老年带状疱疹患者急性期T细胞亚群变化及其与疱疹相关性疼痛的关系

The relationship between T lymphocyte subsets changes and the zoster associated pain in aged patients with acute herpes zoster

目的检测老年带状疱疹患者急性期外周血T细胞亚群水平，观察患者急性期机体细胞免疫状态与带状疱疹急性期疼痛（AHP）和后遗神经痛（PHN）的关系。方法选择急性期老年带状疱疹患者60例，根据AHP视觉模拟评分（visual analogue scales，VAS）分为轻中度AHP组：VAS评分≤6分，重度AHP组：VAS评分〉6分；再根据随访结果是否发生带状疱疹后PHN分为非PHN组和PHN组。选取年龄、性别相匹配的门诊健康体检者25例作为对照组。记录患者AHP最严重时VAs评分，采用流式细胞测定技术测定急性期外周血T细胞亚群CD3＋、CD4＋和CD8＋百分比及计算CD4＋／CD8＋比值。结果各组年龄、性别差异无统计学意义（P〉0．05）；轻中度AHP组、重度AHP组、非PHN组和PHN组CD3＋、CD4＋、CD8＋表达与对照组比较均降低（P〈0．05），重度AHP组CD4＋表达低于轻中度AHP组（P〈0．05）；CD4＋／CD8＋比值轻中度AHP组、非PHN组均高于对照组（P〈0．05），重度AHP组低于轻中度AHP组（P〈0．05），PHN组低于非PHN组（P〈0．05）；PHN组AHPVAS评分高于非PHN组（P〈0．05）。结论老年带状疱疹患者急性期普遍存在细胞免疫功能低下，表现为T细胞亚群百分比降低；重度AHP患者细胞免疫状态更低。PHN患者在疱疹急性期存在更严重的局部损害和更低下免疫应答。

Objective To study T lymphocyte subsets levels in acute zoster patients and investigate its relation to the zoster associated pain. Methods According to the visual analogue scales（VAS） in the acuter phase, 60 patients with herpes zoster were divided into two groups： group A （VAS≤6） and group B （VAS〉6）. According to the follow-up results, patients were divided into another two groups： group C （PHN not developed） and group D （PHN developed）. 25 healthy volunteers with a similar age and gender range as the patients were recruited as control group. T lymphocyte subsets were detected by fluorescence-activated cell sorter （FACS）. Results There was no significant difference in gender and age between groups（P〉0.05）. T lymphocyte subsets were significantly decreased in four groups compared with the control group （P〈0.05）, and the CD4＋ subsets in group B were significantly decreased compared with group A （P〈0.05）. The CD4＋/CD8 ＋ ratios were significantly higher in group A and C than in control group, higher in group A than B and higher in group C than in group D （P〈0.05）. The visual analogue scales（VAS） in group D were significantly higher than in group C （P〈 0.05）. Conclusions Cellular immunity function is decreased with the lower percent of the T lymphocytes subsets in the elderly patients with acute herpes zoster, especially in severe patients. The CD4＋/CD8＋ ratios and the visual analogue scales may be associated with the the risk of post herpetic neuralgia.