水痘-带状疱疹病毒特异性细胞免疫及其预测带状疱疹后遗神经痛的价值  

Varicella-zoster virus specific cellular immunity and its value in predicting PHN occurrence in patients with herpes zoster

作　　者：袁峰[1] 冯丹[1] 李少军 张书力[1] 李敏[1] 胡焓[1] 童胜雄[1] 田佳玉[1] YUAN Feng;FENG Dan;LI Shaojun;ZHANG Shuli;LI Min;HU Yan;TONG Shengxiong;TIAN Jiayu(Department of Pain Management,Wuhan First Hospital,Wuhan 430022,China)

机构地区：[1]武汉市第一医院疼痛科,武汉430022

出　　处：《实用医学杂志》2023年第14期1809-1814,共6页The Journal of Practical Medicine

基　　金：武汉市卫生计生委科研项目(编号:WX19C31)。

摘　　要：目的探讨带状疱疹患者水痘-带状疱疹病毒(Varicella-zoster virus,VZV)特异性细胞免疫的特点,并对发生带状疱疹后遗神经痛(PHN)的预测价值进行分析。方法选择2021年1月至2022年6月于我院体检中心明确为健康的成年人10例作为研究对象,构建VZV特异性组、对照组模型,分析两组间细胞免疫因子之间的差异。选择同时期于我院就诊的带状疱疹(HZ)患者70例作为研究对象,收集初次就诊时患者存在差异的VZV特异性细胞免疫因子指标(后简称指标),而后对患者进行为期半年的随访,对指标预测PHN发生的价值进行分析。结果VZV组患者CD4^(+)T细胞占比低于对照组,而CD8^(+)T细胞及PD-1^(+)CD4^(+)T细胞占比高于对照组,差异有统计学意义(P<0.05)。两组患者PBMC上清液中IFN-γ、IL-2水平比较差异无统计学意义(P>0.05)。VZV组患者PBMC上清液中TNF-α水平高于对照组,差异有统计学意义(P<0.05)。PHN组患者合并前区疼痛占比、多阶段发病占比、发病至开始治疗时间及PBMC上清液的TNF-α水平均高于非PHN组;CD3^(+)T细胞百分比低于非PHN组,差异有统计学意义(P<0.05)。PBMC上清液TNF-α(HR=1.148)是HZ患者PHN发生风险的独立危险因素(P<0.05)。PBMC上清液中TNF-α对于PHN发生具有较好的预测效果(AUC=0.902,P<0.001,95%CI:0.821~0.981)。预测的截断值为>54.36 pg/mL,预测敏感度为82.35%,特异度为85.11%,阳性预测值为66.67%,阴性预测值为93.02%。结论PBMC上清液内TNF-α是影响PHN发生的VZV特异性细胞免疫因子,对于预测HZ患者PHN发生上具有一定的临床意义。Objective To investigate the characteristics of varicella zoster virus(VZV)specific cellular immunity in patients with herpes zoster,and to analyze the predictive value for postherpetic neuralgia(PHN).Methods A total of 10 healthy adults from January 2021 to June 2022 in the Physical Examination Center of our hospital were selected.VZV specific group and control group models were established to analyze the differences of cellular immune factors.Next,70 patients with herpes zoster who were admitted to our hospital at the same time were selected,and differences in VZV-specific cellular immune factor indicators(hereafter referred to as indicators)were collected at the first visit.The patients were followed up for half a year to analyze the value of indicators in predicting the occurrence of PHN.Results The proportion of CD4^(+)T Cell in VZV group was lower than that of the control group,while the proportion of CD8^(+)T Cell and PD-1^(+)CD4^(+)T Cell was higher than that of the control group,with statistically significant difference(P<0.05).There was no significant difference in IFN-γ and IL-2 level in PBMC supernatant between the two groups(P>0.05).The TNF-α level in PBMC supernatant of VZV group was higher than that of the control group,and the difference was statistically significant(P<0.05).The proportion of anterior pain,the proportion of multi-stage disease,the time from onset to treatment and TNF-α of PBMC supernatant in PHN group were all higher than those of the non-PHN group.The percentage of CD3^(+)T Cell was lower than that of the non-PHN group,and the difference was statistically significant(P<0.05).PBMC supernatant TNF-α(HR=1.148)was an independent risk factor for PHN occurrence(P<0.05).TNF-α in PBMC supernatant had a good predictive effect on PHN occurrence(AUC=0.902,P<0.001,95%CI=0.821~0.981).The cut-off value,sensitivity,specificity,positive predictive value,and negative predictive value were>54.36 pg/mL,82.35%,85.11%,66.67%,and 93.02% respectively.Conclusion TNF-α in PBMC supernatant is a VZV-

关 键 词：带状疱疹 带状疱疹后遗神经痛 水痘-带状疱疹病毒 细胞免疫 

分 类 号：R752.12[医药卫生—皮肤病学与性病学]