汉化版PD-Q量表在带状疱疹相关性疼痛的临床价值初探

Application of the Chinese version pain detect questionnaire in zoster associated pain

目的初步探讨汉化版PD—Q量表在带状疱疹患者中评价神经病理性疼痛的临床价值。方法本文选取2013至2014年复旦大学附属华山医院神经科和皮肤科首诊的带状疱疹相关性疼痛（ZAP）患者73例，以临床诊断为标准，将患者分为神经病理性疼痛（NP）和非神经病理性疼痛两组，记录患者人口学资料、病史和体格检查结果，进行汉化版PD—Q量表评分，同时评定医院焦虑／抑郁量表（HAD）与Pittsburgh睡眠质量指数量表（PSQI）来研究患者情绪及睡眠情况。然后将PD—Q评分与临床诊断比较，探讨PD—Q量表用于ZAP中的诊断准确性，并分析入选患者发生NP的可能危险因素。结果汉化版PD—Q量表用于ZAP患者中能区别NP的能力为中等（AUC为0．845），建议采用13分作为PD—Q量表用于ZAP患者中筛选NP的截点分，敏感性可达82．5％，减少对NP的漏诊，增加NP的治疗率。PHN危险因素多因素分析的结果显示，患者发生NP的危险因素与PD—Q评分以及病程显著相关，两者各自的危险度分别为1．30和2．02，说明PD—Q评分增高、病程越长，ZAP患者发生NP的机会就越高。PD—Q量表适用于PHN4种亚型，各亚型间差异有统计学意义，激惹型得分较麻痹型和非激惹型高，说明PD—Q量表对激惹型患者的识别以及个性化治疗的选择具有提示意义。结论汉化版PD—Q量表适用于带状疱疹相关性疼痛，对识别神经病理性疼痛及其亚型有帮助。

Objective To investigate the validity and reliability of the Chinese version pain detect questionnaire （PD-Q） among the Chinese patients of zoster associated pain （ZAP）. Methods Seventy-three patients were enrolled in this study, 40 of them were neuropathic pain （NP） and 33 of them were NoP diagnosed by the clinical criteria. The demographic data, medical history and physical exam results of the recruited patients were collected. All patients fulfilled the Chinese version PD-Q, the hospital anxiety/depression scale （HAD） and the Pittsburgh sleep quality index （PSQI） by themselves. Results The results of clinical evaluation and PD-Q scoring were compared and analyzed statistically. It was found that the recognition NP ability of PD-Q was moderate, the AUC was 0.845. At a PD-Q cutoff point of 13, the sensitivity of PD-Q questionnaire were 82.5%. It was helpful to increase the therapy ratio and relieve the pain of patients. By using logistic regression analysis, the PD-Q score and the duration of disease were significantly related to the presence of neuro- pathic pain in ZAP patients, the risk ratio were 1.30 and 2.02 respectively. The longer the duration of disease, the more presence of neuropathic pain. PD-Q was suitable for the four subtype of PHN, with significant difference among the four subtype. The PD-Q score of irritation subtype was higher than numbness and irritability type. Conclusion Chinese version PD-Q is suitable for zoster associated pain and helpful to recognize the neuropathic pain and its subtypes.