Clincil Study Of Postherpetic Neuralgia

Partâ… A epidemiologic study of postherpetic neuralgiaObjective:The purpose of this study is to investigate the clinical epidemiologic characters of herpes zoster(HZ)for the optima time of diagnosis on pos-therpetic neuralgia(PHN),to explore the effect of correlated factors on PHN,to find the referred base for prevention of PHN.Methods:218 patients with herpes zoster in wards were selected by random number from January to June in 2007.The clinical data included age,gender,motivation,precursory pain,initial treatment time,involved nerve,pain level in acute stage,area of skin lesion,type of skin lesion,complication,therapeutic modalityetc.The incidence of PHN was recorded at 1,3 and 6 months after herpes healing via the followup.According to the statistical analysis on the above-mentioned incidence,the optima time of diagnosis on postherpetic neuralgia was evaluated.A single factor analysis between the optima time of diagnosis and clinical data was carried on.Possible correlated factors could be ascertained. All statistical analysis were performed using an SPSS program.Chi-square test was mainly used.One-sided test value was taken in all statistical results. P＜0.05 was considered statistically significant.P＜0.01 was considered statistically high significant.Results:1.The total incidence of PHN was PHN₁20.6%(45/218),PHN₃8.7% (19/218),PHN₆6.4%(11/218)respectively.There were statistical differences among PHN₁,PHN₃,PHN₆(x²=28.6,P＜0.01).There was statistical difference between PHN₃ and PHN₁(x²=12.4,P＜0.01),while there was no statistical difference between PHN₃ and PHN₆(x²=2.29,P＞0.05).We considered the incidence of PHN₃ as the incidence rate of our study on PHN.2.The patients with herpes zoster were16 to 87years old(50.86±20.66 Y), including 97 mans and 121 women.Two peak incidence of ages of herpes zoster were mainly 20-40 and 50-80years old.The patients with PHN included 9 mans and10 women.The incidence of PHN was high in patients who were more than 50years old.There were 17 patients who were more than 50 years old and 2 patients who were less than 50 years old.So patients were divided into two groups:mid-young group and mid-age group.There was statistically high difference between two groups(x²=9.97,P＞0.05).PHN was relevant to the age,but not gender(x²=0.07,P＞0.05).3.There were 40 cases whose Grigeminal nerve were involved,87cases with Intercostal nerve involved,69 cases with lumbosacral plexus involved,and 22 cases with neck brachial plexus involved.There were 4 cases,7 cases,6 cases a nd 2 cases with PHN respectively.There was no statistical difference in incidence of PHN among the involved nerves(x²=0.07,P＞0.05).4.There were 133 cases with herpes zoster who had precursory pain,and there were 16 cases with PHN among them.There were 3 cases who had PHN among 85 cases without precursory pain.Precursory pain had no statistical difference with incidence of PHN(x²=4.71,P＜0.05).5.113cases with herpes zoster whose initial treatment time was less than 3 days,and there were 5cases with PHN among them,while 95 cases with herpes zoster whose initial treatment time was more than 3 days,and there were 14 cases with PHN.So initial treatment time were associated with PHN significantly(x²=6.48,P＜0.05).6.46 cases with herpes zoster in acute stage whose pain level was mild,and there were 2 cases with PHN among them.103 cases had moderate pain,and there were 6 cases with PHN.69 cases had severe pain,and there were 11 cases with PHN.So PHN was relevant to pain level in acute stage.(x²=6.71,P＜0.05).7.There were 66 cases as big area group with area of skin lesion more than 3%,in whom 11 cases had PHN;There were 87 cases as middle area group with area of skin lesion less than 3%but more than 1%,in whom 5 cases had PHN;There were 65 cases with area of skin lesion less than 1%,in whom 3 cases had PHN.So area of skin lesion was relevant to the PHN(x²=7.58,P＜0.05).8.There were 141 cases with popular type of herpes zoster,52 cases with severe type and 25 cases with abortive type,and there were 5,13,and 1 cases with PHN respectively.So type of herpes zoster was relevant to the PHN(x²=6.22,P＜0.05).9.There were 19 cases with diabetes,6 cases with PHN.There was significant difference(x²=8.18,P＜0.01).Conlusions:1.The standard time on clinical diagnosis of PHN was settled at 3 months after herpes healing.2.PHN was relevant to the age,but not gender.The incidence Of PHN was high in patients who are more than 50years old.This suggests physician should pay more attention to mid-age or aged patients with herpes zoster.3.There was no statistical difference in incidence of PHN among the involved Grigeminal nerves,Intercostal nerve,lumbosacral plexus and neck brachial plexus.4.Precursory pain and initial treatment time were associated with PHN.The earlier precursory pain occurred,the longer initial treatment time lasted,the higher incidence of PHN was.This indicates it be important to diagnose herpes zoster in time.5.PHN was relevant to area of skin lesion,type of skin lesion and pain level in acute stage,and it seems no relevant to the location of the rash.The more serious the clinical symptom was,the higher the incidence of PHN was.It can show the importance of treatment on herpes zoster in time.6.Patients with diabetes had high risk of PHN.Partâ…¡The Effects of Corticosteroid on Herpetic Neuralgia and Postherpetic Neuralgia in Earlier PeriodObjective:To evaluate the therapecutic effects on herpes zoster and neuralgia and its preventative effects on postherpetic neuralgia(PHN)using acyclovir combination with corticosteroid in early stage of disease,while the healing effects on herpes zoster were observed.The purpose of this study is find the referred base for prevention of PHN.Methods:According to clinical factor setting internalize standard,85 patients with herpes zoster in wards were selected by random number from June to December in 2007.Patients to accord with standard were randomly divivded into two groups:corticosteroid group(acylovior combination with methylprednisolone)and non-corticosteroid group(acylovior only).The visual analog scale(VAS)of preliminary and post-treatment,the healing time of herpes,the incidence of neuralgia were observed.The incidence of PHN was recorded at 3 months after herpes healing via the followup.The effects of corticosteroid on herpetic healing and herpetic neuralgia and PHN in Earlier Period was explored.All statistical analysis were performed using an SPSS program. Chi-square test and t-test were mainly used.One-sided test value was taken in all statistical results.P＜0.05 was considered statistically significant.P＜0.01 was considered statistically high significant.Results:The healing time of herpes in corticosteroid group was shorter than that of non-corticosteroid group(t=-3.19,P＜0.05).VAS after treatment in corticosteroid group were lower than those in non-corticosteroid group(t=-4.59,P＜0.05).The incidence of neuralgia after treatment in corticosteroid group were lower than those in non-corticosteroid group(t=5.16,P＜0.05)and PHN in corticosteroid group were lower than those in non-corticosteroid group(t=-6.12,P＜0.05).Conclusion:In earlier period acylovior combination with methylprednisolone were effective for herpes zoster and can shorten the healing time of herpes and reduce the incidence of neuralgia and PHN.