The Study Between Neuroelectrophysiological Feature,Cytokines In Acute Patients With Herpes Zoster And Postherpetic Neuralgia

ObjectivesDetecting the neuroelectrophysiology,the concentration of interleukin-6, tumor necrosis factor-alpha, nerve growth factor in acute patiens with Herpes Zoster,and observing the incidence of PHN.to study the assosiation between the electrophysiological featur,the concentration of interleukin-1, tumor necrosis factor a and nerve growth factor, and the PHN; Observing the effect of NB-UVB combined with Ganciclovir and Glycyrrhizin on treating Middle-aged and elderly Herpes Zoster,to approach the optimal threatment and reduce the incidence of PHN.Methods1,A total of 120 acute patiens with Herpes Zoster were collected in dermatology department of the second hospital of Shandong University from January 2007 to DecemberJune 2008.They were randomly divided into three groups: A(40 cases), B(35 cases), and C(45 cases).20 normally Middle-aged and elderly peoples were collected as the control group.2,The neuroelectrophysiology (mainly including electromyologram and nerve conduction velocity) of patients in each group were exzaminated by using EMG instrument(Keypoint 4M/4C),compared with the Healthy side. We selected immunoradiometric assay on interleukin-6, tumor necrosis factor-alpha, and Enzyme-linked immunosorbent assay on nerve growth factor,all compared with the control group.3,Giveing differnit threatments to each group: acyclovir, Vitamin B₁, Vitamin B₁₂ and Saridon (A group), ganciclovir and glycyrrhizin (B group), narrow-band ultrvioletB,ganciclovir and glycyrrhizin(C group).4,We detailly recorded the clinical datas of each patient by questionnaire.Every patient was asked to regularly return visit, and the time of scabbing, relieving pain, killing pain and crust shedding were observed. After treatment,we fllowed up all patients by telephone to observe the incidence of PHN.5,All datas were analyzed by using the statistical sofeware(SASV8.0).Results1,PHN occurred in 15 patients of A group, and its incidence rate was 37.5%.The neuroelectrophysiology of 9 patients in acute stage who leaved over PHN changed : 9 (60%) patients'sensory nerve conduction velocity all slowed, and 3 (33.33%) patiens' motor nerve conduction velocity simultaneously slowed.Their electromyologram were all normal; The neuroelectrophysiology of 3 patients in acute stage who didn ' t leave over PHN changed:3(12%)patients'sensory nerve conduction velocity all slowed, and no patiens' motor nerve conduction velocity slowed. Their electromyologram were all normal.The difference between the two groups had statistical significance.2,The concentration of interleukin-6 and tumor necrosis factor-alpha in A group separately were ( 0.334±0.099 ) ng/ml, ( 36.027±8.137 ) fmol/ml,which were significantly higher than the control group(P＜0.05) .And they in patients who leaved over PHN were much higer(P＜0.05) . The concentration of nerve growth factor was(44.173±9.301 ) pg/ml, which was also significantly higher than the control group. But the difference between patients leaving over PHN and patients not had no statistical significance(P＞0.05) .3,The neuroelectrophysiology of 12 patients in B group changed and that of 16 patients in C group changed. The concentration of interleukin-6 and tumor necrosis factor-alpha and nerve growth factor separately were (0.356±0.089 ) ng/ml,(37.363±6.462)fmol/ml,(45.090±8.069)pg/ml in B group;they were (0.368±0.105) ng/ml,(37.882±5.916) fmol/ml,(45.649±8.132) pg/ml in C group/They were all significantly higher than the control group(P＜0.05 ),but had no statistical significance, compared with A group.4,The time of scabbing, relieving pain, killing pain and crust shedding in C group was separately (3.49±1.25)d,(5.33±0.90)d,(10.40±6.00)d,(11.07±1.60) d,which was significantly shorter compared with A and B; In B group,3(8.57%) patients developed into PHN, in C group,2(4.44%) patients devlepoed into PHN;At the incidence of PHN, the difference between C group and B group has no statistical significance(P＞0.05) , but they were both significantly lower than that in A group (P＜0.05) .Conclutions1,There is some assosiation between the neuroelectrophysiology feature and the PHN . The incidence rate of PHN whose neuroelectrophysiology changes is higher than that in acute patients whose neuroelectrophysiology is normal.So we should give them active intervention to prevent the occurrence of PHN.2,The concentration of interleukin-6 and tumor necrosis factor a in acute patients is higher,and it is much higer in the patients who will leave over PHN.So we conclude they are involved in the formation of PHN.3,NB-UVB combined Ganciclovir and Glycyrrhizin is the optimal choice for treatment of Middle-aged and Senile Herpes Zoster. The time of scabbing, relieving pain, killing pain and crust shedding can be obviously shorted.