摘要
目的探讨糖尿病与焦虑交互作用对带状疱疹(HZ)患者神经痛发生风险的影响。方法回顾性选取2020年12月至2024年12月我院治疗的206例HZ患者的临床资料,所有患者治疗结束后均随访6个月,根据是否发生带状疱疹后神经痛分为发生组(n=47)和未发生组(n=159)。比较两组临床资料,多因素logistic回归分析糖尿病、焦虑与HZ患者神经痛发生风险的关系,以Andersson编制Excel计算表计算交互作用超额相对危险度(RERI)、交互作用归因百分比(AP)、协同指数(S),绘制受试者工作特征曲线(ROC)分析各指标单独及联合预测HZ患者神经痛发生风险的价值。结果两组年龄、合并T2DM、皮损面积、广泛性焦虑障碍量表(GAD-7)评分、抑郁筛查量表(PHQ-9)评分经比较,差异有统计学意义(P<0.05);多因素logistic回归分析结果显示,合并T2DM和GAD-7评分均为HZ患者神经痛发生风险的独立危险因素(P<0.05);未校正其他变量时,合并T2DM和GAD-7评分≥5分间存在相乘交互作用(P<0.05);但校正年龄、皮损面积、HAMD评分等混杂因素后,二者间不存在相乘交互作用(P>0.05);合并T2DM与GAD-7评分≥5分存在相加交互作用,二者同时存在时,HZ患者神经痛发生风险显著高于未合并T2DM和GAD评分<5分患者,二者同时存在HZ患者神经痛发生风险高于二者单独存在致神经痛风险总和,协同效应为二者单独存在产生效应之和23.05倍,二者同时存在时发生神经痛风险有81.70%风险归因于二者协同作用;糖尿病与焦虑联合预测HZ患者神经痛发生风险的价值高于单独预测(Z_(合并T2DM~联合)=2.230、Z_(GAD-7评分~联合)=3.088,P<0.05)。结论糖尿病和焦虑存在相加交互作用,二者同时存在时,HZ患者神经痛发生风险升高,且联合评估可为预测HZ患者神经痛提供一定参考。
Objective The aim of this study was to investigate the impact of the interaction between diabetes mellitus and anxiety on the risk of developing postherpetic neuralgia in patients with herpes zoster(HZ).Methods The clinical data of 206 HZ patients admitted to our hospital from December 2020 to December 2024 were retrospectively collected.All patients were followed up for 6 months after treatment and then divided into the occurrence group(n=47)and the non-occurrence group(n=159)based on whether postherpetic neuralgia occurred.The clinical data between the two groups were compared.Multivariate Logistic regression analysis was used to explore the relationship between diabetes mellitus,anxiety and the risk of neuralgia in HZ patients.The Excel spreadsheet developed by Andersson was used to calculate the relative excess risk due to interaction(RERI),attributable proportion due to interaction(AP),and synergy index(S).Receiver operating characteristic(ROC)curves were plotted to analyze the value of each indicator alone and in combination in predicting the risk of neuralgia in HZ patients.Results There were statistically significant differences between the two groups in terms of age,coexisting T2DM,skin lesion area,Generalised Anxiety Disorder-7(GAD-7)score,and Patient Health Questionnaire-9(PHQ-9)score(P<0.05).Multivariate logistic regression analysis revealed that both T2DM and GAD-7 scores were independent risk factors for neuropathic pain in HZ patients(P<0.05).Without adjusting for other variables,there was a multiplicative interaction between T2DM and GAD-7 scores≥5(P<0.05).However,after adjusting for confounding factors such as age,skin lesion area,and HAMD scores,no multiplicative interaction was observed between the two(P>0.05).There was an additive interaction between T2DM and a GAD-7 score≥5;when both were present,the risk of neuropathic pain in HZ patients was significantly higher than in patients without T2DM and a GAD score<5.The risk of neuropathic pain in HZ patients with both conditions was higher than the sum of the risks from either condition alone,with a synergistic effect 23.05 times greater than the sum of the effects of either condition alone;When both conditions coexist,81.70%of the risk of neuropathic pain is attributable to their synergistic effect;the combined predictive value of diabetes and anxiety for the risk of neuropathic pain in HZ patients is higher than that of either condition alone(ZT2DM vs.combination=2.230,ZGAD-7 score vs.combination=3.088,P<0.05).Conclusion Diabetes mellitus and anxiety have an additive interaction.When both are present,the risk of neuralgia in HZ patients increases,and combined assessment can provide a certain reference for predicting neuralgia in HZ patients.
作者
邹玲
文谦
陈健勤
ZOU Ling;WEN Qian;CHEN Jianqin(Department of Dermatology,TCM-Integrated Hospital of Southern Medical University,Guangzhou 510315,Guangdong,China;不详)
出处
《实用医学杂志》
北大核心
2025年第23期3704-3710,共7页
The Journal of Practical Medicine
基金
广东省医学科学技术研究基金项目(编号:B20221389)
广东省中医药局中医药科研项目(编号:20221280)。
关键词
糖尿病
焦虑
交互作用
带状疱疹
神经痛
diabetes mellitus
anxiety
interaction
herpes zoster
neuralgia
作者简介
通信作者:陈健勤,E-mail:495976740@qq.com。
