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The Correlation Study Between Substance P Content And Pain Degree, And Posterpetic Neuraligia In Herpes Zoster

Posted on:2008-01-04Degree:MasterType:Thesis
Country:ChinaCandidate:R Z TengFull Text:PDF
GTID:2144360212994135Subject:Dermatology and Venereology
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ObjectiveContiguous observating substance P (SP) content at before and after treatment and duration of PHN, to discuss the correlation of SP and pain level, mental status and postherpetic neuraligia (PHN) in herpes zoster. Methods1. 38 cases (≥50 years old) definite herpes zoster basis on clinical situation were selected excluding systemic disease of chronic pain and without previous psychiatric history and family history. All cases were untreated 5-7day after morbility. All cases known the fact and agreed with the therapeutic regimen.2. All cases list clinic general data such as gender, age, remote cause, course of disease, precursory symptom, developing succession of pain and cutaneous deficiency involved nerve, area of cutaneous deficiency and so on. All patient's PHN were classfied by VAS and MPQ , mental state were examinated by passion questionnaire.3. All patient were conventional therapied 10 day according to text book, and followed up at 3 weeks and 8weeks after morbility with recording pain degree.4. Homolateral ulnar vein blood at patient' cutaneous deficiency were draw off to test SP content at before treatment and 20 days and 2months after treatment, with mental state examinated by passion questionnaire. 30 health even-aged adult in control group were draw ulnar vein blood once off to test SP.5. SP content in plasma was detected by radio-immunity.6 .The measurement data was represented by x|-±s, and the results between groups were analyzed by T test and x~2 test, p < 0.05 indicate to has statistical significance.Results38 patients consist of 17 male and 21 females, aged 50-82 years, with an average age of 63.7±7.5. 38 patients completed the 20-day follow-up, 31 patients completed the two months of follow-up, 7 patients lost. There were 9 cases of postherpetic neuralgia occurred in 31 patients. The incidence of PHN is 29.03%.1. Comparison of SP content in different phase of herpes zoster: SP content before treatment is 100.1±10.13 pg/ ml, obviously higher than that after treatment 64.12±13.81 pg/ ml and control group 43.01±6.21 pg/ ml. Compared the SP content before treatment with the normal control group and after treatment, the differences is highly significant (p<0.01) and significantly (p<0.05). SP content after treatment is still higher than that of control group, but without statistic difference (p>0.05).2. Comparison of SP content and pain degree.:(1) 38 patients were divided into 3 group of high VAS score (VAS score≥7), middle scores (VAS score4-6), low scores (VAS score≤3). The SP content before treatment in high score group (n = 16), middle score group (n = 18) and low score group (n = 4) were 118.01±12.03 pg/ml, 92.30±9.11 pg/ml and 63.68±15.36 pg/ml respectively. Compared the SP content of high scores group with middle score and low score group, the difference were significantly (p<0.05). It is show that the SP content is coincident with pain, and the more severe the pain is, the higher the SP content will be.(2) After treatment①the SP content in high score group (n=16), middle score group (n=7) and low score group (n=25) were 92.65±9.87 pg/ml,73.31±7.95 pg/ml and 55.84±6.29 pg/ml respectively. The SP content of high scores group is higher than that of middle score and low score group with significant difference (p<0.05).②Compared the SP content of middle scores group with low score group, the difference were not significantly (p<0.05). It is still show that the SP content is coincident with pain.3. Comparison of SP content with depression degree: 38 patients with herpes zoster were divided into 3 groups by depression degree, including non-depression group ( < 0.5), low-mild depression group (0.5-0.59), moderate-severe depression group (0.60-0.69). The SP content of 3 group were compared by single factor.(1)Before treatment SP content of non-depression group (n=10), low-mild depression group (n=13) and moderate-severe depression group (n=15) were 63.47±16.34 ml. pg/ml, 88.97±13.09 ml, 133.71±8.64 pg/ml.①Compared f no-depression group with the low-mild depression group and moderate-severe depression group, the SP content is decreased with highly significant (p<0.01) and significantly (p<0.05).②Low-mild depression group compared with moderate-severe depression group with statistically significant (p<0.05). The results showed that the changes of SP content is consistent with the depression degree.(2)After treatment the SP content of non-depression group (n=19), low-mild depression group (n=12) and moderate-severe depression group (n=7) were 50.13±8.07 pg/ml,73.81±16.34pg/ml and 98.93±19.12pg/ml respectively.①Compared of non-depression group with the low-mild depression group and moderate-severe depression group, the SP content is decreased with highly significant (p<0.01) and significantly (p<0.05).②Low-mild depression group compared with moderate-severe depression group, without statistically significant (p > 0.05). In short, the patients' mental state has improved remarkably and SP content decreased after treatment.4. The relations of SP content, VAS score and postherpetic neuralgia.(1) Comparison of SP content①Before treatment the SP content of PHN group(n=9, 140.71±18.13 pg/ml) is higher than that of no-PHN group(n=22, 84.32±10.21 pg/ml) with statistical significance (p<0.05). It is indicated that the SP content in early phase of herpes zoster could predict the occurrence of PHN.②After treatment the SP content of PHN group(101.23±1.89 pg/ml) is still higher than that of non-PHN group(52.12±8.81 pg/ml) with significant difference (p<0.05) . The SP content of PHN group is higher than control group with significant difference(p<0.05), but the no-PHN group without significant difference(p> 0.05).③After treatment the SP content of non-PHN patients (52.12±8.81 pg/ml) is lower than that of before treatment (84.32±10.21 pg/ml) with statistical significance (p<0.05). But compared after treatment the SP content of PHN patients (101.23±1.89 pg/ml) with that of before treatment (140.71±18.13 pg/ml), the difference is not significant(p<0.05). After treatment the SP content of PHN group decreased less than that of non-PHN group, suggesting that slow down decrease of SP content before and after treatment may be relative to the occurrence of PHN.④At 2 months after morbility, SP content of PHN patients was 77.34±12.31 pg/ml, still higher than that of control group with significant difference (p <0.05). It was shown that SP content is concordance with pain degree.(2) Comparison of VAS score of different groups①The VAS score of PHN group and non-PHN group before treatment were 8.17±1.51 and 6.09±1.04 respectively. The VAS score of PHN group is higher than that of non-PHN group with significant difference (p <0.05) It was suggested that early pain degree may have some role in the forecast of PHN.②The VAS score of PHN group and the non-PHN Group after treatment were 6.67±2.14 and 1.9±0.07 respectively. The VAS score of PHN group is still higher than that of non-PHN group with significant difference (p <0.05), suggesting that more severe PHN after treatment was prone to occur PHN.5. Comparison of clinical factors with postherpetic neuralgia.: There were 9 cases of postherpetic neuralgia occurred in 31 patients who completed a full course. The incidence of PHN is 29.03%.(1) The relations of age and PHN : The incidence of PHN in more than 60-year-old group (8/16) was higher than that in the 50-60 age group (1/15) with significant difference (p<0.05), suggesting that the greater the age occurred, the higher the risk of PHN will be.(2) The relationship of gender and PHN: The incidence of PHN in gender is unrelated to gender (p>0. 05).(3) The relationship of prodromal symptoms and PHN : The incidence of prodromal symptoms in PHN group (7/9) was higher than that in non-PHN group (1/22). The difference was statistically significant (p<0.05), suggesting that prodromal symptoms may be a high risk factor of PHN.(4) The relationship of serious disease and PHN: The incidence of PHN group accompanied with serious diseases (6/9)is higher than that in non-PHN Group (2/22). The difference was statistically significant (p<0.05), suggesting that serious disease was prone to occur PHN.(5) The relations of area of cutaneous deficiency skin lesion and PHN : Compared the different incidence of PHN with lesion area, it is shown that the incidence of PHN with large areas of cutaneous deficiency (≥5%, 7/8) is higher than that with small area of cutaneous deficiency ( < 5%, 2/23). The difference was statistically significant (p <0.05), suggesting that cutaneous deficiency is the high risk factor of PHN. (6) The relations of time of and PHN: Compared the time of preliminary diagnosis between the two groups, the time of preliminary diagnosis of PHN group (5.56 days) is longer than that of non-PHN group (3.14 days). The difference was statistically significant (p <0.05), suggesting that early treatment of PHN may be a effective measures of reducing the occurrence of PHN.In short, the incidence of PHN will increased with rise of some clinical factors such as age, the area of cutaneous deficiency, prodromal symptoms, accompanied serious diseases and prolonged preliminary diagnosis. Conclusin1. The study further confirmed that the SP is one of the main pain mediator in the acute phase of herpes zoster and postherpetic neuralgia.2. The result of pain score and detection of SP content in different phases shown that SP content is consistent with pain degree and SP content objectively quantified pain degree of herpes zoster.3. The patients with high content of SP and severe pain in the acute phase of the herpes zoster had the increased incidence of PHN, which suggested the detection of SP content and assessment of the pain degree in acute phase is help to predict postherpetic neuralgia.4. Continual observation find the SP content is consistent with pain degree depression level, thereby illustrating the multiple factors and complex mechanisms causing PHN.5. Age is the main factor of postherpetic neuralgia. Other risk factors of postherpetic neuralgia include the precursor symptoms, accompanied by serious medical diseases, area of cutaneous deficiency, serious skin rashes and pain in acute phase, precursor pain appeared before herpes zoster accompanied by systemic diseases, application of immunosuppressants.6. Elderly patients with herpes zoster is commonly associated with depression, suggesting that patients should be appropriate psychological counseling in the acute phase of herpes zoster and treatment of postherpetic neuralgia, and adding antidepressant drugs to improve the quality of life of patients when necessary.7. Compared McGill with VAS pain score, the VAS score is simple, reliable and could as an objective quantitative approach of pain degree of herpes zoster.
Keywords/Search Tags:herpes zoster, postherpetic neuraligia, substance P, pain determination
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