基于Nomogram预测模型构建带状疱疹患者发生后遗神经痛的危险因素

Construction of risk factors for postherpetic neuralgia in patients with herpes zoster based on nomogram prediction model

目的 :探讨带状疱疹患者发生后遗神经痛的危险因素,并构建Nomogram预测模型。方法 :选取我院2019年12月~2021年9月收治的带状疱疹患者150例,治疗后随访3个月后根据患者是否发生后遗神经痛,将患者分为发生组(56例)和未发生组(94例)。所有患者ROC曲线分析获取各因素的最佳截断值,多因素Cox回归分析患者并发后遗神经痛的独立风险因素,R.2.15.3版本软件“rms”包构建预测带状疱疹患者发生后遗神经痛高风险的Nomogram模型,校正曲线用来对Nomogram模型进行内部验证,决策曲线用来评估nomogram模型的预测效能。结果 :发生组患者年龄、合并糖尿病比例、前驱疼痛比例、皮疹类型(血疱型、播散型)比例、皮疹面积、急性期疼痛程度及初治时间均高于未发生组,而CD4~+/CD8~+水平低于为发生组(P<0.05);年龄、病程、皮疹面积、急性期疼痛程度、CD4~+/CD8~+、初治时间的曲线下面积(AUC)分别是0.982、0.734、0.874、0.835、0.728、0.914;最佳截断值分别是50岁、23个月、5%、5分、1.65、7d;年龄(≥50岁)、合并糖尿病(是)、前驱疼痛(是)、皮疹面积(≥5%)、急性期疼痛程度(≥5分)、初治时间(≥7d)是患者并发后遗神经痛的独立危险因素(P<0.05);此Nomogram预测模型的C-index为0.769(0.667~0.931);决策曲线显示当风险阈值> 0.12时,此预测模型所提供的临床净收益均高于单个独立危险因素,并且在预测疾病发生的高风险方面可以提供显著额外的临床净收益。结论 :本研究基于年龄、糖尿病、前驱疼痛、皮疹面积、急性期疼痛程度、初治时间构建预测带状疱疹患者发生后遗神经痛风险的Nomogram模型,该Nomogram模型,为后遗神经痛的发生的防治提供重要策略指导。

Objective To investigate the risk factors of postherpetic neuralgia in patients with herpes zoster, and to establish a Nomogram prediction model. Methods 150 patients with herpes zoster who were admitted to our hospital from December 2019 to September 2021 were selected. After 3 months of follow-up, the patients were divided into the occurrence group(56 cases)and the non occurrence group(94 cases) according to whether the patients had postherpetic neuralgia. The ROC curve of all patients was analyzed to obtain the best cutoff value of each factor. The multivariate Cox regression was used to analyze the independent risk factors of patients with postherpetic neuralgia. The software “rms” package in R.2.15.3 version was used to build a Nomogram model to predict the high risk of postherpetic neuralgia in patients with herpes zoster. The correction curve was used to internally verify the Nomogram model, and the decision curve was used to evaluate the prediction efficiency of the Nomogram model. Results The age of patients in the occurrence group, the proportion of patients with diabetes, the proportion of prodromal pain, the proportion of rash types(blood blister type, disseminated type), the area of rash, the degree of pain in the acute phase,and the time of initial treatment were higher than those in the non occurrence group, while the level of CD4+/CD8+was lower than that in the occurrence group(P<0.05);The area under the curve(AUC) of age, course of disease, rash area, acute pain degree,CD4+/CD8+, and initial treatment time were 0.982, 0.734, 0.874, 0.835, 0.728, 0.914, respectively;The best cutoff values were 50 years old, 23 months old, 5%, 5 points, 1.65 and 7 days, respectively;Age(≥ 50 years old), diabetes(yes), prodromal pain(yes), rash area(≥ 5%), acute pain degree(≥ 5 points), and initial treatment time(≥ 7 days) were independent risk factors for patients with postnatal neuralgia(P<0.05);The C-index of the Nomogram prediction model is 0.769(0.667~0.931);The decision curve shows that when the risk threshold is greater than 0.12, the clinical net income provided by this prediction model is higher than a single independent risk factor, and it can provide significant additional clinical net income in predicting the high risk of disease occurrence. Conclusion Based on age, diabetes, prodromal pain, rash area, acute pain level and initial treatment time, this study constructed a Nomogram model to predict the risk of postherpetic neuralgia in patients with herpes zoster. The Nomogram model provides important strategic guidance for the prevention and treatment of postherpetic neuralgia.