摘要
目的 研究带状疱疹(herpes zoster,HZ)患者急性期血清25-羟基维生素D[25(OH)D]变化及其对后遗神经痛(postherpetic neuralgia,PHN)预测价值.方法 回顾性研究北京博爱医院皮肤科门诊2019年7月至2022年6月带状疱疹患者202例,根据其是否发生PHN分为PHN组和非PHN组,收集并比较患者一般临床资料及其初次就诊时外周静脉血25(OH)D、ESR、CRP、NLR、IL-6水平.影响因素通过多因素Logistic回归进行分析.使用Brier Score和AUC对预测指标进行评价.结果 纳入202例患者,PHN组55例(27.2％),非PHN组147例(72.8％).两组在年龄、VAS评分、HZ分型、是否合并泼尼松治疗、血清IL-6、CRP、25(OH)D差异有统计学意义(x2值/Z值分别为-4.32、-3.719、9.943、7.316、7.226、9.063、10.53;P值分别为<0.0001、<0.0001、0.004、0.007、0.007、0.003、0.005).两组性别、皮疹出现天数、NLR、ESR差异无统计学意义(x2值/Z值分别为0.836、-4.427、0.438、-0.337;P值分别为0.360、0.154、0.091、0.076).多因素Logistic回归表明,年龄(OR=1.04,95％CI 1.02～1.07,P=0.001)、CRP(OR=3.99,95％CI 1.27～12.56,P=0.018)、血清25(OH)D(OR=4.49,95％CI 1.320～1.522,P=0.016)是HZ患者发生PHN的影响因素.血清25(OH)D、CRP水平及二者联合预测HZ患者发生PHN的AUC分别为0.701、0.728、0.846,Brier score为0.164.结论 血清25(OH)D水平在急性期HZ患者中下降,CRP、IL-6水平在急性期HZ患者中上升,年龄、血清25(OH)D、CRP水平可能对预测PHN发生具有一定价值.
Abstract
Objective This study aims to investigate alterations in serum levels of 25(OH)D,ESR,CRP,NLR,and IL-6 during the acute stage of herpes zoster(HZ)and to evaluate their predictive values for postherpetic neuralgia(PHN).Methods A retrospective cohort study was conducted for a total of 202 patients diagnosed with HZ between July,2019 and June,2022 who were selected from the Dermatology Department of Beijing Boai Hospital.Patients were divided into PHN group and non-PHN group according to whether PHN occurred.General clinical data and peripheral venous blood 25 (OH)D,ESR,CRP,NLR and IL-6 levels were collected and compared at the first visit.Analysis of influencing factors was performed through multiple logistic regression.Brier Score and AUC were used as evaluation metrics to evaluate predicting performance of PHN.Results Of the 202 patients included,55(27.2％)were in the PHN group and 147(72.8％) were in the non-PHN group.There were significant differences in age,VAS score,HZ classification,whether prednisone was combined with treatment,serum IL-6,CRP and 25(OH)D between the two groups (x2/Z values were-4.320,-3.719,9.943,7.316,7.226,9.063,10.53,respectively;The P values were<0.0001,<0.0001,0.004,0.007,0.007,0.003,0.005,respectively).There was no significant difference in gender,days of rash occurrence,NLR and ESR between the two groups (x2/Z were 0.836,-4.427,0.438,-0.337,respectively;The P values were 0.360,0.154,0.091,0.076,respectively. Multivariate logistic regression showed that age(OR=1.04,95％CI 1.02-1.07,P=0.001),CRP(OR=3.99,95％ CI 1.27-12.56,P=0.018),and serum 25(OH)D(OR=4.49,95％ CI 1.320-1.522,P=0.016)were influencing factors for the occurrence of PHN in HZ patients.AUC values of serum 25(OH)D,CRP levels,and their combined prediction for the occurrence of PHN in HZ patients were 0.701,0.728,and 0.846,respectively,with Brier score of 0.164.Conclusion Serum 25 (OH)D levels decrease in acute phase HZ patients,while CRP and IL-6 levels increase in acute phase HZ patients.Age,serum 25(OH)D,and CRP levels could be useful markers in predicting the occurrence of PHN.
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