Does treatment of acute herpes zoster prevent or shorten postherpetic neuralgia?
Does treatment of acute herpes zoster prevent or shorten postherpetic neuralgia?
复制标题
急性带状疱疹的治疗可以预防或缩短带状疱疹后神经痛吗？
DOI：
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复制
发表时间：
2000
影响因子：
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通讯作者：
P. R. Lewis
中科院分区：
文献类型：
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作者：
B. Alper;P. R. Lewis
客观化
我们的目标是确定急性带状疱疹的任何治疗是否会改变带状疱疹后遗神经痛(PHN)的发生率或持续时间，PHN是老年患者的一种常见后遗症。
搜索策略
我们系统地检索了MEDLINE和Cochrane图书馆。我们还检查了已确定的试验和综述的参考清单。
遴选标准
我们纳入了所有以英文发表的带状疱疹治疗的随机对照试验，其中包括皮疹愈合后的任何时间的疼痛评估。
数据收集/分析
42项试验符合纳入标准，2名评价者独立评估了它们的方法学质量以及结果的统计和临床意义。
主要成果
对692名患者进行的四项口服阿昔洛韦的安慰剂对照试验提供了带状疱疹发病后1至3个月疼痛发生率降低的边缘证据。在一项对419名患者进行的安慰剂对照试验中，泛昔洛韦显著缩短了PHN的持续时间，但没有降低PHN的发生率。在一项有1141名患者参加的阿昔洛韦对照试验中，万乃洛韦显著缩短了PHN的持续时间，但没有降低PHN的发生率。类固醇对PHN无影响。在一项对80名患者进行的安慰剂对照试验中，阿米替林治疗90天可减少6个月后疼痛的发生率。一项对50名患者进行的经皮电神经刺激(PENS)的单一试验表明，与泛昔洛韦相比，在3个月和6个月时疼痛发生率降低。
结论
目前的干预措施能够预防或缩短PHN的证据有限。在已发表的单项试验中，泛昔洛韦和万乃洛韦已被证明可以缩短PHN的持续时间。应该进行阿米替林和钢笔的设计良好和更大规模的试验。
OBJECTIVE
Our goal was to determine if any treatment of acute herpes zoster alters the incidence or duration of postherpetic neuralgia (PHN), a common sequela in elderly patients.
SEARCH STRATEGY
We systematically searched MEDLINE and The Cochrane Library. We also examined the reference lists of identified trials and reviews.
SELECTION CRITERIA
We included all randomized controlled trials of treatments of zoster published in English that included assessment of pain at any time after rash healing.
DATA COLLECTION/ANALYSIS
Forty-two trials met inclusion criteria, and 2 reviewers independently evaluated them for methodologic quality and the statistical and clinical significance of results.
MAIN RESULTS
Four placebo-controlled trials of oral acyclovir with 692 patients provided marginal evidence for reduction in pain incidence at 1 to 3 months following zoster onset. Famciclovir significantly reduced duration but not incidence of PHN in one placebo-controlled trial of 419 patients. Valacyclovir significantly reduced duration but not incidence of PHN in one acyclovir-controlled trial of 1141 patients. Steroids had no effect on PHN. Amitriptyline for 90 days reduced pain incidence at 6 months in one placebo-controlled trial of 80 patients. A single trial of percutaneous electrical nerve stimulation (PENS) in 50 patients suggested a decrease in pain incidence at 3 and 6 months compared with famciclovir.
CONCLUSIONS
There is limited evidence that current interventions prevent or shorten PHN. Famciclovir and valacyclovir have been shown to reduce the duration of PHN in single published trials. Well-designed and larger trials of amitriptyline and PENS should be conducted.