臺灣博碩士論文加值系統

目的：評估帶狀疱疹後神經痛(postherpetic neuralgia; PHN)患者體內維生素D不足{血清25-羥基維生素D [1,25(OH)2D]的濃度低於30ng/ml}的盛行率以及帶狀疱疹後神經痛與維生素D不足之間的關係。
材料和方法：這是一個回溯性病例對照研究方法，以電腦自動搜尋電子病歷，病例組62人與對照組186人，比例為1：3。病例組為在本院的疼痛門診就診，50歲以上，初次被診斷為帶狀疱疹和/或帶狀疱疹後神經痛，並有檢查血清25(OH)D的患者。對照組為以年齡及性別為配對，搜尋在本院接受健康檢查的健康民眾。搜尋後回溯病歷，紀錄病人相關數據。所得數據依連續變相及類別變相的不同，使用不同的計算方式，來檢視統計結果之間有無差別。所得相關因子再以條件邏輯式回歸分析。另外以皮爾森相關計算衡量組別之間的關係。
結果：疱疹後神經痛患者血中維生素D缺乏的盛行率高於對照組(77.4% vs. 49.5%, p <0.001)。而其引發的自發性疼痛的疼痛程度與血清中維生素D濃度高低呈負相關。
結論：維生素D不足可能在疱疹後神經痛的發生中有重要作用。

Aim: To assess the prevalence of hypovitaminosis D in postherpetic neuralgia (PHN) patients and the relationship between PHN and hypovitaminosis D.
Materials and methods: Aretrospective case-control study with a ratio 1:3(62 cases, 186 controls) was conducted. An automatched search was employed for the PHN patients who visited our pain clinic with diagnosed herpes zoster and/or postherpetic neuralgia for the first time, age ≧50 years old and had the examination of serum 25(OH)D were included. Patients who received healthexamination in our hospital were the controls. Medical charts were reviewed and data were recorded and analyzed. The difference ofcontinuousdata between two groups was conducted by Student T test. Chi-square test or Fisher exact test was used for the categoricalvariables. A p value of <0.05 was considered significant.
Results:Higher prevalence of hypovitaminosis D was noted in PHN patients compared to that in the controls (77.4%vs. 49.59%, p<0.001). PHN patients with moderate to severe pain had significantly lower serum 25(OH)D concentrations than those with mild pain.
Conclusion: Hypovitaminosis D may play an important role in the development of PHN.

目次
中文摘要 i
Abstract ii
目次 iv
前言 1
1.帶狀疱疹 1
2.帶狀疱疹後神經痛（postherpetic neuralgia; PHN） 2
3.維生素D的簡介 4
4.維生素D在免疫方面的功能 7
5.研究的動機與假設研究 10
材料與方法 11
1.帶狀疱疹就診評估情形 11
2.自動搜尋配對疱疹性神經痛的標準 13
3.病歷回溯審查皰疹後神經痛病人的標準及項目 13
4.共病的篩選 14
5.標本收集，處理和生化測定 14
6.統計方法 14
結果 16
討論 37
參考文獻 41

1.Yawn BP, Saddier P, Wollan PC, St Sauver JL, Kurland MJ, Sy LS: A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction.Mayo Clin Proc 2007, 82:1341-1349.
2.van Seventer R, Sadosky A, Lucero M, Dukes E: A cross-sectional survey of health state impairment and treatment patterns in patients with postherpetic neuralgia.Age Ageing 2006, 35:132-137.
3.Chen JY, Chang CY, Feng PH, Chu CC, So EC, Hu ML: Plasma vitamin C is lower in postherpetic neuralgia patients and administration of vitamin C reduces spontaneous pain but not brush-evoked pain.Clin J Pain 2009, 25:562-569.
4.Yawn BP, Itzler RF, Wollan PC, Pellissier JM, Sy LS, Saddier P: Health care utilization and cost burden of herpes zoster in a community population.Mayo Clin Proc 2009, 84:787-794.
5.Chen JY, Chu CC, Lin YS, So EC, Shieh JP, Hu ML: Nutrient deficiencies as a risk factor in Taiwanese patients with postherpetic neuralgia.Br J Nutr 2011, 106:700-707.
6.van Seventer R, Bach FW, Toth CC, Serpell M, Temple J, Murphy TK, Nimour M: Pregabalin in the treatment of post-traumatic peripheral neuropathic pain: a randomized double-blind trial.Eur J Neurol 2010, 17:1082-1089.
7.Rosen CJ: Clinical practice. Vitamin D insufficiency.N Engl J Med 2011, 364:248-254.
8.Holick MF: Vitamin D deficiency.N Engl J Med 2007, 357:266-281.
9.McKenna MJ, Freaney R: Secondary hyperparathyroidism in the elderly: means to defining hypovitaminosis D.Osteoporos Int 1998, 8 Suppl 2:S3-6.
10.Thomas MK, Lloyd-Jones DM, Thadhani RI, Shaw AC, Deraska DJ, Kitch BT, Vamvakas EC, Dick IM, Prince RL, Finkelstein JS: Hypovitaminosis D in medical inpatients.N Engl J Med 1998, 338:777-783.
11.Crack LR, Jones L, Malavige GN, Patel V, Ogg GS: Human antimicrobial peptides LL-37 and human beta-defensin-2 reduce viral replication in keratinocytes infected with varicella zoster virus.Clin Exp Dermatol 2012, 37:534-543.
12.Bikle DD: Extraskeletal actions of vitamin D.Ann N Y Acad Sci 2016, 1376:29-52.
13.White JH: Vitamin D metabolism and signaling in the immune system.Rev Endocr Metab Disord 2012, 13:21-29.
14.Griffin MD, Lutz W, Phan VA, Bachman LA, McKean DJ, Kumar R: Dendritic cell modulation by 1alpha,25 dihydroxyvitamin D3 and its analogs: a vitamin D receptor-dependent pathway that promotes a persistent state of immaturity in vitro and in vivo.Proc Natl Acad Sci U S A 2001, 98:6800-6805.
15.Piemonti L, Monti P, Sironi M, Fraticelli P, Leone BE, Dal Cin E, Allavena P, Di Carlo V: Vitamin D3 affects differentiation, maturation, and function of human monocyte-derived dendritic cells.J Immunol 2000, 164:4443-4451.
16.Soderstrom LH, Johnson SP, Diaz VA, Mainous AG, 3rd: Association between vitamin D and diabetic neuropathy in a nationally representative sample: results from 2001-2004 NHANES.Diabet Med 2012, 29:50-55.
17.Yesil H, Sungur U, Akdeniz S, Gurer G, Yalcin B, Dundar U: Association between serum vitamin D levels and neuropathic pain in rheumatoid arthritis patients: A cross-sectional study.Int J Rheum Dis 2018, 21:431-439.
18.Vafai A, Wellish M, Gilden DH: Expression of varicella-zoster virus in blood mononuclear cells of patients with postherpetic neuralgia.Proc Natl Acad Sci U S A 1988, 85:2767-2770.
19.Mahalingam R, Wellish M, Brucklier J, Gilden DH: Persistence of varicella-zoster virus DNA in elderly patients with postherpetic neuralgia.J Neurovirol 1995, 1:130-133.
20.Ellis A, Bennett DL: Neuroinflammation and the generation of neuropathic pain.Br J Anaesth 2013, 111:26-37.
21.van Wilgen CP, Keizer D: Neuropathic pain mechanisms in patients with chronic sports injuries: a diagnostic model useful in sports medicine?Pain Med 2011, 12:110-117.
22.Chen JY, Lan KM, Sheu MJ, Tseng SF, Weng SF, Hu ML: Peptic ulcer as a risk factor for postherpetic neuralgia in adult patients with herpes zoster.J Med Virol 2015, 87:222-229.
23.Klompas M, Kulldorff M, Vilk Y, Bialek SR, Harpaz R: Herpes zoster and postherpetic neuralgia surveillance using structured electronic data.Mayo Clin Proc 2011, 86:1146-1153.
24.Koivula MK, Matinlassi N, Laitinen P, Risteli J: Four automated 25-OH total vitamin D immunoassays and commercial liquid chromatography tandem-mass spectrometry in Finnish population.Clin Lab 2013, 59:397-405.
25.Huang CH, Huang YA, Lai YC, Sun CK: Prevalence and predictors of hypovitaminosis D among the elderly in subtropical region.PLoS One 2017, 12:e0181063.
26.Thacher TD, Clarke BL: Vitamin D insufficiency.Mayo Clin Proc 2011, 86:50-60.
27.Grant WB: A Review of the Evidence Supporting the Vitamin D-Cancer Prevention Hypothesis in 2017.Anticancer Res 2018, 38:1121-1136.
28.Antico A, Tozzoli R, Giavarina D, Tonutti E, Bizzaro N: Hypovitaminosis D as predisposing factor for atrophic type A gastritis: a case-control study and review of the literature on the interaction of Vitamin D with the immune system.Clin Rev Allergy Immunol 2012, 42:355-364.
29.Boontanrart M, Hall SD, Spanier JA, Hayes CE, Olson JK: Vitamin D3 alters microglia immune activation by an IL-10 dependent SOCS3 mechanism.J Neuroimmunol 2016, 292:126-136.
30.Jiao KP, Li SM, Lv WY, Jv ML, He HY: Vitamin D3 repressed astrocyte activation following lipopolysaccharide stimulation in vitro and in neonatal rats.Neuroreport 2017, 28:492-497.
31.Chao CT, Chiang CK, Huang JW, Hung KY: Vitamin D is closely linked to the clinical courses of herpes zoster: From pathogenesis to complications.Med Hypotheses 2015, 85:452-457.
32.Chen JY, Chang CY, Lan KM, Sheu MJ, Lu CL, Hu ML: Is peptic ulcer disease a risk factor of postherpetic neuralgia in patients with herpes zoster?Med Hypotheses 2013, 81:834-838.
33.Chen JY, Cheng TJ, Chang CY, Lan KM, Weng SF, Sheu MJ, Tseng SF, Hu ML: Increased incidence of herpes zoster in adult patients with peptic ulcer disease: a population-based cohort study.Int J Epidemiol 2013, 42:1873-1881.
34.Forbes HJ, Bhaskaran K, Thomas SL, Smeeth L, Clayton T, Mansfield K, Minassian C, Langan SM: Quantification of risk factors for postherpetic neuralgia in herpes zoster patients: A cohort study.Neurology 2016, 87:94-102.
35.Djouhri L, Koutsikou S, Fang X, McMullan S, Lawson SN: Spontaneous pain, both neuropathic and inflammatory, is related to frequency of spontaneous firing in intact C-fiber nociceptors.J Neurosci 2006, 26:1281-1292.
36.Johnson RW, Rice AS: Clinical practice. Postherpetic neuralgia.N Engl J Med 2014, 371:1526-1533.
37.Lee P, Chen R: Vitamin D as an analgesic for patients with type 2 diabetes and neuropathic pain.Arch Intern Med 2008, 168:771-772.
38.Shehab D, Al-Jarallah K, Abdella N, Mojiminiyi OA, Al Mohamedy H: Prospective evaluation of the effect of short-term oral vitamin d supplementation on peripheral neuropathy in type 2 diabetes mellitus.Med Princ Pract 2015, 24:250-256.
39.Basit A, Basit KA, Fawwad A, Shaheen F, Fatima N, Petropoulos IN, Alam U, Malik RA: Vitamin D for the treatment of painful diabetic neuropathy.BMJ Open Diabetes Res Care 2016, 4:e000148.
40.Shee C: Is hypovitaminosis D a consequence rather than cause of disease?Thorax 2013, 68:679-679.