Oaklander A L, Romans K, Horasek S, Stocks A, Hauer P, Meyer R A
Department of Neurosurgery, the Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Ann Neurol. 1998 Nov;44(5):789-95. doi: 10.1002/ana.410440513.
Shingles can cause chronic neuropathic pain (postherpetic neuralgia) long after skin lesions heal. To investigate its causes, we quantitated immunolabeled sensory neurites in skin biopsies from 18 subjects with and 16 subjects without postherpetic neuralgia after unilateral shingles. Subjects rated the intensity of their pain. Punch skin biopsies were evaluated from the site of maximum pain or shingles involvement, the homologous contralateral location, and a site on the back, distant from shingles involvement. Sections were immunostained with anti-PGP9.5 antibody, a pan-axonal marker, and the density of epidermal and dermal neurites determined. The group with postherpetic neuralgia had a mean density of 339 +/- 97 neurites/mm2 in shingles-affected epidermis compared with a density of 1,661 +/- 262 neurites/mm2 for subjects without pain. Neurite loss was more severe in epidermis than dermis. Unexpectedly, the group with pain had also lost half of the neurites in contralateral epidermis. Contralateral damage occurred despite the lack of contralateral shingles eruptions or pain, correlated with the presence and severity of ongoing pain at the shingles site, and did not extend to the distant site. Thus, the pathophysiology of postherpetic neuralgia pain may involve a new bilateral mechanism.
带状疱疹可在皮肤损伤愈合很长时间后引发慢性神经性疼痛（带状疱疹后神经痛）。为了探究其病因，我们对18例患带状疱疹后神经痛的受试者和16例未患该疾病的受试者的皮肤活检样本中的免疫标记感觉神经突进行了定量分析。受试者对自身疼痛强度进行了评分。从疼痛最严重部位或带状疱疹累及部位、对侧相应部位以及背部远离带状疱疹累及的部位采集钻孔皮肤活检样本。切片用抗PGP9.5抗体（一种泛轴突标记物）进行免疫染色，并测定表皮和真皮神经突的密度。带状疱疹后神经痛组在带状疱疹累及的表皮中神经突平均密度为339±97个/平方毫米，而无痛受试者的密度为1661±262个/平方毫米。表皮中的神经突损失比真皮更严重。出乎意料的是，疼痛组对侧表皮中的神经突也损失了一半。尽管对侧没有带状疱疹发作或疼痛，对侧仍出现了损伤，这与带状疱疹部位持续疼痛的存在和严重程度相关，且未扩展至远处部位。因此，带状疱疹后神经痛的病理生理学可能涉及一种新的双侧机制。
