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標題: 帶狀皰疹後神經痛患者血漿中之抗氧化維生素狀態以及補充維生素C之效果
The plasma antioxidant profile of patients with post-herpetic neuralgia and the effect of vitamin C supplementation
作者: 陳貞吟
chen, jen-yin
關鍵字: post-herpetic neuralgia;帶狀皰疹後神經痛;antioxidant vitamins;vitamin C;抗氧化維生素;維生素C
出版社: 食品科學系
Herpes zoster is a reactivation of varicella-zoster virus (VZV). Post-herpetic neuralgia (PHN) occurs in approximately 9% to 13% of patients with herpes zoster. The precise definition of post-herpetic neuralgia is controversial and there is little information about the blood levels of antioxidant vitamins in patients with post-herpetic neuralgia. Hence, this study compared the antioxidant profiles including retinol, α-tocopherol, lycopene, α-carotene, β-carotene and vitamin C in 38 patients with post-herpetic neuralgia lasting longer than 3 months in comparison with those of 39 healthy controls. Numeric rating scales were used in evaluating pain at the first visit to our pain clinic. Our analysis illustrated that retinol, α-tocopherol, lycopene and β-carotene between patients with post-herpetic neuralgia and controls were not significantly different. The contents of α-carotene in patients with PHN (4.5 ± 4.3μg/dL) were significantly lower than in controls (5.5 ± 3.7μg/dL ) (p<0.05). The contents of vitamin C were also significantly lower in patients (4.6 ± 3.1μg/mL) than in controls (13.4 ± 6.0μg/mL)(p<0.001). An inverse linear regression between numeric rating pain scale and serum vitamin C was noted. (p<0.001)
We, therefore, investigated the analgesic effect of intravenous ascorbate in patients with PHN. This study was conducted as comparative, double-blind, placebo-controlled trial in outpatients consulting Pain clinic at Chi-Mei hospital during 2003. Twenty-four patients assigned to one of the two parallel treatment groups to receive intravenous 500ml normal saline infusion with or without ascorbate (50 mg/kg, maximum dose: 2.5 g per day). Every patient received intravenous administration three times on day 1, 3 & 5 with infusion rate of 100-150 mL/hr. Every patient was requested to answer a questionnaire which included numeric rating pain scale, global impression of change on day 7, sleep interference, side effects. Efficacy was judged on the following two parameters: change from baseline in pain intensity on numeric rating pain scale (NRS) and global impression of change.
The change in average daily pain score from baseline day 1 to day 7 showed a mean change of 3.0 for patients treated with intravenous ascorbate vs. 0.64 for placebo group. (p<0.001) Percent of patients treated with ascorbate (61.5%) showed significantly higher than placebo patients (9.1%) in moderate to much improvement in patients' global impression of change. And patients' global impression of change in patients treated with ascorbate also showed significantly greater (p<0.05) than placebo patients. There was one each in each group who complained of worse painful after intravenous infusion twice and didn't receive the third infusion. No other patients suffered any side effects.
Our results showed that intravenous ascorbate is effective in partial relieving the pain of PHN. The results suggest that supplement of vitamin C to patients with post-herpetic neuralgia may boost plasma & CSF antioxidant defense and facilitate neuroprotection and pain modulation.

中 文 摘 要
帶狀皰疹是水痘-帶狀皰疹病毒再活化造成的疾病,其中約9 ~ 13 % 病患罹患帶狀皰疹後神經痛的後遺症。帶狀皰疹後神經痛仍未有一致性定義,其病理致病機轉至今未明,且帶狀皰疹後神經痛患者血中抗氧化維生素資料甚少。本研究採定義皮膚發疹後,超過三個月患者仍感受持續疼痛者為帶狀皰疹後神經痛。研究38名帶狀皰疹後神經痛患者與39名健康自願者,血中抗氧化維生素(含維生素A,維生素E,茄紅素, α、β胡蘿蔔素與維生素C)對照比較,同時採用數字評估疼痛指數,進行帶狀皰疹後神經痛患者血中抗氧化維生素與數字疼痛指數相關性分析。分析發現:健康自願者與帶狀皰疹後神經痛患者的血中維生素A,維生素E,茄紅素與β胡蘿蔔素,無顯著不同,但帶狀皰疹後神經痛患者血中α胡蘿蔔素:4.5 ± 4.3μg/dL ; 健康自願者:5.5 ± 3.7μg/dL, (p<0.05)。帶狀皰疹後神經痛患者血中維生素C:4.6 ± 3.1μg /mL ; 健康自願者:13.4 ± 6.0μg /mL (p<0.001)。兩種抗氧化維生素皆明顯偏低,尤其帶狀皰疹後神經痛患者血中維生素C與疼痛指數,呈有意義負相關 (p<0.001)。
因此2003年我們於奇美醫院,採雙盲、治療-控制組設計,探討經靜脈點滴補充維生素C對帶狀皰疹後神經痛患者的止痛效果。24位病患隨機採二種之一種注射液,500mL 生理食鹽水加或不加維生素C,(50 mg/kg, 且每人每日最高劑量: 2.5 g )。每位病患於第一、三、五日注射前與第七日均需回答問卷,問卷含數字疼痛指數評估,第七天時的整體印象改變評估和睡眠改善評估,副作用報告。止痛有效性依據數字疼痛指數改變數目與第七天時的整體疼痛印象改變評估為評量。
第一天到第七天的數字疼痛指數改變數字比值,維生素C治療組與對照組為3.0 比0.64 (p<0.001)。第七天時的整體疼痛印象改變評估值,61.5% 維生素C治療組病患報告中或大幅進步,但僅有9.1% 對照組病患報告中或大幅進步,整體疼痛印象改變評估值,維生素C治療組大於對照組(p<0.05)。無病患有重大不良副作用。
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