带状疱疹后遗神经痛风险因素的研究

摘要

目的:带状疱疹后遗神经痛(postherpetic neuralgia,PHN)是带状疱疹最常见的并发症之一,了解其发生的原因对指导临床治疗有重要的作用,本文旨在对可能引起带状疱疹发展为带状疱疹后神经痛的危险因素进行分析.方法:通过收集我科2009年1月至2011年3月共101例住院带状疱疹患者信息,定义PHN为出疹90天后仍有疼痛.将年龄、性别、早期治疗、疼痛程度、疱疹面积、高血压、糖尿病、免疫疾病等列为自变量,建立logistic回归模型,利用向前逐步法筛选出有统计学意义的变量.结果:研究数据的logistic回归分析显示,风险因素中年龄(P＜ 0.0001,OR=1.125,95％CL1.062～ 1.191)、疼痛程度(P=0.0003,OR=5.598,95％ CL)是带状疱疹后神经痛发生危险因素；疱疹位置(P=0.0069,OR=0.131,95％ CL 0.030～0.573)、早期抗病毒治疗(P=0.0059,OR=0.019,95％ CL 0.001～0.321)、抗病理神经痛治疗(P=0.0190,OR=0.136,95％ CL 0.026～ 0.720)为有利因素.结论:重视高年龄、头面部带状疱疹的患者,早期进行抗病毒、抗病理神经痛治疗能有效预防疱疹后神经痛.%Objective: Postherpetic neuralgia (PHN) is the most common complication of herpes zoster (HZ). Risk factors of PHN is crucial to impact the clinical treatment. This study aimed to explore the risk factors of PHN and identify the predictors of PHN. Methods: 101 Patients with HZ from January of 2009 to March of 2011 were collected. PHN was defined as pain persisting or appearing more than 90 days after rash onset. We established the logistic regression model in this study. The independent variable included age, gender, early treament, severity of pain, area of onset, hypertension, diabetes, immunological diseases. Result: Logistic stepwise regression analysis screened out the following factors: age (P＜ 0.0001, OR = 1.125, 95% CL 1.062 ～ 1.191), severity of pain (P = 0.0003, OR = 5.598, 95% CL), position of onset (P = 0.0069, OR = 0.131, 95% CL 0.030 ～ 0.573), early antiviral therapy (P = 0.0059, OR = 0.019, 95% CL 0.001 ～ 0.321), anticonvulsant therapy (P = 0.0190, OR = 0.136, 95 % CL 0.026 ～ 0.720). The age and severity of pain were risk factors. Position of onset, the early antiviral therapy and anti-neuropathic pain therapy were advantage factors. Conclusion: Paying attention to the elderly and facial HZ patients, using the antiviral and anticonvulsant medicine as soon as possible, could avoid the PHN effectively.