难治性带状疱疹后神经痛危险因素分析

Risk factors of refractory postherpetic neuralgia

目的探究难治性带状疱疹后神经痛(PHN)危险因素。方法选取山西医科大学第一医院2017年1月至2019年1月确诊为PHN的住院病人123例,以随访6个月后疼痛缓解程度分为病例组和对照组。采用单因素及多因素logistic回归分析难治性PHN的危险因素,并探究危险因素之间的交互作用。结果单因素分析示病例组与对照组病程[8.00(3.00,12.20)月比3.00(1.50,6.00)月]、入院疼痛评分[(8.38±1.41)分比(7.18±1.38)分]、合并痛觉异常(64.29%比40.30%)及感觉异常(55.36%比37.31%)、累及三叉神经分布区(37.50%比5.97%)、合并肿瘤或免疫系统疾病(14.29%比2.99%)、行经毁损术(35.71%比19.40%)、手术疗效(46.43%比67.16%)等因素比较,差异有统计学意义(P<0.05),多因素回归分析证实病程长、疼痛评分高、有痛觉异常、累及三叉神经分布区是难治性PHN的危险因素(P<0.05),并且病程长及入院疼痛评分高与其他危险因素对难治性PHN的发生有显著的正向交互作用。结论难治性PHN的危险因素较多,临床上应尽早识别其危险因素并予以合理个体化治疗。

Objective To explore the risk factors of refactoty postherpetic neuralgia(PHN).Methods The clinical data of 123 patients,diagnosed with PHN in First Hospital of Shanxi Medical University from January 2017 to January 2019,were analyzed retrospectively.The patients were assigned into case group and control group according to the degree of pain relief after 6 months of follow-up.Univariate and multivariate logistic regression analysis was used to identify the risk factors of refractory PHN and to explore the interaction between the risk factors.Results Univariate analysis results showed that there were differences between the case group and the control group in the course of disease[8.00(3.00,12.20)months vs.3.00(1.50,6.00)months],the score of admission pain[(8.38±1.41)score vs.(7.18±1.38)score],the combination of pain(64.29%vs.40.30%)and sensory abnormalities(55.36%vs.37.31%),the involvement of trigeminal nerve distribution area(37.50%vs.5.97%),the combination of tumor or immune system disease(14.29%vs.2.99%),the operation through damage(35.71%vs.19.40%),the effect of surgery(46.43%vs.67.16%)and other factors(P<0.05).Multivariate regression analysis results confirmed that long course of disease,high pain score,abnormal pain perception and trigeminal nerve involvement were risk factors for refractory PHN(P<0.05),and long course of disease and high admission pain score had significant positive interaction with other risk factors on the occurrence of refractory PHN.Conclusion There are many risk factors for refractory PHN,so we should identify the risk factors as early as possible and give reasonable individualized treatment.