| Objective1.To study the brain activity changes of acute Herpes Zoster by resting-state f MRI technic,and to analyze the correlation between these changes with postherpetic neuralgia.2.To investigate the clinical data of disseminated herpes zoster,analyze the independent pathogenic factors of disseminated herpes zoster and postherpetic neuralgia.Methods1.32 Patients with acute herpes zoster at Affiliated Zhong Da Hospital of Southeast University(experimental group)and 18 healthy volunteers matched with gender,age and educational level(healthy control)from September 2017 to Janurary 2020 were selected as research objects.The gender,age and education level of all research objects were collected.The underlying diseases,clinical manifestations(affected nerve,characters of skin lesions,fever,headache),duration between attack and initiation of anti-viral treatment,Visual analog score(VAS)of experimental group members were recorded.32 cases of the AHZ patients were followed up 1 month after been discharged from the hospital,and has been divided into two subgroups by whether they were developed with Postherpetic neuralgia.BOLD and ASL sequence images of the experimental group and the control group were collected using rs-f MRI technology to obtain ALFF,Re Ho,and r CBF values.The changes of functional activity in the brain region of patients with acute HZ were studied by statistical analysis.The correlation between f MRI data of brain regions with abnormal functional changes above and clinical data was analyzed.2.Patients with disseminated herpes zoster and typical herpes zoster between September 2014 and June 2019 at Southeast University Affiliated Zhongda Hospital was chosen as research objects.The triggers,history of underlying diseases,clinical manifestations(affected nerves,skin lesions,fever,headache,etc.),duration between attack and initiation of anti-viral treatment,Visual analog score(VAS),blood routine,liver function,cancer markers,course and prognosis were recorded.Clinical data of two group of patients were analyzed retrospectively.Results1.Study of changes of brain regions activities and cerebral blood flow of acute HZ patients:As compared to healthy controls,ALFF values increased in the left middle frontal gyrus and decreased in the right supramarginal gyrus,left parietal lobe and left posterior lobe of cerebellum(t=3.79,P=0.01;t=-4,72,P=0.01),Re Ho values increased in the right inferior temporal gyrus and decreased in bilateral supramarginal gyrus,bilateral cingulate gyrus and right middle frontal gyrus(P=0.01,Alphasim correction)among experimental group.As compared to none-PHN subgroup,Re Ho values increased in the right inferior temporal gyrus and r CBF values decreased in lingual gyrus(t=2.23,P=0.001;t=3.47,P=0.03).2.correlation analysis within clinical data and brain regions activities: Among experimental group,ALFF values in the right supramarginal gyrus was negatively correlated with severity score(r=-0.41,P=0.024),Re Ho values in bilateral supramarginal gyrus was negatively correlated with the VAS pain score r=-0.45,P=0.014;r=-0.47,P=0.009).The Among patients who suffered premonitory pain,ALFF values in the left middle frontal gyrus and left inferior frontal gyrus were significantly increased than those without premonitory pain,so as the Re Ho values in the right inferior temporal gyrus;meanwhile,the Re Ho values in the right supramarginal gyrus decreased(t=2.73,P=0.011;t=-2.08,P=0.047;t=2.15,P=0.041).3.Analysis of independent pathogenic factors of DHZ patients: The incidence rates of bullae,pustules,fever,ulcers and mucosal involvement were all significantly higher in the disseminated herpes zoster group than in the common herpes zoster group(29.0% vs.7.1%,c2=8.62,P<0.05;38.7% vs.10.0%,c2=11.59,P<0.05;41.9% vs.8.6%,c2=15.66,P<0.05;25.8% vs.5.7%,c2=8.28,P<0.05;9.7% vs.1.4%,c2=3.84,P<0.05).The disseminated herpes zoster group also showed significant difference in laboratory tests at serum albmin,prealbumin and cholesterol level compared with the common herpes zoster group(t=-3.52、-3.67、-2.21,P<0.05).The disseminated herpes zoster group also showed significantly longer duration between attack and initiation of anti-viral treatment and higher VAS pain scores at admission compared with the common herpes zoster group(Median[P25-P75]: 6[4-7]vs.4[3-7],Z =-2.52,P<0.05;Median[P25-P75]: 6[4-7] vs.4[3-7],Z =-2.52,P<0.05).Logistic regression analysis revealed that cancer,fatigue,fever,headache,dystrophy,serum albumin decreasing,prolonged time before initiation of anti-viral treatment were significantly associated with the occurrence of disseminated herpes zoster,male and elderly patients who suffered from Disseminated Herpes Zoster have higher risk of getting postherpetic neuralgia.Conclusion1.There are abnormal activity changes in multiple brain regions among acute HZ patients.2.The abnormal activity changes in brain regions may have correlation with clinical manifestations of acute HZ and the occurrence of PHN.3.Cancer,fatigue,fever,headache,dystrophy,serum albumin decreasing,prolonged time before initiation of anti-viral treatment were significantly associated with the occurrence of disseminated herpes zoster.Male and elderly patients who suffered from disseminated herpes zoster have higher risk of getting postherpetic neuralgia. |
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