2019 年第 9 期 第 14 卷

带状疱疹后遗神经痛的危险因素分析

Risk factors of postherpetic neuralgia

作者：李玉秋徐文英潘南楠钱熙亮王琛贺细菊

英文作者：

单位：530021南宁，广西壮族自治区人民医院皮肤科(李玉秋、徐文英、潘南楠、钱熙亮、王琛)；442000湖北省十堰市，湖北医药学院人体解剖学教研室（贺细菊）

英文单位：

关键词：带状疱疹；后遗神经痛；亚急性带状疱疹神经痛

英文关键词：

• 摘要：

• 【摘要】目的    探讨带状疱疹后遗神经痛（PHN）的危险因素，为临床防治PHN提供依据。方法    选取2014年1月至2017年12月在广西壮族自治区人民医院皮肤科门诊和住院的带状疱疹患者400例，采用自拟的《带状疱疹后遗神经痛危险因素调查表》进行临床资料调查，采用门诊复查、电话以及问卷调查等方式进行随访，观察PHN发生率，比较发生与未发生PHN患者临床资料的差异，分析PHN发生的危险因素。结果    400例带状疱疹患者最终完成随访348例（87.0%），其中发生PHN患者52例，PHN发生率为14.9%。多因素Logistic回归分析结果显示，PHN的危险因素有年龄≥50岁、严重型皮损、皮损面积＞5%、重度急性期疼痛、初治时间≥3 d、合并糖尿病以及空腹血糖异常、白蛋白/球蛋白比值异常和CD+4/CD+8比值异常（比值比=1.345、1.398、2.987、1.897、3.415、7.143、3.246、4.113、3.248，95%置信区间：1.067～1.435、1.081～2.472、1.282～3.438、1.243～3.215、2.432～5.762、3.452～15.762、2.447～6.892、2.489～11.246、2.039～5.782，均P＜0.05）。348例患者中疼痛分期亚急性带状疱疹神经痛24例，急性带状疱疹神经痛272例；PHN患者年龄≥50岁、重度急性期疼痛以及严重型皮损比例均高于亚急性和急性带状疱疹神经痛组［92.3%(48/52)比66.7%（16/24）、68.4%（186/272），73.1%（38/52）比33.3%（8/24）、40.4%（110/272），65.4%（34/52）比58.3%（14/24）、12.5%（34/272）］，急性带状疱疹神经痛组严重型皮损比例低于亚急性带状疱疹神经痛组，差异均有统计学意义（均P＜0.05）。结论    高龄、严重型皮损、皮损面积大、重度急性期疼痛、初治时间长、合并糖尿病患者发生PHN风险高，机体免疫状态可能和PHN发生有关，亚急性带状疱疹神经痛并不仅仅是带状疱疹急性痛和PHN之间时间上的过渡，三者可能存在更为复杂的关系。

• 【Abstract】Objective    To explore the risk factors of postherpetic neuralgia(PHN). Methods    A total of 400 patients with herpes zoster were enrolled from January 2014 to December 2017 in the People′s Hospital of Guangxi Zhuang Autonomous Region. Clinical survey was performed using a self-made questionnaire containing indicators of PHN. Incidence of PHN was followed up through outpatient reexamination, telephone and questionnaire survey. Risk factors were analyzed between patients with and without PHN. Results    Totally 348 patients（87.0%） had regular follow-up, PHN occurred in 52 patients (14.9%). Multivariate logistic regression analysis showed that the risk factors of PHN included age≥50 years, severe skin lesions, area of skin lesions>5%, severe and acute pain, initial treatment time≥3 d, diabetes, fasting blood glucose abnormality, albumin/globulin ratio abnormality and CD+4/CD+8 abnormality（odds ratio=1.345, 1.398, 2.987, 1.897, 3.415, 7.143, 3.246, 4.113, 3.248; 95% confidence interval: 1.067-1.435, 1.081-2.472, 1.282-3.438, 1.243-3.215, 2.432-5.762, 3.452-15.762, 2.447-6.892, 2.489-11.246, 2.039-5.782; all P＜0.05）. Among the 348 patients, 24 patients had subacute herpes zoster neuralgia and 272 patients had acute herpes zoster neuralgia. Proportions of age≥50 years, severe and acute pain, severe skin lesions in PHN patients were significantly higher than those in patients with subacute and acute herpes zoster neuralgia［92.3%(48/52) vs 66.7%（16/24）, 68.4%（186/272）; 73.1%（38/52） vs 33.3%（8/24）, 40.4%（110/272）; 65.4%（34/52） vs 58.3%（14/24）, 12.5%（34/272）］（all P＜0.05）. Proportion of severe skin lesions in patients with acute herpes zoster neuralgia was significantly higher than that in patients with subacute herpes zoster neuralgia group(P＜0.05). Conclusions    Advanced age, severe skin lesions, large area of skin lesions, severe and acute pain, long initial treatment time and diabetes are associated with high risk of PHN. Immune status may be related to the occurrence of PHN. Subacute herpes zoster neuralgia is more than the intermediate phase between acute herpes zoster neuralgia and PHN.