早期应用糖皮质激素降低带状疱疹后遗神经痛的临床观察

Clinical Observation of the Early-stage Usage of Glucocorticoid to Alleviate Post Herpetic Neuralgia

目的:观察早期应用糖皮质激素对降低带状疱疹后遗神经痛(PHN)发病率的效果和安全性。方法:180例带状疱疹住院患者根据发病时间分为3组。A组60例,发病时间<7 d,给予基础治疗加地塞米松10 mg,iv,qd,3 d后减为5 mg,5 d后停用地塞米松。B组60例,发病时间>7 d,用药与A组相同。C组60例,发病时间<7d,仅用基础用药。比较3组止疱时间、疼痛缓解时间、皮损痊愈时间及PHN发病率。结果:3组止疱时间和皮损痊愈时间比较,差异无统计学意义(P>0.05)。与C组比较,A、B两组疼痛缓解时间差异有统计学意义(P<0.05);A、B两组比较,疼痛缓解时间差异无统计学意义(P>0.05)。3组间PHN发病率比较,差异有统计学意义(P<0.05)。结论:中、老龄带状疱疹患者在有效抗病毒治疗的基础上应用糖皮质激素,能明显缩短疼痛时间,降低PHN的发病率;早期应用效果更好。

Objective： To observe the therapeutic effects and safety of post herpetic neuralgia to alleviate post herpetic neuralgia. Methods：IS0 cases of inpatients clinically diagnosed as herpes zoster were divided into three groups according to the time of their onset. Group A was composed of 60 cases of patients whose time of onset were fewer than 7 days. The patients of Group A were treated with basal therapy plus 10rag dexamethasone, iv, qd for the first 3 days, fol- lowed by 5mg dexamethasone, iv, qd for the next 2 days. Group B was composed of 60 cases of patients whose time of onset were more than 7 days. The patients in Group B were treated in the same way as Group A. Group C was composed of 60 cases of patients whose time of onset were fewer than 7 days. Only the basal treatment was applied in Group C. The time of ceasing new blister, time of pain relieving, time of cure and incidence of PHN were compared among the 3 groups. Resuits ： There was no significant difference in terms of the time of ceasing new blister and the time of cure among the 3 groups （P 〉 0.05）, whereas significant difference were found in terms of the time of pain relieving and the incidence of PHN （ P 〈 0.05）. Conclusion ： The early-stage usage of glucocorticoid could Obviously decrease the time of pain and reduce the in- cidence of PHN with good safety. Based on the effective anti-virus therapy, glucocorticoid should be applied as soon as possible to treat herpes zoster in middle-age and old people to decrease the time of pain and to reduce the incidence of PHN.