带状疱疹后神经痛的危险因素和预防措施

Risk factors and prevention measures of postherpetic neuralgia

目的∶通过对近年来带状疱疹后神经痛的危险因素和预防措施研究现状的总结,以探讨带状疱疹后神经痛的独立危险因素和有效预防措施。资料来源∶应用计算机检索Medline2000-01/2005-03期间的关于带状疱疹后神经痛的危险因素和预防措施方面的文章,检索词为“herpeszoster,neuralgia,riskfactors,prevention&control”,并限定文章语言种类为English;检索维普数据库2000-01/2004-12期间与带状疱疹后神经痛相关文章,检索词为“带状疱疹,神经痛,治疗,预防,危险因素,带状疱疹后神经痛”,限定语言种类为中文。资料选择∶对资料进行初审,选取包括干预组和对照组的文献,筛除明显非随机的研究,对剩余的文献查找全文,进一步判断为随机对照试验。也包括其他对比研究及调查分析类文献。筛除重复性及综述类文献。资料提取∶共收集到72篇文献,按带状疱疹后神经痛危险因素和预防措施相关性研究的新观点进行提炼,对文献进行分类整理,用于综述,其中14篇选用为参考文献。排除的58篇为重复试验或综述类文献。资料综合∶17篇文献中5篇探讨了带状疱疹后神经痛的危险因素,对其进行综合分析确定带状疱疹后神经痛的独立危险因素为老年、女性、疱疹出现前有前驱性疼痛、带状疱疹急性期发生严重的皮疹和疼痛。9篇试验包括采用抗病毒药物、皮质激素、神经阻滞、三环类抗抑郁剂、疫苗接种以及联合治疗等干预措施来预防带状疱疹后神经痛的发生。结论∶对带状疱疹后神经痛危险因素的研究,有助于制定带状疱疹后神经痛的预防措施并且可确定哪些患者真正需要这些预防措施的干预多项研究已证实抗病毒药物与适量肾上腺皮质激素或神经阻滞联合应用对缓解带状疱疹相关性疼痛及预防带状疱疹后神经痛更为适用。

OBJECTIVE： To summarize the present status of study on the risk factors and prevention measures of postherpetic neuralgia（PHN） in recent years, so as to investigate the independent risk factors of PHN and effective prevention for it. DATA SOURCES： An online search of Medline database was undertaken by using the keywords of “herpes zoster, neuralgia, risk factors, prevention ＆ control” to identify the articles about PHN published in English from January 2000 to March 2005. Meanwhile, Chinese articles about PHN published from January 2000 to December 2004 were scanned in VIP database with the key words “herpes zoster, neuralgia, risk factors, prevention, treatment, postherpetic neuralgia”. STUDY SELECTION： After the above research, the trials including intervention and control groups were selected, while the obvious non-randomized trials were excluded, and then the full texts of the selected articles were searched for randomized controlled study. It was also including that the articles of other comparative study and survey analysis, and the repetitive papers and reviews were excluded. DATA EXTRACTION： Seventy-two articles were collected according to the new opinions about the risk factors and prevention of PHN, and then they were classified and sorted for summarization, and 17 of them served as references. The 55 excluded articles were repetitive trials or reviews. DATA SYNTHESIS： The risk factors of PHN were revealed in 6 articles, and believed the independent contributions to the prediction of PHN made by older age, female sex, presence of a prodrome, greater rash severity, and greater acute pain severity. The other 11 articles included preventions of PHN by using antiviral drugs, corticoid, nerve block, tricyclic antidepressants, vaccine inoculation and therapeutic alliance. CONCLUSION： Continuing research on risk factors for PHN will be help to develop methods to prevent PHN and identify which patients have the greatest need for such preventive efforts but will also increase our knowledge of the pathogenesis of PHN. Many of studies have verified that using antiviral drugs and adrenal cortical hormone or nerve block united are more applicable to relief the herpes zoster associated pain or to prevent the occurrence of PHN.