带状疱疹患者血清miR-199-3p和miR-223-3p表达对带状疱疹后遗神经痛的预测价值

The predictive value of serum miR-199-3p and miR-223-3p expression in patients with herpes zoster for postherpetic neuralgia

目的探讨带状疱疹(herpes zoster,HZ)患者血清微小核糖核酸(micro ribonucleic acid,miR)-199-3p、miR-223-3p的表达情况及2者对HZ后遗神经痛(postherpetic neuralgia,PHN)的预测价值。方法选取2020年2月至2022年11月衡水市人民医院收治的512例HZ患者为对象(研究组),同时期我院接收的512例健康体检人员为对照组。通过实时荧光定量聚合酶链式反应测定血清miR-199-3p、miR-223-3p表达水平。对研究组HZ患者随访1个月并依据其是否并发PHN分为PHN组和非PHN组,采用Logistic回归模型分析HZ患者并发PHN的影响因素,并通过受试者工作特征(receiver operating characteristic ROC)曲线分析血清miR-199-3p、miR-223-3p表达水平对HZ患者并发PHN的预测价值。结果研究组血清miR-199-3p、miR-223-3p表达水平均低于对照组(P均<0.05)。HZ患者并发PHN的发生率为11.91%(61/512)。PHN组年龄≥50岁、合并糖尿病、高血压、皮损类型为坏疽、急性期重度疼痛、皮损面积>5%、发病至治疗时间>3 d、前驱痛、C反应蛋白水平升高、红细胞沉降率升高患者比例均高于非PHN组(P均<0.05),皮损类型为典型患者比例以及血清miR-199-3p、miR-223-3p表达水平均低于非PHN组(P均<0.05)。多因素Logistic回归分析结果,年龄≥50岁、皮损类型、皮损面积、发病至治疗时间、血清miR-199-3p、miR-223-3p表达水平均为HZ患者并发PHN的影响因素(P均<0.05)。ROC曲线分析结果显示,血清miR-199-3p、miR-223-3p联合预测HZ患者并发PHN的敏感度高于单独预测(P<0.05)。结论HZ并PHN患者血清miR-199-3p、miR-223-3p表达水平均下调,2者可作为预测HZ患者并发PHN的临床指标,且2者联合预测的效能更佳。

Objective To investigate the expression of microRNA-199-3p(miR-199-3p)and miR-223-3p in the serum of patients with herpes zoster(HZ)and their predictive value for the development of postherpetic neuralgia(PHN).Methods A total of 512 HZ patients admitted to our hospital from February 2020 to November 2022 were included as the study group,and 512 individuals from the health examination cohort served as the control group.Serum levels of miR-199-3p and miR-223-3p were measured by real-time fluorescence quantitative polymerase chain reaction(qRT-PCR).HZ patients were followed up for 1 month and divided into PHN group and non-PHN group based on the presence of PHN.Logistic regression analysis was applied to analyze the factors associated with PHN in HZ patients.Receiver operating characteristic(ROC)curve was applied to assess the predictive value of serum miR-199-3p and miR-223-3p levels for the occurrence of PHN in HZ patients.Results The serum levels of miR-199-3p and miR-223-3p in the study group were lower than those in the control group(P<0.05).The incidence of PHN in HZ patients was 11.91%(61/512).In the PHN group,the proportion of patients with age≥50 years,combined with diabetes,hypertension,skin lesion type of gangrene,acute severe pain,skin lesion area>5%,time from onset to treatment>3 days,prodromal pain,elevated C-reactive protein,and elevated erythrocyte sedimentation rate were higher than those in the non-PHN group(P<0.05).Conversely,the proportion of patients with typical skin lesions and the serum levels of miR-199-3p and miR-223-3p were lower than those in the non-PHN group(P<0.05).Multivariate logistic regression analysis identified that age≥50 years,skin lesion type,skin lesion area,time from onset to treatment,serum miR-199-3p and miR-223-3p as significant factors influencing the development of PHN in HZ patients(P<0.05).ROC analysis results revealed that the sensitivity of the combination of serum miR-199-3p and miR-223-3p had higher sensitivity in predicting PHN in HZ patients compared to single marker(P<0.05),and the area under the ROC curve(AUC)for the combined markers was significantly greater than for the individual markers(P<0.05).Conclusion The expression levels of miR-199-3p and miR-223-3p in the serum of HZ patients with PHN are both down-regulated,and both act as protective factors for HZ patients with PHN.They can be used as clinical biomarkers to predict HZ patients with PHN,and their combined use enhanced predictive accuracy.