Li Yunze, Jin Jiali, Kang Xianhui, Feng Zhiying
Department of Pain Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China.
Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Pain Ther. 2024 Oct;13(5):1095-1117. doi: 10.1007/s40122-024-00640-3. Epub 2024 Aug 10.
Postherpetic neuralgia (PHN) manifests as persistent chronic pain that emerges after a herpes zoster outbreak and greatly diminishes quality of life. Unfortunately, its treatment efficacy has remained elusive, with many therapeutic efforts yielding less than satisfactory results. The research to discern risk factors predicting the onset, trajectory, and prognosis of PHN has been extensive. However, these risk factors often present as nonspecific and diverse, indicating the need for more reliable, measurable, and objective detection methods. The exploration of potential biological markers, including hematological indices, pathological insights, and supportive tests, is increasing. This review highlights potential biomarkers that are instrumental for the diagnosis, management, and prognosis of PHN while also delving deeper into its genesis. Drawing from prior research, aspects such as immune responsiveness, neuronal injury, genetic makeup, cellular metabolism, and pain signal modulation have emerged as prospective biomarkers. The immune spectrum spans various cell subtypes, with an emphasis on T cells, interferons, interleukins, and other related cytokines. Studies on nerve injury are directed toward pain-related proteins and the density and health of epidermal nerve fibers. On the genetic and metabolic fronts, the focus lies in the detection of predisposition genes, atypical protein manifestations, and energy-processing dynamics, with a keen interest in vitamin metabolism. Tools such as functional magnetic resonance imaging, electromyography, and infrared imaging have come to the forefront in the pain signaling domain. This review compiles the evidence, potential clinical implications, and challenges associated with these promising biomarkers, paving the way for innovative strategies for predicting, diagnosing, and addressing PHN.
带状疱疹后神经痛（PHN）表现为带状疱疹发作后出现的持续性慢性疼痛，严重降低生活质量。不幸的是，其治疗效果一直难以捉摸，许多治疗努力的结果都不尽如人意。辨别预测PHN发病、病程和预后的危险因素的研究已经很广泛。然而，这些危险因素往往表现为非特异性和多样化，这表明需要更可靠、可测量和客观的检测方法。对潜在生物标志物的探索不断增加，包括血液学指标、病理学见解和辅助检查。本综述重点介绍了对PHN的诊断、管理和预后有重要作用的潜在生物标志物，同时也深入探讨了其发病机制。根据先前的研究，免疫反应性、神经元损伤、基因构成、细胞代谢和疼痛信号调制等方面已成为潜在的生物标志物。免疫谱涵盖各种细胞亚型，重点是T细胞、干扰素、白细胞介素和其他相关细胞因子。对神经损伤的研究针对与疼痛相关的蛋白质以及表皮神经纤维的密度和健康状况。在基因和代谢方面，重点在于检测易感基因、非典型蛋白质表现和能量处理动态，对维生素代谢尤为关注。功能磁共振成像、肌电图和红外成像等工具在疼痛信号领域已崭露头角。本综述汇集了与这些有前景的生物标志物相关的证据、潜在临床意义和挑战，为预测、诊断和应对PHN的创新策略铺平了道路。
