带状疱疹患者急性期后疼痛的危险因素研究

Exploring risk factors associated with post-acute herpetic neuralgia

目的探讨带状疱疹患者急性期后(发疹1个月后)疼痛的危险因素。方法选取2020年11月至2021年4月于首都医科大学宣武医院皮肤科门诊就诊的带状疱疹患者为研究对象。记录患者的一般资料,于初诊时(发疹时)和随访时(发疹1个月后)评估患者的视觉模拟评分法(VAS)、广泛性焦虑障碍量表-2(GAD-2)、患者健康问卷-2(PHQ-2)和匹兹堡睡眠质量指数(PSQI)评分。对患者急性期后疼痛的危险因素进行单因素和二分类Logistic回归分析。结果共纳入235例患者,其中男102例,女133例;发病年龄(52.59±16.30)岁;急性期后29.8%(70/235)的患者伴有疼痛。单因素分析显示,发病年龄、是否合并慢性疾病、初诊时VAS评分、随访时GAD-2和PHQ-2评分以及发疹后睡眠紊乱情况是带状疱疹患者急性期后疼痛的影响因素(P<0.05)。二分类Logistic回归分析显示,发病年龄≥50岁(P=0.005,OR=3.919,95%CI:1.520~10.106)、初诊时VAS评分≥4分(P=0.016,OR=3.735,95%CI:1.277~10.929)、随访时GAD-2评分(P=0.001,OR=3.944,95%CI:1.817~8.562)、发疹后睡眠持续性评分为1分(P=0.008,OR=7.569,95%CI:1.699~33.725)是患者急性期后疼痛的危险因素。结论年龄≥50岁、初诊时伴有中度及以上疼痛、发疹后处于焦虑状态和睡眠持续性差是带状疱疹患者急性期后疼痛的危险因素,临床应重视患者的焦虑状态和睡眠情况。

Objective To explore the risk factors of pain in patients with herpes zoster after acute stage(1 month after onset).Methods The patients with herpes zoster who visited the Department of Dermatology Xuanwu Hospital of Capital Medical University from November 2020 to April 2021 were selected as the research objects.The general data of patients were recorded,and the scores of Visual Analogue Scale(VAS),Generalized Anxiety Disorder(GAD-2),Patient Health Questionaire-2(PHQ-2)and Pittsburgh Sleep Quality Index(PSQI)were evaluated at the initial diagnosis(onset)and follow-up(1 month after onset).Univariate analysis and dichotomous Logistic regression analysis were applied to explore the high-risk factors for the occurrence of post-acute pain.Results A total of 235 patients were enrolled,including 102 males and 133 females.The onset age was(52.59±16.30)years old.Pain was present in 29.8%(70/235)of patients 1 month after onset.Univariate analysis showed that onset age,chronic disease,VAS score at initial diagnosis,GAD-2 and PHQ-2 score at follow-up,and sleep disorder after onset were the influencing factors of post acute pain in patients with herpes zoster(P<0.05).The binary Logistic regression analysis showed that onset age≥50 years old(P=0.005,OR=3.919,95%CI:1.520-10.106),VAS score≥4 points at the initial diagnosis(P=0.016,OR=3.735,95%CI:1.277-10.929),GAD-2 score after onset(P=0.001,OR=3.944,95%CI:1.817-8.562),and 1 score of sleep persistence after onset(P=0.008,OR=7.569,95%CI:1.699-33.725)were the risk factors for pain after acute stage.Conclusions The risk factors of post-acute herpetic neuralgia in patients are age≥50 years old,pain with moderate or above at the time of initial diagnosis,anxiety state after onset and poor sleep persistence.Clinical attention should be paid to the anxiety state and sleep status of patients with herpes zoster.