合并糖尿病对带状疱疹患者的预后影响及其危险因素研究

Study on the Influence of Diabetes Mellitus on Prognosis and Risk Factors of Patients with Herpes Zoster

摘要:

目的：探讨糖尿病（diabetes mellitus，DM）与带状疱疹（herpes zoster，HZ）预后情况的关系。方法：采用前瞻性的队列研究方法，将2018年8月至2019年8月于我院治疗的90例HZ患者根据是否患有DM分为D组（糖尿病组）及N组（非糖尿病组），每组45例。两组均给予抗病毒、营养神经、镇痛药物及物理治疗，比较两组之间带状疱疹后神经痛（postherpetic neuralgia，PHN）的发生率、疱疹皮损持续时间及治疗前后数字等级疼痛评分（numerical rating scale，NRS）和阿森斯失眠量表（athens insomnia scale，AIS），同时记录补救镇痛例数及不良事件发生例数；采用单因素及多因素Logistic回归分析确定HZ患者预后情况的影响因素。结果：与N组相比，D组在发疹时间、住院天数、皮疹愈合时间、高血压、PHN发生率以及NRS及AIS评分上存在统计学差异（P<0.05）；HZ患者预后情况的Logistic回归结果显示，合并DM的HZ患者发生PHN的风险较非DM要高4.52倍（OR=4.52，95%CI：1.05-19.43）。年龄、性别、初始疼痛以及皮疹愈合时间也与预后有明显的关系（OR=2.49，95%CI：1.22-5.08；OR=5.57，95%CI：1.23-25.24；OR=3.57，95%CI：1.65-7.74；OR=1.26，95%CI：0.93-1.69）。D组住院期间补救药物使用例数及不良反应总例数较N组明显增多，差异具有统计学意义（P＜0.05）。结论：DM、年龄、性别、初始疼痛以及皮疹愈合时间是HZ患者发展为PHN的重要危险因素；合并DM的HZ患者在疼痛、睡眠质量等临床症状方面更加严重，并且消耗量了更多镇痛药物及发生了更多的不良反应。

Abstract:

Objective To investigate the relationship between diabetes mellitus (DM) and prognosis of herpes zoster (HZ). Methods 90 cases of HZ patients hospitalized in our department from August 2018 to August 2019 were divided into group D (diabetes group) and group N (non-diabetes group) according to whether they had diabetes, with 45 patients in each group. The incidence of PHN, duration of herpes lesions, Numerical rating scale (NRS), and Athens insomnia scale (AIS) before and after treatment were compared between the two groups, which were given antiviral, neurotrophic, analgesic drugs as well as physical treatment. Meanwhile, the number of remedial analgesic cases and the total number of adverse events were recorded during treatment. Univariate and multivariate Logistic regression analysis was used to determine the factors affecting the prognosis of patients with HZ. Results Compared with group N, group D had statistical differences in eruption time, hospitalization days, rash healing time, hypertension, PHN incidence rate, and the scores of NRS and AIS(P<0.05). Logistic regression analysis of the prognosis of HZ patients showed that the risk of poor prognosis in HZ patients complicated with DM was 4.52 times higher than that in non-DM patients (OR=4.52, 95%CI: 1.05-19.43). Besides, Age, Sex, initial pain, and healing time are significantly associated with an increased risk of poor diagnosis (OR=2.49, 95%CI: 1.22-5.08; OR=5.57, 95%CI: 1.23-25.24; OR=3.57, 95%CI: 1.65-7.74; OR=1.26, 95%CI: 0.93-1.69). The number of cases of remedial drug use and the total number of adverse reactions in group D were significantly higher than those in group N(P<0.05). Conclusion Diabetes mellitus, Age, Sex, initial pain, and healing time are important risk factors for poor prognosis. Herpes zoster patients complicated with diabetes have severer clinical symptoms in pain and sleep, which increases the consumption of analgesics and adverse events.