带状疱疹疼痛患者远期疼痛危险因素分析

Analysis of long-term pain risk factors in patients with herpes zoster pain

目的探讨带状疱疹(HZ)急性期疼痛患者发生远期(>6个月)疼痛的危险因素。方法采用1∶1配对的病例对照研究方法,纳入6个月后VAS评分≥3分的带状疱疹神经痛患者102例为病例组,与其年龄、性别、受累神经节段相匹配且未发生远期疼痛的患者102例为对照组,对影响因素行单因素和多因素条件Logistic回归分析。结果前驱痛(OR=4.26,95%CI:2.09~8.69)、糖尿病(OR=4.06,95%CI:1.62~10.07)、72 h内使用抗病毒药物(OR=0.26,95%CI:0.12~0.55)、使用钙通道调节剂(OR=0.35,95%CI:0.17~0.75)、阿片类药物使用<4周(OR=0.29,95%CI:0.11~0.74)、阿片类药物使用≥4周(OR=1.87,95%CI:0.79~4.45)、72 h内就医(OR=0.61,95%CI:0.28~1.33)与带状疱疹急性期疼痛患者发生远期疼痛存在相关性。结论前驱痛、糖尿病是HZ急性期疼痛患者发生远期疼痛的危险因素;72 h内使用抗病毒药物、使用钙通道调节剂、阿片类药物使用<4周是HZ急性期疼痛患者发生远期疼痛的保护因素;72 h内就医是可能保护因素;阿片类药物使用≥4周是可疑的危险因素。

Objective To explore the risk factors of long-term pain over more than 6 months in patients with herpes zoster(HZ)at acute stage.Methods A 1∶1 matched case-control study method was used,A total of 102 patients with postherpetic neuralgia who had VAS score≥3 after 6 months were included as the case group,and 102 patients who did not have long-term pain matched with their age,gender and involved same ganglion segment served as the control group,then the univariate regression analysis and multivariate conditional Logistic regression analysis were carried out.Results Longterm pain was associated with prodromal pain(OR:4.26,95%CI:2.09~8.69),diabetes mellitus(OR:4.06,95%CI:1.62~10.07),antiviral drugs within 72 hours(OR=0.26,95%CI:0.12~0.55),calcium channel regulators(OR:0.35,95%CI:0.17~0.75),taking opioids less than 4 weeks(OR:0.29,95%CI:0.11~0.74),taking opioids for 4 weeks or more(OR:1.87,95%CI:0.79~4.45),medical treatment hours within 72 hours(OR:0.61,95%CI:0.28~1.33).Conclusion Prodromal pain and diabetes mellitus are risk factors for long-term pain in patients with acute herpetic neuralgia.Use of antiviral drugs within 72 hours,calcium channel regulators and the use of opioids<4 weeks are the protective factors.Medical treatment within 72 hours is a possible protective factor.Opioids use≥4 weeks is a suspected risk factor.