带状疱疹与带状疱疹后神经痛患者温度觉阈值变化及其意义

THE DIFFERENCE OF THERMAL SENSATION THRESHOLD IN PATIENTS WITH HERPES ZOSTER AND POST HERPETIC NEURALGIA

目的:分析躯干部位带状疱疹、带状疱疹后神经痛患者皮肤温度觉阈值的变化与差异,推测其感觉功能改变及疼痛的病理机制。方法:应用TSA-II温度觉定量分析仪测定躯干部位带状疱疹、带状疱疹后神经痛患者及对照组相应皮肤的温度觉阈值。结果:带状疱疹后神经痛患者较带状疱疹患者皮肤的冷觉、热觉、热痛觉阈值均升高,其中冷觉阈值升高最为明显。带状疱疹患者冷觉与热觉阈值之间相关性无统计学意义,而带状疱疹后神经痛患者冷觉与热觉阈值之间呈负相关。结论:病变发展过程中,Aδ、C类神经纤维损伤程度有所加重,并以传导冷觉的Aδ神经纤维受损更为严重,表现为带状疱疹后神经痛患者对冷觉、热觉和热痛觉耐受性高于带状疱疹患者,而且对温度觉或痛觉的辨别度减低。

Objective： To analyze the thermal thresholds in patients with herpes zoster（HZ） and post herpetic neuralgia（PHN）,and to speculate the mechanism of HZ and PHN.Methods： The TSA-II thermal sensory analyzer was used to test the different sensory modalities in patients with HZ and PHN as well as in the control group subjects.Results： The threshold of cold sensation,warm sensation and heat pain sensation in patients with PHN was significantly elevated when compared with corresponding threshold in patients with HZ,especially in cold sensation.No significant correlation between cold sensation threshold and warm sensation threshold was found,while a negative correlation between cold sensation and warm sensation in patients with PHN was observed.Conclusion： The degree of injured Aδ,C primary afferent fibers is aggravated during the process of HZ to PHN,especially the injured Aδ fibers which conducts cold sensation.The tolerances of cold sensation,warm sensation and heat pain sensation in patients with PHN were higher than that in patients with HZ,while the ability to discriminate between thermal sensation and pain sensation was lower than that in patients with HZ.