带状疱疹后遗神经痛的诊断及治疗进展

Progress on Diagnosis and Treatment of Postherpetic Neuralgia

带状疱疹后遗神经痛(PHN)是带状疱疹(HZ)最常见的并发症,为水痘-带状疱疹病毒激发免疫和/或炎症反应持续损伤周围或/和中枢神经元所致慢性复杂性神经病理性疼痛,通常指HZ皮疹出现后疼痛持续≥90d且疼痛强度的Likert评分≥30分。以普通人群和HZ患者为基数统计PHN发病率分别为0.34‰~2.5‰和5%~30%,均随年龄增长而升高。PHN危险因素包括HZ患者高龄、前驱症状重、急性期皮疹和疼痛重、免疫力低下、女性、三叉神经眼支受累等。诊断主要依据HZ病史及疼痛特点。接种HZ减毒活疫苗或重组亚单位疫苗可有效预防HZ及PHN。PHN可持续数年,治疗困难。口服药如三环类抗抑郁药、抗惊厥药和阿片类,外用药如5%利多卡因垫和8%辣椒素垫,非药物治疗如微创介入疼痛治疗,或不同作用机制镇痛方法联用,可用于治疗PHN。

Postherpetic neuralgia（PHN）,the most common complication of herpes zoster,is a chronic complex neuropathic pain resulting from a persistent damage of the periphery or/and central neurons by varicella-zoster virus-induced immunological and/or inflammatory reactions.It is conventionally defined as dermatomal pain lasting at least 90 days after appearance of the zoster rashes,of which a Likert scale of pain intensity is at least 30.The incidence of PHN based on the general population and the patients with zoster are 0.34‰~2.5‰ and 5%~30%,respectively,both of which increase with advancing age.Risk factors for PHN include an older age,intensive prodrome,severe skin rashes and severe pain in acute zoster,immunocompromise,female gender,and involvement of the trigeminal nerve.Diagnosis of PHN mainly depends upon the history of zoster and the nature of pain.Vaccination with a live-attenuated zoster vaccine or a recombinant subunit vaccine is an effective prophylaxis for HZ and PHN.PHN may persist for years and is difficult to treat.Oral drugs including tricyclic antidepressants,anticonvulsants and opioids,topical preparations such as 5% lidocaine and 8% capsaicin patch,non-drug measures like mini-invasive interventional pain management,or a combination of pain-relief therapeutics with different mechanisms,may be used for the treatment of PHN.