本文選題：帶狀皰疹 + 糖皮質(zhì)激素��； 參考：《西南醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:帶狀皰疹(Herpes zoster,HZ)是由潛伏在感覺神經(jīng)節(jié)內(nèi)的水痘帶狀皰疹病毒(Varicella-zoster virus,VZV)再激活引起的一種常見的感染性疾病,90%的HZ患者伴有劇烈的神經(jīng)痛。臨床研究發(fā)現(xiàn)早期小劑量短療程的糖皮質(zhì)激素(Glucocorticoid,GC)聯(lián)合常規(guī)治療可以促進HZ患者皮損的早期愈合,減輕急性期疼痛的嚴(yán)重程度、縮短疼痛的持續(xù)時間。但小劑量短療程GC聯(lián)合常規(guī)治療HZ是否會造成病毒感染擴散,加重神經(jīng)損害,加重病情等一直存在爭議,其焦點在于這種聯(lián)合治療是否會影響HZ患者機體的免疫功能。本研究擬通過觀察小劑量短療程GC聯(lián)合常規(guī)治療HZ患者的臨床療效、外周血VZV DNA載量、血漿S100β蛋白濃度及T細(xì)胞亞群變化情況,探討該治療對HZ患者的臨床療效及T細(xì)胞亞群的影響,為小劑量短療程GC聯(lián)合常規(guī)治療HZ提供一定的理論依據(jù)。方法1.收集急性期HZ患者100例作為HZ組,健康正常對照組40例作為C組;將HZ組患者按其治療期間使用GC與否分為GC組(52例)與非GC組(48例),記錄HZ患者的止皰時間、止痛時間、結(jié)痂時間,治療前及治療1、2周后的疼痛視覺模擬評分(Visual analogue scale,VAS)及病情評分,隨訪出院1月后PHN的發(fā)生率;并于治療前、治療2周后分別抽取外周血采用實時熒光定量PCR法檢測VZV DNA載量,酶聯(lián)免疫法(ELISA法)檢測血漿中神經(jīng)損傷因子S100β蛋白的濃度,采用SPSS17.0軟件進行數(shù)據(jù)分析,比較GC組與非GC組HZ患者的臨床療效、外周血VZV DNA載量、神經(jīng)損傷標(biāo)志物S100β蛋白變化情況。2.隨機選取上述HZ患者50名作為HZT組(其中GC組選取25例作為GC_T組,非GC組選取25例作為非GC_T組)以及健康正常對照組20例作為CT組,分別于治療前及治療2周后抽取外周血采用流式細(xì)胞儀檢測患者T細(xì)胞亞群(CD3~+T、CD4~+T、CD8~+T、CD4~+CD25~+Treg、CD4~+CD25~+Foxp3~+Treg、CD4~+CD25~+GITR~+Treg的百分比)。采用SPSS17.0軟件分析比較GC_T組與非GC_T組T細(xì)胞亞群的變化情況。結(jié)果:1.治療后GC組止皰時間、止痛時間、結(jié)痂時間及治療1周后的病情評分、VAS均低于非GC組,差異具有顯著的統(tǒng)計學(xué)意(P0.05);GC組與非GC組治療2周后病情評分、VAS、S100β蛋白水平、外周血VZV DNA載量比較差異無統(tǒng)計學(xué)意義(P0.05);治療結(jié)束1月后電話隨訪帶狀皰疹后遺神經(jīng)痛(Postherpetic neuralgia,PHN)發(fā)生率差異無統(tǒng)計學(xué)意義(P0.05)。2.治療前及治療2周后HZT組T細(xì)胞亞群(CD3~+T、CD4~+T、CD8~+T百分比及CD4~+T/CD8~+T比值)均較CT組顯著降低(P0.01);CD4~+CD25~+Treg、CD4~+CD25~+TFoxp3~+Treg、CD4~+CD25~+GITR~+Treg百分?jǐn)?shù)均較CT組升高(P0.01)。3.HZT組治療前及治療2周后比較,T細(xì)胞亞群中CD3~+T、CD4~+T、CD8~+T、CD4~+CD25~+T、CD4~+CD25~+TFoxp3~+Treg、CD4~+CD25~+GITR~+Treg百分?jǐn)?shù)及CD4~+T/CD8~+T比值均具有明顯的差異性(P0.05)。4.治療2周后GC_T組與非GC_T組比較,T細(xì)胞亞群(CD3~+T、CD4~+T、CD8~+T、CD4~+CD25~+T、CD4~+CD25~+TFoxp3~+Treg、CD4~+CD25~+GITR~+Treg百分比及CD4~+T/CD8~+T比值)比較均無統(tǒng)計學(xué)差異(P0.05)。結(jié)論:1.小劑量短療程GC聯(lián)合常規(guī)治療急性期HZ患者有助于減輕患者的癥狀及體征,但對外周血VZV DNA載量、血漿S100β無影響;2.小劑量短療程GC聯(lián)合常規(guī)治療急性期HZ對患者的T細(xì)胞亞群無明顯影響;3.小劑量短療程GC聯(lián)合常規(guī)治療急性期HZ是安全有效的治療方案。
[Abstract]:Objective: Herpes zoster (HZ) is a common infectious disease caused by the reactivation of varicella zoster virus (Varicella-zoster virus, VZV) latent in the sensory ganglia, and 90% of HZ patients are accompanied by severe neuropathic pain. Clinical studies have found a combination of early small dose and short course of Glucocorticoid (Glucocorticoid, GC). Routine treatment can promote the early healing of the skin lesions of HZ patients, reduce the severity of acute pain and shorten the duration of pain. However, the small dose short course of GC combined with routine treatment of HZ will cause the spread of virus infection, aggravation of the nerve damage, and the aggravation of the disease. The focus is whether this combination of treatment will affect HZ. The purpose of this study is to observe the clinical efficacy of the small dose short course GC combined with routine treatment of HZ patients, the VZV DNA load in peripheral blood, the concentration of S100 beta protein in plasma and the changes of T cell subsets, and to explore the effect of the treatment on the clinical efficacy and the subsets of T cells in HZ patients, and for the small dose and short course GC combined with routine treatment of H. Z provided a certain theoretical basis. Method 1. 100 cases of acute HZ patients were collected as HZ group and 40 healthy normal control group were used as group C. The patients in group HZ were divided into GC group (52 cases) and non GC group (48 cases) according to their treatment during the period of treatment. The time of stop blister, time of pain stopping, scab time, pain visual model before and after 1,2 weeks after the treatment were recorded. The Visual analogue scale (VAS) and the disease score were followed up and the incidence of PHN was followed up after January; and before the treatment, 2 weeks after treatment, the peripheral blood was extracted by real-time fluorescence quantitative PCR method to detect VZV DNA load, and the enzyme linked immunosorbent assay (ELISA method) was used to detect the concentration of S100 beta protein of nerve damage factor in plasma, and the data were carried out by SPSS17.0 software. To compare the clinical efficacy of GC and non GC group HZ patients, VZV DNA load in peripheral blood and the change of S100 beta protein of nerve damage marker,.2. randomly selected 50 of the above HZ patients as HZT group (among which 25 were selected as GC_T group, 25 in non GC group) and 20 in normal control group as group, respectively. T cell subgroups (CD3~+T, CD4~+T, CD8~+T, CD4~+CD25~+Treg, CD4~+CD25~+Foxp3~+Treg, CD4~+CD25~+GITR~+Treg) were detected by flow cytometry before and after 2 weeks of treatment. The changes in the T cell subgroup of the GC_T group and non GC_T group were compared with the SPSS17.0 software. Results: 1. after the treatment, the time of the blisters and the pain in the GC group were relieved. Time, time of scab and 1 weeks after treatment, VAS was lower than non GC group, and the difference had significant statistical meaning (P0.05), and there was no statistical difference between GC and non GC group after 2 weeks of treatment, and the level of VAS, S100 beta protein and VZV DNA load in peripheral blood (P0.05); after the end of January, the follow-up of herpes zoster sequela (Po) neuralgia (Po) There was no significant difference in the incidence of stherpetic neuralgia, PHN) (P0.05), before.2. treatment and 2 weeks after treatment, the T cell subgroups of HZT group (CD3~+T, CD4~+T, CD8~+T percentage and CD4~+T/CD8~+T ratio) were significantly lower than those of the CT group. Before and after 2 weeks of treatment, CD3~+T, CD4~+T, CD8~+T, CD4~+CD25~+T, CD4~+CD25~+TFoxp3~+Treg, CD4~+CD25~+GITR~+Treg percentage and CD4~+T/CD8~+T ratio in the subsets of T cells were significantly different (P0.05) and CD4~+T/CD8~+T ratio (P0.05) for 2 weeks, the GC_T group was compared with the non GC_T group. 3~+Treg, CD4~+CD25~+GITR~+Treg percentage and CD4~+T/CD8~+T ratio were not statistically different (P0.05). Conclusion: 1. small dose and short course GC combined with routine treatment of acute HZ patients can help to reduce the symptoms and signs of patients, but there is no effect on VZV DNA load in peripheral blood and S100 beta in plasma; 2. small dose short course GC combined with routine treatment of acute treatment. Phase HZ had no significant effect on T cell subsets of patients. 3. small dose of short course GC combined with routine treatment of acute HZ is a safe and effective treatment.

【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R752.12

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