| BackgrandHerpes zoster (HZ) which is caused by varicella-zoster virus (VZV), is characterized by pain as well as erythema and vesicle. HZ mostly occur in certain groups of individuals such as elderly people, immunosuppressed individuals and patients who use immunosuppressors. With the widely use of the corticosteroids and immunomodulators, the incidence of herpes zoster is increasing year after year, and the people who suffer from shingles become younger. In Japan, the mean hepers zosters ranges from1.96to7.84/1,000person-years among different age groups from1998to2008, and the incidence of the disease increase year by year.. In America,more than90%adults are be susceptible to herpes zoster. Nearly30%human will suffer from herpes zoster at least once in their whole life. The high morbidity deserves our high attention.In the United States there are about1million new cases of herpes zoster each year, and among them50000to60000patients require hospitalization. For patients with cancer, autoimmune disease and the patients who use immunosuppressant, the incidence of herpes zoster is higher, and the situation and complication is more serious as well. According to a canadian report, the overall incidence of HZ following solid organ transplantation was8.6%(liver5.7%, renal7.4%, lung15.1%and heart16.8%). A retrospective survey about1145patients who suffer from Systemic Lupus Erythematosus (SLE) showed that51of those people were complicated by shingles. And the incidence was4.45%. Herpes zoster belongs to incomplete immune. Only4%of patients relapse after herpes zoster. But in patients with abnormal immune function, such as cancer, SLE and transplantation, the disease is prone to recurrence, high fever, infection, ulcer and so on. The current epidemiological investigations of herpes zoster are mostly reports from foreign countries. Our country has no nationwide epidemiological investigation yet. So it is necessary to do something to lay the foundation of nationwide epidemiological investigation of herpes zoster.VZV, which causes chickenpox and shingles, is a member of the herpesviridae family. It is a virus150-200run in diameter, with double-stranded DNA in core, and the surface of which is symmetry with a membrane. VZV is also a neurotropic alpha-herpes virus, it has reported that it is prone to CD4+and CD8+T lymphocytes. Varicella (chickenpox) is a primary infection of epithelial cells of the skin during childhood. Zoster (shingles), caused by the reactivation of the latent virus from the dorsal root ganglia and trigeminal ganglion, is be related to some nonspecific Stimulation, such as:cold, tired, drinking, sick, menstruation, etc. When the virus get reactived, it can cause ganglia inflammation, necrosis, neuralgia as well as erythema clustered. Currently, we mostly make a diagnosis of herpes zoster relying on clinical experience, but sometimes it is difficult to distinguish the herpes zoster from other blister diseases such as herpes simplex and pemphigus. So some scholars propose a measurement which use the blister fluid extracted from the patients to detect VZV DNA. The method is more objective. Then new problems such as zoster sine herpete arises, zoster sine herpete usually occurs with the symptoms that patients can feel painful but no rash appear while virological experiments confirmed that VZV herpes zoster do exist. A new method which collect the VZV DNA from the patient’s blood to ensure the evidence of VZV do exist and this method seems more standard. Compared with the blister fluid test, blood test is convenient and less contaminative. People used to guess the detectable VZV DNA in acute herpes zoster. In fact, there is a certain proportion of VZV DNA detected in health individual body, ranging from16%to100%. At the6th months after the acute phase, there is the detectable VZV DNA still in whole blood in the vast majority of the patients, and the quantity has some relationship with the time of neurologic symptom recovery. Some experts detect the VZV DNA in herpes zoster neuralgia (postherpetic neuralgia, PHN) patients and conclude that the ganglion of PHN patients have higher levels of VZV and that the virus will be penetrated to the peripheral blood mononuclear cells continuously. Similarly, people find detectable levels of VZV DNA in saliva of herpes zoster patients. This suggests that patients at the early stage of herpes zoster have detectable levels of VZV DNA in saliva and the quantity of VZV DNA may have some connection with herpes zoster neuralgia.At present, age is one of the important risk factors to the herpes zoster and this attribute to the reduced immunity in elderly pepole. T cells are the most important cluster of the immune system and the normal immune function rely on the interactions between T lymphocyte subgroups. Human are apt to infected with virus and bacterium When the number and functions of the T lymphocyte subgroups are abnormal. In the virus infection, VZV specific T cell immune response plays an important role in supressing virus reactivation and the recovery phase. In SCID-hu mouse model, VZV have characteristics with eosinophilic lymphoid cells for human CD4+and CD8+T cells, like other neuropathic herpes virus. When incubating tissue infected with the virus with peripheral blood mononuclear cells, people found that T cells recognizes a variety of proteins in extracts including glycoprotein, regulatory proteins of virus particles, structural protein and non structural protein needed for virus replication. In patients with HIV/AIDS, VZV infection is the first opportunistic infection following by the CD4+T cells decline. In the rhesus monkey infected with herpesvirus simiae (SVV) the lack of CD8+T cells can result in higher viral load and prolonged viremia. Meanwhile animals lack of CD4+T cells would produce antibodies slowly and reduce the CD8+T cell response.However the lack of B cells do not alter the severity of the disease. In patients with herpes zoster, people find that the CD4+and CD3+T lymphocytes decreased significantly whlie CD8+T lymphocytes has a rising trend. The reduction of CD4+T lymphocytes appears earlier than another, so it is suggested that the disease occurrance due to the inhibition of the function of CD4+T cells.In view of the lack of relevant epidemiological studies in our country for herpes zoster as well as the important role of cellular immunity for herpes zoster. We analyse the cases of herpes zoster in our hospital within5years and explore the influence factors and the clinical features firstly. In order to provide a better advice for clinical diagnosis and treatment, we analyse the relationship between clinical features, T cell subsets and VZV DNA copies in patients with acute herpes zoster.ObjectiveIn order to provide a basis for clinical diagnosis, treatment and prognosis of herpes zoster, we analyse the hospitalization and influence factors that in patients with herpes zoster using Logistic regression. Then we explore the relationship between clinical characteristics, T cell subsets and the VZV DNA copies in peripheral blood lymphocyte in patients with acute herpes zoster and speculate the important laboratory indicators relate to the clinical features in patients with acute herpes zoster.Method1. Gather the information of401patients with herpes zoster in our hospital in five years from December31,2006to December31,2011, Statistical analyse the information of the patients. The information include gender, age, diseasedparts, the course prior to admission, basic diseases, antivirus therapy, corticosteroid hormone use, the hospitalization time, the rash on admission, complications, the prognosis of disease, PHN and hospital departments, statistical analyse the information with Logistic regression model.2. Select the41patients who are hospitalized between May2013and August2013, and then test the peripheral blood T cell subsets and VZV copies following the disease assessment. Analyse the relationship between clinical features, T cells subsets and the viral copies in peripheral blood lymphocyte using SPSS13.0.Result1. Age, antivirus therapy, the immune disease, diseasedparts, hospital departments and the rash on admission can affect the length of stay. Complications may relate to age, the rash on admission and hospital departments. Gender, hospital departments, and PHN could influence the prognosis of disease. And the course prior to admission and prognosis may result in PHN.2. The clinical features except the number of blister (cluster number, the degree of pain, erythema area, illness scores) have significant correlation with the percentage of CD3+T lymphocytes, CD4+T lymphocyte and CD4/CD8.There are differences in the number of blister, cluster, erythema area, blister change, blood VZV DNA between different disease classification.The viral copies in peripheral blood lymphocyte is associated with immune disease, pain.Conclusion1. Age, the rash on admission can influence the recovery of herpes zoster and complications, so, we should pay attention to the old patients with the long course prior to admission.2. The patients with the immune disease have a significantly higher hospitalization duration than the normal patients, imply that they recovered slowerly, so they need individualized treatments. The patients with longer duration of out-of-hospital and who discharged from hospital without completely cured, are more likely suffer from PHN, and they should have standard treatment.3. The patients with different age have different clinical and laboratory indicators.Old people have severe clinical manifestations,and the viral load even higher, so they need more attention. Patients with severe clinical manifestations have restrained cellular immunity, viral load is higher, so they recover slowly.4. There are close correlation between the clinical features, T cells subsets and the viral copies in peripheral blood lymphocyte. We can speculate the cell-mediated immunity and the viremia of the patients through the clinical features. |
PDF Full Text Request