| 早期疼痛和心理因素变化与带状疱疹后神经痛风险的相关性 |
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| 引用本文： | 王珊珊,刘勇.早期疼痛和心理因素变化与带状疱疹后神经痛风险的相关性[J].蚌埠医学院学报,2021,46(12):1673-1676. |
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| 作者姓名： | 王珊珊 刘勇 |
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| 作者单位： | 陆军军医大学第二附属医院 疼痛康复科, 重庆 400037 |
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| 基金项目： | 国家自然科学基金项目8177050290 |
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| 摘 要： | 目的分析带状疱疹病人早期疼痛及心理因素变化情况与带状疱疹后神经痛（PHN）风险的相关性。方法选择377例带状疱疹病人，根据是否合并PHN分为PHN组及对照组，对病人的就诊时间、疱疹部位及病人入院时疼痛评分及焦虑抑郁评分等相关指标进行比较，采用多因素logistic回归对影响病人PHN的指标进行分析，并采用受试者工作特征曲线对影响PHN相关因素的诊断价值进行比较。结果PHN组年龄，患糖尿病及自身免疫性疾病/恶性肿瘤的比例，就诊时间，累计面积，视觉模拟评分法（VAS）、皮肤病生活质量指标（DLQI）、焦虑抑郁量表（HADS）评分及合并A/G比值及CD4+/CD8+异常比例均高于对照组（P < 0.05~P < 0.01）；而2组病人的性别、吸烟、饮酒史、发病部位及疱疹类型等指标间差异无统计学意义（P>0.05）；多因素logistic分析示高龄、就诊时间过长、皮疹面积大及高VAS、DLQI、HADS评分是发生后神经痛的独立危险因素（P < 0.05~P < 0.01），而无糖尿病则是后神经痛的保护因素（P < 0.05）；ROC曲线示，VAS及HADS评分联合预测PHN的诊断效能明显高于单独指标年龄、就诊时间、DLQI评分、糖尿病及皮疹面积的诊断效能（P < 0.05~P < 0.01）。结论带状疱疹病人早期疼痛较重、合并焦虑、抑郁等不良心理因素是导致带状疱疹后神经痛风险独立危险因素，VAS联合HADS评分可有效对PHN进行预测。
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| 关 键 词： | 带状疱疹 带状疱疹后神经痛 心理因素 相关性分析 |
| 收稿时间： | 2020-02-07 |
Correlation analysis of the early pain and changes of psychological factors with risk of post-herpetic neuralgia |
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| Affiliation: | Department of Pain Rehabilitation, The Second Affiliated Hospital of The Army Medical University, Chongqing 400037, China |
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| Abstract: | ObjectiveTo analyze the relationship between the early pain, changes of psychological factors and risk of post-herpetic neuralgia(PHN).MethodsThree hundred and seventy-seven patients with shingles were divided into the PHN group and control group according to whether or not the PHN was merged.The admission time, site of herpes, pain score, anxiety and depression scores were compared between the two groups.The indicators affecting PHN of patients were analyzed using the multivariate logistic regression analysis, and the ROC curve was used to compare the diagnostic value of related factors affecting PHN.ResultsThe age, proportion of diabetes mellitus, autoimmune disease to malignant tumor, visit time, cumulative area, visual analogue scale(VAS) score, dermatology life quality index(DLQI) score, hospital anxiety and depression scale(HADS) score, combined A/G ratio and CD4+/CD8+ abnormality ratio in PHN group were higher than those in control group(P < 0.05 to P < 0.01).There was no statistical significance in gender, smoking history, drinking history, site of disease and type of herpes between the two groups(P>0.05).The results of multivariate logistic analysis showed that the advanced age, long visit time, large rash area, high VAS, DLQI and HADS scores were the independent risk factors of the development of PHN(P < 0.05 to P < 0.01), while the absence of diabetes mellitus was a protective factor of the development of PHN(P < 0.05).The results of ROC curve showed that the diagnostic efficacy of VAS and HADS scores in predicting PHN was significantly higher than that of age, visit time, DLQI score, diabetes mellitus and rash area alone(P < 0.05 to P < 0.01).ConclusionsThe severe early pain, anxiety, depression and other negative psychological factors in patients with herpes zoster are the independent risk factors of the development of PHN, and the VAS combined with HADS score can effectively predict the PHN. |
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