睡眠障碍及感觉过敏与带状疱疹后神经痛风险的相关性及可能机制分析

The correlation and possible mechanism between somnipathy and hyperesthesia and the risk of postherpetic neuralgia

目的探讨睡眠障碍及感觉过敏与带状疱疹后神经痛(PHN)风险的相关性及可能机制。方法回顾性纳入2017年1月至2019年12月于陆军军医大学第二附属医院就诊的PHN患者70例作为研究对象,记录所有患者基本临床资料、睡眠质量[匹兹堡睡眠质量指数(PSQI)量表]、睡眠时间、有无感觉过敏、感觉过敏程度[疼痛视觉模拟量表(VAS)]、PHN疼痛程度[数字评分法(NRS)量表]等数据,比较不同睡眠质量患者感觉过敏和PHN疼痛程度,分析PHN患者睡眠质量、感觉过敏和PHN疼痛程度的相关性,比较不同睡眠时间患者睡眠质量、感觉过敏和PHN疼痛程度,分析睡眠障碍与PHN关联中感觉过敏的中介效应。结果睡眠障碍患者感觉过敏比例、感觉过敏VAS评分和PHN疼痛程度NRS评分均高于睡眠正常患者[75.5%(37/49)比47.6%(10/21)、(6.7±1.9)分比(3.8±1.2)分、(6.6±1.8)分比(3.5±1.1)分],差异均有统计学意义(均P<0.05)。中度、重度睡眠障碍患者PSQI评分、感觉过敏VAS评分、PHN疼痛程度NRS评分均高于睡眠正常及轻度睡眠障碍患者,差异均有统计学意义(均P<0.05)。Pearson相关性分析显示,PSQI评分与感觉过敏VAS评分和PHN疼痛程度NRS评分均呈正相关(r=0.677、0.731,均P<0.001),感觉过敏VAS评分与PHN疼痛程度NRS评分呈正相关(r=0.625,P<0.001)。睡眠时间6~7 h和>7 h患者PSQI评分、感觉过敏VAS评分和PHN疼痛程度NRS评分均明显低于<6 h患者[(13.5±2.6)、(10.5±2.9)分比(17.7±2.1)分;(5.0±1.8)、(3.4±2.6)分比(6.9±2.2)分;(5.5±1.4)、(4.7±1.1)分比(7.3±1.5)分],差异均有统计学意义(均P<0.017)。感觉过敏在睡眠障碍与PHN发生中具有中介效应,占总效应比例为37.07%(0.456/1.230)。结论感觉过敏在睡眠障碍与PHN关联中具有中介作用,可以通过改善睡眠质量减少感觉过敏发生,减轻PHN疼痛程度。

Objective To explore the correlation and possible mechanism between sleep disorder and hypersensitivity and the risk of postherpetic neuralgia(PHN).Methods Totally 70 PHN patients admitted to the Second Affiliated Hospital of Army Medical University from January 2017 to December 2019 were included.The basic clinical data,sleep quality[pittsburgh sleep quality index(PSQI)scale],sleep time,sensory hypersensitivity,sensory hypersensitivity degree[Visual Analogue Scale(VAS)score],PHN pain degree[numeric rating scale(NRS)scale]and other data of all patients were recorded.The degree of hypersensitivity and PHN pain in patients with different sleep quality was compared.Correlations between sleep quality,hypersensitivity and PHN pain were analyzed in patients with PHN.The sleep quality,hypersensitivity and PHN pain degree of patients with different sleep time were compared,and the mediating effect of hypersensitivity between sleep disorder and PHN was analyzed.Results The percentage of hyperesthesia,VAS score of hyperesthesia and NRS score of PHN pain in patients with sleep disorders were higher than those in patients with normal sleep[75.5%(37/49)vs 47.6%(10/21),(6.7±1.9)vs(3.8±1.2),(6.6±1.8)vs(3.5±1.1),all P<0.05].The scores of PSQI,VAS and NRS in patients with moderate and severe sleep disorders were higher than those in patients with normal and mild sleep disorders(all P<0.05).Pearson correlation analysis showed that PSQI score was positively correlated with hypersensitivity VAS score and PHN pain level NRS score(r=0.677,0.731,both P<0.001);hypersensitivity VAS score was positively correlated with PHN pain level NRS score(r=0.625,P<0.001).The PSQI score,hyperesthesia VAS score and pain NRS score of PHN in patients with sleep time of 6-7 h and>7 h were significantly lower than those in patients with sleep time of<6 h[(13.5±2.6),(10.5±2.9)vs(17.7±2.1);(5.0±1.8),(3.4±2.6)vs(6.9±2.2);(5.5±1.4),(4.7±1.1)vs(7.3±1.5)](all P<0.017).Hyperalgesia plays an intermediary role in sleep disorders and PHN.Conclusion Sensory hypersensitivity plays a mediating role in the correlation between sleep disorders and PHN,which can reduce the occurrence of sensory hypersensitivity and reduce the pain degree of PHN by improving sleep quality.