Objective To investigate the characteristics of varicella zoster virus（VZV）specific cellular immunity in patients with herpes zoster，and to analyze the predictive value for postherpetic neuralgia（PHN）. Methods A total of 10 healthy adults from January 2021 to June 2022 in the Physical Examination Center of our hospital were selected. VZV specific group and control group models were established to analyze the differences of cellular immune factors. Next，70 patients with herpes zoster who were admitted to our hospital at the same time were selected ，and differences in VZV⁃specific cellular immune factor indicators（hereafter referred to as indica⁃ tors）were collected at the first visit. The patients were followed up for half a year to analyze the value of indicators in predicting the occurrence of PHN. Results The proportion of CD4+ T Cell in VZV group was lower than that of the control group，while the proportion of CD8 + T Cell and PD ⁃1 + CD4 + T Cell was higher than that of the control group，with statistically significant difference（P < 0.05）. There was no significant difference in IFN⁃γ and IL⁃2 level in PBMC supernatant between the two groups（P > 0.05）. The TNF ⁃α level in PBMC supernatant of VZV group was higher than that of the control group，and the difference was statistically significant（P < 0.05）. The proportion of anterior pain，the proportion of multi⁃stage disease，the time from onset to treatment and TNF⁃α of PBMC super⁃ natant in PHN group were all higher than those of the non ⁃PHN group. The percentage of CD3 + T Cell was lower than that of the non⁃PHN group，and the difference was statistically significant（P < 0.05）. PBMC supernatant TNF⁃α （HR = 1.148）was an independent risk factor for PHN occurrence（P < 0.05）. TNF⁃α in PBMC supernatant had a good predictive effect on PHN occurrence（AUC = 0.902，P < 0.001，95%CI = 0.821 ~ 0.981）. The cut⁃off value， sensitivity，specificity，positive predictive value，and negative predictive value were > 54.36 pg/mL，82.35% ， 85.11%，66.67%，and 93.02% respectively. Conclusion TNF⁃α in PBMC supernatant is a VZV⁃specific cellular immune factor affecting the occurrence of PHN，which has certain clinical significance in predicting the occurrence of PHN in patients with herpes zoster.