Natural history of cutaneous innervation following herpes zoster
Natural history of cutaneous innervation following herpes zoster
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DOI：
10.1016/j.pain.2010.04.002
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发表时间：
2010-07-01
期刊：
影响因子：
7.4
通讯作者：
Rowbotham, Michael C.
中科院分区：
文献类型：
--
作者：
Petersen, Karin Lottrup;Rice, Frank L.;Rowbotham, Michael C.
作为带状疱疹(HZ)自然病史综合研究的一部分，94名带状疱疹后遗神经痛(PHN)高危人群中的57名同意在基线和随访时从受影响皮肤、镜像皮肤和远距离对照皮肤收集3 mm皮肤穿孔活检。由于长期重度PHN的皮肤神经支配减少，我们验证了PHN的发展与初始神经损伤的严重程度和/或神经恢复失败相关的假设。使用单标记PGP9.5免疫荧光显微镜进行的定量分析显示，与对照和镜像皮肤相比，带状疱疹皮肤的表皮轮廓在研究进入时减少了约40%。带状疱疹皮肤的真皮下神经丛密度约低15%。与对照皮肤相比，镜面皮肤未失神经。尽管在所有的就诊中并不显著，但HZ皮肤中的表皮神经纤维密度与热感、超敏、辣椒素反应和平均每日疼痛之间的相关性都与更严重的异常与较低的表皮神经支配有关。有限的证据表明，在15名最终确诊为PHN的受试者中，最初的神经损伤更严重。总体而言，疼痛和与疼痛相关的残疾解决得最快。局部应用辣椒素的感觉异常和症状加重在6个月内表现出部分和选择性的恢复。相比之下，皮肤神经支配在6个月后完全没有恢复，这是消除疼痛和超常疼痛不需要皮肤神经支配的确凿证据。需要更长的观察期来确定带状疱疹影响的皮肤是否会重新获得神经。(C)2010年国际疼痛研究协会。爱思唯尔出版公司版权所有。
As part of a comprehensive study of the natural history of herpes zoster (HZ), 57 of 94 subjects in a cohort at elevated risk for post-herpetic neuralgia (PHN) consented to collection of 3-mm skin punch biopsies from affected, mirror-image, and distant control skin at baseline and followup visits. As cutaneous innervation is reduced in longstanding severe PHN, we tested the hypothesis that development of PHN is correlated with severity of initial neural injury and/or a failure of neural recovery. Quantitative analysis using single-label PGP9.5 immunofluorescence microscopy showed epidermal profiles were reduced in zoster skin by approximately 40% at study entry compared to control and mirror skin. The density of the subepidermal plexus was approximately 15% lower in zoster skin. Mirror skin was not denervated compared to control skin. Although not significant at all visits, correlations between epidermal nerve fiber density in HZ skin and thermal sensation, allodynia, capsaicin response, and average daily pain all associated more severe abnormalities with lower epidermal innervation. There was limited evidence that the initial neural injury was more severe in the 15 eventual PHN subjects. Overall, pain and pain-related disability resolved the fastest. Sensory abnormalities and symptom aggravation by focal capsaicin application showed partial and selective recovery over 6 months. In contrast, cutaneous innervation showed no recovery at all by 6 months, conclusive evidence that resolution of pain and allodynia does not require cutaneous reinnervation. A much longer period of observation is needed to determine if zoster-affected skin is ever reinnervated. (C) 2010 International Association for the Study of Pain. Published by Elsevier B. V. All rights reserved.