红外热成像早期预测带状疱疹后神经痛的临床价值

Clinical predictive value of infrared thermal imaging for early prediction of postherpetic neuralgia

目的:探讨红外热成像与视觉模拟评分法(visual analogue scale,VAS)早期预测带状疱疹后神经痛(postherpetic neuralgia,PHN)的临床价值。方法:选择带状疱疹(herpes zoster,HZ)病人59例,于入院时、出院时行红外热成像检查,测量患侧与对应健侧的温度差(ΔT)及VAS。1月后随访并分组,分为PHN组(n=14)与非PHN组(n=45)。分析入院、出院时ΔT及VAS与PHN的关系。通过受试者工作特征曲线(receiver operator characteristic curve,ROC)计算曲线下面积(area under the curve,AUC)和约登指数,寻找预测临界值。结果:两组病人入院时ΔT比较无统计学意义(t=0.665,P=0.509);出院时ΔT比较PHN组显著高于非PHN组(t=3.771,P=0.000);入院时、出院时VAS比较PHN组均显著高于非PHN组(t=3.350,2.076;P=0.001,0.042)。ROC曲线分析示:在出院时ΔT中,AUC为0.814,预测PHN的临界值为0.75℃,ΔT≥0.75℃共14例,发生PHN 9例;在入院时VAS中,AUC为0.767,预测PHN的临界值为4.5,VAS≥4.5共26例,发生PHN 10例;在出院时VAS中,AUC为0.671,预测PHN的临界值为2.5,VAS≥2.5共9例,发生PHN 5例。结论:红外热成像较VAS法早期预测PHN更有意义且更客观。

Objective: To investigate the role of infrared thermal imaging technology and visual analogue scale(VAS) in the early prediction of postherpetic neuralgia(PHN). Methods: Fifty nine cases of herpes zoster(HZ) patients were selected. The temperature difference of the herpes area and the symmetrical area(ΔT) at admission and discharge were recorded using infrared thermal imaging. The VAS scores were measured at admission and discharge. The patients were followed up after the dischage for 1 month and divided into PHN group and non-PHN group. The relationship between ΔT/VAS and PHN were analyzed. The ROC curve was made and the area under the curve(AUC) and Yoden index were calculated to find the found cutoff value. Results: Fourteen cases developed into PHN and 45 cases did not. The ΔT at admission between the two groups has no significant difference(t = 0.665, P = 0.509) and the ΔT at discharge in PHN group was significantly higher than that in non-PHN group(t = 3.771, P = 0.000). The VAS score at admission and discharge in PHN group were both significantly higher than those in non-PHN group(t = 3.350, 2.076;P = 0.001, 0.042). The ROC curve results showed that: in the curve of ΔT at discharge, the AUC was 0.814, and the cut-off value was 0.75℃. There are 14 cases whose ΔT ≥ 0.75℃ and 9 cases of them developed into PHN. In the curve of VAS at admission, the AUC was 0.767, and the cut-off value was 4.5. There are 26 cases whose VAS ≥ 4.5 and 10 cases of them developed into PHN. In the curve of VAS at discharge, the AUC was 0.671, and the cut-off value was 2.5. The VAS values of 9 cases were ≥ 2.5 and 5 of them developed into PHN. Conclusion: The infrared thermal imaging technology is objective and more significant for early prediction of PHN than VAS.