Associated Factors Clinical Study Of Postherpetic Neuralgia

ObjectiveBy investigating epidemiology about clinical factors of herpes zoster, to explore the correlation factors about developing postherpetic neuralgia, to provide the help in preventing PHN.MethodsClinical data of the 165 outpatient and inpatient of herpes zoster during 2006.1-2006.11 in Qilu hospital were collected including age, sex, mood, clinical characteristics of HZ, prodrome, severity of acute pain, severity of rash, settings, time of initial treatment, ways of the therapy, laboratory investigation, accompanied systemic diseases, exposure of immunity-inhibitors, and following-up information for 4 to 6 months froml65 patients. All available data are dealt with univariate by SPSS for windows 13.0.Postherpetic neuralgia is defined as pain or and allodynia, itching, numbness in the zoster dermatome more than3 months after healed rash.Severity of acute pain was measured by VAS, while the-6-point behavioral rating scale (RBS-s ) was used in following up patients.Results1. Epidemiologic data: of the 165 patients, 80 male and 85 female, the mean age 56.44±16.61 years (range from20-90). 64 patients (38.8% in 165) developed PHN, the mean age of patients who developed PHN is 61.59±12.53 years. 2. Age and gender165 patients were divided into five groups by age, the incidence of PHN is significantly different. There is no significant difference between male and female.3. MoodIn our study, 20patients are anxious or depressed, 16 patients developed PHN(80.00% 16/20), 145patients are not anxious or depressed,48 patients developed PHN (33.10% 48/145), statistical results show that the incidence ofPHN is significantly different between mood of twe group ( x~2 =16.280, P =0.000<0.001) .4. Association between prodrome and PHNOf 165patients, 105 had prodromal symptoms, while 55 not. There is no significantly different between them. ( x~2 =0.82, P >0.05) .5. Settings, clinical type, area of the lesion and PHNSpecific dermatol distribution (cranial and cervical, thoracic, lumbosacral, extremity), area of the lesion, clinical type were compared to, chi-squarex~2 demonstrating the prevalence of PHN was not significant difference in settings, while severity of the acute rash has statistical significance.6. Acute pain and PHNAccording to the intensity of the acute pain, 165patients were divided into three groups (mild, moderate, severe), there is significantly different in the incidence of PHN.7. Laboratory test and PHNAlbumin/Globulin of 124 patients were checked, Albumin/Globulin of 53patients is normal, 71 is abnormal. There was significantly different in the prevalence of PHN, (x~2 =7.887, P =0.005<0.05); In 125 patients, 29 patients with high Glucose, 17patients developed PHN; CD4/CD8 were checked, of 95 patients, 10 patients is normal, 1 patients developed PHN, 85 patients is abnormal, 36 patients developed PHN. There is significantly different between them.8. Time of the first therapy and PHNOf 64 patients who have developed PHN, the mean time of the first therapy is5.30±3.93days; Of 101patients who have not developed PHN, the mean time is 3.83±2.33 days. t -test showing there is significantly different between them. (t =2.700, P<0.05).9. Different ways of therapy in acute herpes zosterAntivirals were divided different 4 groups, whether or not exposure to cortico steroids, comparing the incidence of PHN, there is not significantly different in them. (P>0.05)10. Systemic diseases and PHNPatients with diabetic mellitus or connective tissue disease compared other systemic diseases, there is significantly different in the incidence of PHN.11. PHN has different clinical features: such as itching, allodynia, lancinating, spontaneous shotting, numbness and so on.Conclusions1) The risk of PHN increases progressively with age; in our studies, the prevalence of PHN is 38.8%, the mean age of patients who developed PHN is 61.59±12.53 years. Individuals aged 50 years or older have higher prevalence of PHN relative to individuals younger than 50 years.2) Mood including anxiety and depression is the risk factors of PHN and may indict that medical care and psychological nursing is important.3) Prodromal symptoms is not associated with higher prevalence of PHN, in contrast, initial pain severity is clearly associated with a higher prevalence of PHN.4) Distribution of the rash is not associated with PHN, the clinical type, rash severity is relative to PHN, the more severity of rash, the more possibility of PHN.5) The time of initial treatment is critical to prevent PHN,the earlier to receive therapy, the lower the incidence of PHN. Antivirals or exposure to corticosteroids cannot reduce the prevalence of PHN.6) Diabetic mellitus and connective tissue disease seemed that they are higher risks of PHN.