Study On The Relationship Between Herpes Zoster Neuralgia And Vitamin D

Objective:Postherpetic neuralgia（PHN）,the sequelae of herpes zoster（HZ）,is difficult to cure and the course of the disease is protracted.Additionally,PHN can cause anxiety,depression,and sleep disorders in patients.Vitamin D is a natural antiviral substance,but whether its level affects the prognosis of HZ and PHN is still unclear.This study aims to explore the relationship between vitamin D levels and disease conditions in patients with HZ and PHN.Methods:1.Serum vitamin D level and Ca²⁺content detection:10ml of peripheral venous blood will be collected from healthy volunteers,patients with lumbar disc herniation,HZ or PHN,and automatic biochemical analyzer will be used to detect serum vitamin D and Ca²⁺levels.Serum vitamin D and Ca²⁺contents will be compared in the subjects of different genders,and among healthy volunteers,patients with lumbar disc herniation,HZ or PHN.2.Pearson correlation analysis of vitamin D level and Ca²⁺level with pain time and pain degree will be performed in HZ and PHN patients;ROC curve analysis on vitamin D and Ca²⁺level against pain degree will be performed in HZ and PHN patients.3.Enzyme linked immunosorbent assay（ELISA）will be used to detect the content of varicella-zoster virus（VZV）antibody（Anti-VZV Ig G/Ig M）in the serum of healthy volunteers,HZ and PHN patients:Compare the serum anti-VZV Ig G/Ig M content of healthy controls and HZ and PHN patients;Perform Pearson correlation analysis on the vitamin D level and Ca²⁺level of HZ and PHN patients with the serum anti-VZV Ig G/Ig M content;Analyze the ROC of serum levels of vitamin D and Ca²⁺with anti-VZV Ig G/Ig M levels in HZ and PHN patients.4.Observe the effect of vitamin D supplementation on the efficacy of HZ and PHN:Patients with abnormal vitamin D will be randomly divided into vitamin D group and control group.Vitamin D supplementation for patients in the vitamin D group（if the vitamin D level is less than 20ng/ml,intramuscularly inject 10mg vitamin D₂;If it is less than 12ng/ml,intramuscularly inject 15mg）;The control group will be given vitamin D according to the method of the vitamin D group on the day of discharge.The patients with HZ and PHN were randomly divided into five groups:VAS=6 group,VAS=7 group,VAS=8 group,VAS=9 group,VAS=10 group.The operation stopped the statistics on the same day.5.Observe the effect of vitamin D on the pain threshold in PHN mice:PHN mouse will be constructed and divide into three groups:Control group（n=12）,RTX group（n=12）,and the Vehicle group（n=12）.C57/BL6J mice were intraperitoneally injected with resiniferatoxin（RTX,5μg/kg）.Before injection and on days 1,2,4,7,14,and 28after injection,the heat and mechanical pain threshold changes will be detected to confirm the success of PHN mice modeling.Then,the mice will be divided into 5groups:Control group（n=10）,Control-VD group（n=10）,RTX group（n=10）,RTX-Vehicle group（n=10）,RTX-VD group（n=10）.Mice were injected intramuscularly with VD₂（50IU/g）,and the thermal and mechanical pain threshold of the mice will be measured on the 1,4,7,14,28 days after the successful modeling.Results:1.Compared with male healthy controls,female healthy controls have lower serum vitamin D levels,and there are statistical differences between female and male patients（P<0.05）.Compared with male patients with lumbar disc herniation,female patients with lumbar disc herniation had the same serum vitamin D content,and there was no statistical difference between female and male patients（P>0.05）.Compared with male HZ patients,female HZ patients have lower serum vitamin D levels（P<0.05）,and there are statistical differences between female and male patients（P<0.05）.Compared with male PHN patients,female PHN patients have lower serum vitamin D levels,and there are statistical differences between female and male patients（P<0.05）.2.Compared with male healthy controls,female healthy controls have lower serum Ca²⁺content（P<0.05）.Compared with male patients with lumbar disc herniation,female patients with lumbar disc herniation have lower serum Ca²⁺content（P<0.05）.Compared with male HZ patients,the serum Ca²⁺content of female HZ patients is equivalent（P>0.05）.Compared with male PHN patients,the serum Ca²⁺content of female PHN patients is equivalent（P>0.05）.3.Compared with healthy controls,Ca²⁺decreased in patients with intervertebral disc herniation,HZ and PHN,and there was a statistical difference between the two（P<0.05）.Compared with healthy controls,patients with intervertebral disc herniation have lower vitamin D（P<0.05）.Compared with healthy controls and patients with intervertebral disc herniation,HZ and PHN patients have lower vitamin D,and there is a statistical difference between female and male patients（P<0.05）.4.Pearson correlation analysis showed that there was no significant correlation between vitamin D levels and pain duration in patients with HZ and PHN（P>0.05）.The vitamin D level and pain intensity of HZ and PHN patients were not statistically significant.ROC curve analysis showed that the area under the ROC of pain intensity（VAS score）and vitamin D level in PHN patients was 92%,P<0.0001,indicating that vitamin D content can be used to evaluate the pain degree of PHN.ROC analysis showed that the area under the ROC of pain intensity and Ca²⁺level in PHN patients was 100%,P<0.0001,suggesting that Ca²⁺level can be used to evaluate PHN pain level.5.Compared with healthy controls,serum anti-VZV Ig G/M levels in patients with HZ and PHN are significantly higher（P<0.05）.Pearson correlation analysis showed that:There was no significant correlation between vitamin D levels and serum anti-VZV Ig G levels in HZ and PHN patients（P>0.05）;There was no significant correlation between the vitamin D and the anti-VZV Ig M content in HZ and PHN patients（P>0.05）;There was no significant correlation between the levels of Ca²⁺and serum anti-VZV Ig G levels in HZ and PHN patients（P>0.05）;There was no significant correlation between the levels of Ca²⁺and serum anti-VZV Ig M in HZ and PHN patients（P>0.05）.6.ROC curve analysis shows:1)The area under the ROC of serum anti-VZV Ig G content and vitamin D level of HZ and PHN patients is 100%,P<0.0001,indicating that the vitamin D level can be used to evaluate the serum anti-VZV Ig G content in HZ and PHN patients.2)The area under the ROC of serum anti-VZV Ig M content and vitamin D level in HZ and PHN patients was 87%,P<0.001,suggesting that vitamin D level can be used to evaluate serum anti-VZV Ig M content in HZ and PHN patients.3)The area under the ROC of serum anti-VZV Ig G content and Ca²⁺level in HZ and PHN patients is 100%,P<0.0001,indicating that Ca²⁺level is a good indicator for evaluate the serum anti-VZV Ig G content in HZ and PHN patients.4)The area under the ROC of serum anti-VZV Ig M content and Ca²⁺level in HZ and PHN patients is 100%,P<0.0001,indicating that Ca²⁺level can be used to evaluate the serum anti-VZV Ig M content in HZ and PHN patients.7.Compared with the control group,vitamin D supplementation can significantly reduce the pain score and breakthrough pain times of HZ and PHN patients.8.Mice in the RTX group,Vehicle group and Control group were tested for pain threshold before and after modeling（days 1,2,4,7,14,and 28）.Mice in the RTX group showed a significant decrease in mechanical pain threshold on the 4th day（P<0.05）;A stable increase in the latent period of heat pain threshold began on the14th day（P<0.05）;There was no change in the pain threshold of the mice in the Vehicle and Control groups（P>0.05）.Compared with the RTX and RTX-Vehicle groups,the mechanical pain threshold of mice in the RTX-VD group began to increase significantly on the 4th day after intramuscular injection of vitamin D₂（P<0.05）.There was no change in the mechanical pain threshold of the mice in the Control group and the Control-VD group（P>0.05）.Compared with the RTX and RTX-Vehicle groups,the heat pain threshold of mice in the RTX-VD group began to decrease significantly on the 7th day after intramuscular injection of vitamin D₂（P<0.05）.There was no change in the heat pain threshold of the mice in the Control and Control-VD groups（P>0.05）.Conclusion:1.Serum vitamin D and Ca²⁺levels in patients with HZ and PHN are reduced.Vitamin D and Ca²⁺levels are negatively related to the severity of HZ and PHN diseases.2.Insufficiency of vitamin D and Ca²⁺may affect the reactivation of VZV and aggravate the condition of HZ and PHN.3.Vitamin D supplementation can relieve HZ and PHN pain.