耳带状疱疹病毒感染合并面瘫及预后的影响因素分析

Factors influencing the development of facial paralysis and the associated prognosis in patients with herpes zoster virus infection

目的分析成人耳带状疱疹病毒感染合并面瘫的影响因素及其预测价值,探讨影响面瘫预后的危险因素。方法对2016年1月至2022年4月医院耳鼻咽喉科收治的125例耳带状疱疹病毒感染患者进行回顾性分析,根据是否合并面瘫,将患者分为面瘫组及未面瘫组,比较两组患者的临床资料、血常规参数及超敏C反应蛋白(hs-CRP)差异,采用多因素回归分析筛选耳带状疱疹病毒感染合并面瘫的独立影响因素,采用受试者工作特征(ROC)曲线评估指标对耳带状疱疹合并面瘫的预测价值。再根据是否发生面瘫后遗症,将患者分为后遗症组及非后遗症组,分析影响预后的独立危险因素。结果hs-CRP、淋巴细胞计数/单核细胞计数比值(LMR)是耳带状疱疹病毒感染合并面瘫的独立影响因素,对耳带状疱疹病毒感染合并面瘫有预测价值。当hs-CRP的临界值≤3.05 mg/dL时,灵敏度为50.77%,特异性为86.67%,阳性预测率80.49%,阴性预测率61.9%。当LMR的临界值≥2.89时,灵敏度为44.44%,特异性为88.64%,阳性预测率87.8%,阴性预测率46.43%。年龄大于50岁、初始面瘫程度大于III级、面瘫至激素治疗的时间超过72 h、面瘫前未使用抗病毒药物治疗是耳带状疱疹合并面瘫患者出现面瘫后遗症的独立危险因素。结论hs-CRP、LMR对预判耳部带状疱疹病毒感染是否会合并面瘫有一定参考价值。面瘫前使用抗病毒药物治疗可减少不可逆的面瘫后遗症。

Objective The aim of this study was to analyze the influencing factors and predictors of adult facial herpes zoster virus infection complicated with facial paralysis,and to explore the risk factors affecting the prognosis of facial paralysis.Methods From January 2016 to April 2022,125 patients with herpes zoster virus infections of the ear,who were admitted to the Otolaryngology Department of Changsha Affiliated Hospital of Hunan Normal University and Ningxiang Hospital of Traditional Chinese Medicine Hospital were retrospectively analyzed.Clinical data,routine blood parameters,and high-sensitivity C-reactive protein(hs-CRP)concentrations were compared between the facial paralysis and non-facial-paralysis groups.The predictive value of the receiver operating characteristic curve evaluation index for herpes zoster complicated with facial paralysis was determined.Based on the occurrence of facial paralysis sequelae,the patients were then divided into the sequelae and non-sequelae groups,and independent risk factors affecting their prognosis were analyzed.Results The hs-CRP concentration and lymphocyte-to-monocyte ratio(LMR)were independent influencing factors and had predictive value for herpes zoster virus infection complicated with facial paralysis.When the cut-off value of hs-CRP concentration was less than or equal to 3.05 mg/dL,the sensitivity was 50.77%,the specificity was 86.67%,the positive predictive rate was 80.49%,and the negative predictive rate was 61.9%.When the cut-off LMR value was greater than or equal to 2.89,the sensitivity was 44.44%,the specificity was 88.64%,the positive predictive rate was 87.8%,and the negative predictive rate was 46.43%.An age greater than 50 years,an initial degree of facial paralysis greater than grade III,more than 72 hours from facial paralysis to hormone therapy,and no antiviral treatment before facial paralysis were independent risk factors for facial paralysis sequelae in patients with herpes zoster virus infections.Conclusion hs-CRP concentration and LMR have a certain reference value in predicting whether herpes zoster virus infections of the ear will be complicated with facial paralysis.The use of antiviral drugs before the onset of facial paralysis may reduce the irreversible sequelae.