关性(RR=2.23,95%CI=1.71-2.92)。  3. 影响日常功能的疼痛。对两项研究的汇总分析提示影响日常功能的带状疱疹

在出疹前就出现疼痛,可能是带状疱疹后遗神经痛的危险因素(Pooled effect estimate 2.29, 95%CI=1.42~3.69)。


尽管不同文献对“剧烈疼痛”的定义不同,但带状疱疹时的严重的疼痛与之后罹患疱疹后遗神经痛的风险有非常明确的相关性(RR=2.23,95%CI=1.71-2.92)。

影响日常功能的疼痛。对两项研究的汇总分析提示影响日常功能的带状疱疹疼痛与后遗神经痛有密切的相关性(summary RR=2.10, 95%CI=1.27-3.48)。

严重出疹与后遗神经痛有密切相关性(summary RR=2.63, 95%CI=1.89-3.66)。

眼部受累的带状疱疹较眼部无受累的带状疱疹,发生后遗神经痛的概率为其两倍以上(summary RR=2.51, 95%CI=1.29-4.86)。

有一项研究发现针刺觉的减退与出现后遗神经痛十分相关(adjOR=7.72,95%CI=2.00-29.90)。

一些研究发现,带状疱疹患者每增加十岁,罹患后遗神经痛的相对危险度大约增加1.22到3.11。

SLE、近期的创伤、人格障碍各自在一项研究中被认为与PHN相关。

更久时间的皮疹或许和后续发生后遗神经痛可能有负相关。

有一篇文献认为出现触发痛的患者发生后遗神经痛的概率是无触发痛患者的四倍,但是另外两篇文献都认为两者无关。

免疫缺陷状态、糖尿病,是否对后遗神经痛的发生有相关性,不同的研究有不同结果。

抑郁、肿瘤被认为与后遗神经痛的发生无关。

因此,高龄、出疹前有疼痛、眼部受累、出疹时便疼痛剧烈的等有危险因素的带状疱疹患者必须接受更加积极的治疗。

带状后遗神经痛的预防

带状疱疹的主要治疗方式是药物治疗和介入治疗。

指南推荐,在出疹后72小时内应当开始抗病毒药物的治疗。两项META分析提示,抗病毒药物可以降低疼痛的持续时间和发生带状疱疹后遗神经痛的发病率。其中一项分析结果表明,使用阿昔洛韦和不使用抗病毒药物的患者,于出疹后六个月内出现“任何疼痛”的OR=0.54(95%CI=0.36-0.81),差异十分巨大。

不超过2个月的硬脑膜外注射类固醇激素也被推荐为带状疱疹后遗神经痛的预防手段。韩国早先的一项调查显示,硬脑膜外注射是该国用于带状疱疹后遗神经的最常使用的介入疗法。其他介入疗法例如椎旁阻滞、外周神经阻滞、交感神经阻滞在治疗带状疱疹和带状疱疹后遗神经痛上也被许多临床医生认为是有效的。不过他们都需要进一步的循证医学证据。

有作者提到,带状疱疹和带状疱疹后遗神经痛的预防和治疗。他们提到,针对VZV的疫苗可以作为带状疱疹和带状疱疹后遗神经痛的第一道防线。先前的综述报道过疫苗有效减少了带状疱疹和带状疱疹后遗神经痛的发病率。

在50~59岁的人群中,VZV疫苗降低了大约70%的带状疱疹的发病率。在60岁以上的人群中,疫苗降低了66.1%的带状疱疹和66.5%的带状疱疹后遗神经痛的发病风险。可见,50岁以上的人群使用VZV疫苗,可有效预防带状疱疹和带状疱疹后遗神经痛的发生。

尽管带状疱疹后遗神经痛难于治疗,但是针对带状疱疹尽早开始的、积极的治疗可以降低带状疱疹后遗神经痛的发生率。在健康的老年人群,应用VZV疫苗也能降低带状疱疹和带状疱疹后遗神经痛的发病率。

原始出处:

1.Forbes HJ, Thomas SL, et al. A systematic review and meta-analysis of risk factors for postherpetic neuralgia. Pain. 2016; 157(1):30-54.

2.Kim JH. Risk Factor and Prevention of Postherpetic Neuralgia. Korean J Pain. 2015; 28(3): 167–168.

4.Kumar V, Krone K, Mathieu A. Neuraxial and sympathetic blocks in herpes zoster and postherpetic neuralgia: an appraisal of current evidence. Reg Anesth Pain Med. 2004; 29(5):454-61. 

6.Schmader KE, Levin MJ, Gnann JW, Jr, McNeil SA, Vesikari T, Betts RF, et al. Efficacy, safety, and tolerability of herpes zoster vaccine in persons aged 50-59 years. Clin Infect Dis. 2012;54:922–928.

7.Oxman MN, Levin MJ, Johnson GR, Schmader KE, Straus SE, Gelb LD, et al. Shingles Prevention Study Group. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med. 2005;352:2271–2284.

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    2016-12-05 gospel007

    相当于一篇指南,受用。

    0

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  3. [GetPortalCommentsPageByObjectIdResponse(id=160314, encodeId=e2af1603149a, content=相当于一篇指南,受用。, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9b2a1732571, createdName= gospel007, createdTime=Mon Dec 05 00:46:36 CST 2016, time=2016-12-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1691648, encodeId=b5801691648ca, content=<a href='/topic/show?id=fa8148552d5' target=_blank style='color:#2F92EE;'>#带状疱疹后神经痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=48552, encryptionId=fa8148552d5, topicName=带状疱疹后神经痛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=213529278967, createdName=jeanqiuqiu, createdTime=Tue Aug 23 18:20:00 CST 2016, time=2016-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=87511, encodeId=dba78e51145, content=很好有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=185, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Mon May 30 08:03:00 CST 2016, time=2016-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1540809, encodeId=43c9154080963, content=<a href='/topic/show?id=ac8de440615' target=_blank style='color:#2F92EE;'>#神经痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74406, encryptionId=ac8de440615, topicName=神经痛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0d8213287489, createdName=贵阳, createdTime=Sat May 28 05:20:00 CST 2016, time=2016-05-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1580363, encodeId=b8e1158036336, content=<a href='/topic/show?id=c026e05485f' target=_blank style='color:#2F92EE;'>#疱疹#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70548, encryptionId=c026e05485f, topicName=疱疹)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2dcf16628144, createdName=ms2694732865965676, createdTime=Sat May 28 05:20:00 CST 2016, time=2016-05-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=87277, encodeId=14978e27703, content=高龄、出疹前有疼痛、眼部受累、出疹时便疼痛剧烈的等有危险因素的带状疱疹患者必须接受更加积极的治疗,早期积极治疗对带状疱疹神经痛具有一定的缓解作用!, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160516/IMG5739CFE7F40967394.jpg, createdBy=c8001723204, createdName=aduah520, createdTime=Thu May 26 17:04:00 CST 2016, time=2016-05-26, status=1, ipAttribution=)]
    2016-05-30 忠诚向上

    很好有用

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=160314, encodeId=e2af1603149a, content=相当于一篇指南,受用。, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9b2a1732571, createdName= gospel007, createdTime=Mon Dec 05 00:46:36 CST 2016, time=2016-12-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1691648, encodeId=b5801691648ca, content=<a href='/topic/show?id=fa8148552d5' target=_blank style='color:#2F92EE;'>#带状疱疹后神经痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=48552, encryptionId=fa8148552d5, topicName=带状疱疹后神经痛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=213529278967, createdName=jeanqiuqiu, createdTime=Tue Aug 23 18:20:00 CST 2016, time=2016-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=87511, encodeId=dba78e51145, content=很好有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=185, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Mon May 30 08:03:00 CST 2016, time=2016-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1540809, encodeId=43c9154080963, content=<a href='/topic/show?id=ac8de440615' target=_blank style='color:#2F92EE;'>#神经痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74406, encryptionId=ac8de440615, topicName=神经痛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0d8213287489, createdName=贵阳, createdTime=Sat May 28 05:20:00 CST 2016, time=2016-05-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1580363, encodeId=b8e1158036336, content=<a href='/topic/show?id=c026e05485f' target=_blank style='color:#2F92EE;'>#疱疹#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70548, encryptionId=c026e05485f, topicName=疱疹)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2dcf16628144, createdName=ms2694732865965676, createdTime=Sat May 28 05:20:00 CST 2016, time=2016-05-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=87277, encodeId=14978e27703, content=高龄、出疹前有疼痛、眼部受累、出疹时便疼痛剧烈的等有危险因素的带状疱疹患者必须接受更加积极的治疗,早期积极治疗对带状疱疹神经痛具有一定的缓解作用!, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160516/IMG5739CFE7F40967394.jpg, createdBy=c8001723204, createdName=aduah520, createdTime=Thu May 26 17:04:00 CST 2016, time=2016-05-26, status=1, ipAttribution=)]
    2016-05-28 贵阳
  5. [GetPortalCommentsPageByObjectIdResponse(id=160314, encodeId=e2af1603149a, content=相当于一篇指南,受用。, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9b2a1732571, createdName= gospel007, createdTime=Mon Dec 05 00:46:36 CST 2016, time=2016-12-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1691648, encodeId=b5801691648ca, content=<a href='/topic/show?id=fa8148552d5' target=_blank style='color:#2F92EE;'>#带状疱疹后神经痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=48552, encryptionId=fa8148552d5, topicName=带状疱疹后神经痛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=213529278967, createdName=jeanqiuqiu, createdTime=Tue Aug 23 18:20:00 CST 2016, time=2016-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=87511, encodeId=dba78e51145, content=很好有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=185, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Mon May 30 08:03:00 CST 2016, time=2016-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1540809, encodeId=43c9154080963, content=<a href='/topic/show?id=ac8de440615' target=_blank style='color:#2F92EE;'>#神经痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74406, encryptionId=ac8de440615, topicName=神经痛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0d8213287489, createdName=贵阳, createdTime=Sat May 28 05:20:00 CST 2016, time=2016-05-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1580363, encodeId=b8e1158036336, content=<a href='/topic/show?id=c026e05485f' target=_blank style='color:#2F92EE;'>#疱疹#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70548, encryptionId=c026e05485f, topicName=疱疹)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2dcf16628144, createdName=ms2694732865965676, createdTime=Sat May 28 05:20:00 CST 2016, time=2016-05-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=87277, encodeId=14978e27703, content=高龄、出疹前有疼痛、眼部受累、出疹时便疼痛剧烈的等有危险因素的带状疱疹患者必须接受更加积极的治疗,早期积极治疗对带状疱疹神经痛具有一定的缓解作用!, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160516/IMG5739CFE7F40967394.jpg, createdBy=c8001723204, createdName=aduah520, createdTime=Thu May 26 17:04:00 CST 2016, time=2016-05-26, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=160314, encodeId=e2af1603149a, content=相当于一篇指南,受用。, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9b2a1732571, createdName= gospel007, createdTime=Mon Dec 05 00:46:36 CST 2016, time=2016-12-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1691648, encodeId=b5801691648ca, content=<a href='/topic/show?id=fa8148552d5' target=_blank style='color:#2F92EE;'>#带状疱疹后神经痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=48552, encryptionId=fa8148552d5, topicName=带状疱疹后神经痛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=213529278967, createdName=jeanqiuqiu, createdTime=Tue Aug 23 18:20:00 CST 2016, time=2016-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=87511, encodeId=dba78e51145, content=很好有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=185, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Mon May 30 08:03:00 CST 2016, time=2016-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1540809, encodeId=43c9154080963, content=<a href='/topic/show?id=ac8de440615' target=_blank style='color:#2F92EE;'>#神经痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74406, encryptionId=ac8de440615, topicName=神经痛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0d8213287489, createdName=贵阳, createdTime=Sat May 28 05:20:00 CST 2016, time=2016-05-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1580363, encodeId=b8e1158036336, content=<a href='/topic/show?id=c026e05485f' target=_blank style='color:#2F92EE;'>#疱疹#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70548, encryptionId=c026e05485f, topicName=疱疹)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2dcf16628144, createdName=ms2694732865965676, createdTime=Sat May 28 05:20:00 CST 2016, time=2016-05-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=87277, encodeId=14978e27703, content=高龄、出疹前有疼痛、眼部受累、出疹时便疼痛剧烈的等有危险因素的带状疱疹患者必须接受更加积极的治疗,早期积极治疗对带状疱疹神经痛具有一定的缓解作用!, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160516/IMG5739CFE7F40967394.jpg, createdBy=c8001723204, createdName=aduah520, createdTime=Thu May 26 17:04:00 CST 2016, time=2016-05-26, status=1, ipAttribution=)]
    2016-05-26 aduah520

    高龄、出疹前有疼痛、眼部受累、出疹时便疼痛剧烈的等有危险因素的带状疱疹患者必须接受更加积极的治疗,早期积极治疗对带状疱疹神经痛具有一定的缓解作用!

    0

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