接受介入性疼痛管理的带状疱疹后神经痛患者预后不良的危险因素。
Risk factors for poor prognosis in patients with zoster-associated neuralgia who underwent interventional pain management.
作者信息
Yuan Junpeng, Yu Youjia, Liu Hong, Xu Huichan, Li Yan, Jin Xiaohong
机构信息
Department of Pain Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Pain Medicine, Suzhou Xiangcheng People's Hospital, Suzhou, China.
出版信息
Front Mol Neurosci. 2024 Oct 2;17:1393219. doi: 10.3389/fnmol.2024.1393219. eCollection 2024.
BACKGROUND
Zoster-associated neuralgia (ZAN) is recognized as a challenging neuralgia that often leads to poor prognosis in patients receiving interventional pain management. Identifying risk factors early can enable clinicians to develop personalized treatment plans; however, research in this area is limited.
METHODS
We retrospectively screened all patients with ZAN who received interventional therapy in the Pain Department of Soochow University First Affiliated Hospital from January 1, 2022 to August 31, 2023. Data on patient demographics, medical history, neutrophil-to-lymphocyte ratio (NLR), clinical scoring, and treatment methods were collected. Interventional therapy included short-term nerve electrical stimulation (st-NES), pulsed radiofrequency (PRF) and radiofrequency thermocoagulation (RF-TC). Patients were categorized into poor prognosis and control groups based on outcomes 3 months post-discharge. Multivariate logistic regression was used to identify risk factors for poor prognosis.
RESULTS
The final analysis included 282 patients. The rate of poor prognosis was 32.6% (92/282). Multivariate logistic regression analysis revealed that age ≥ 65 years (odds ratio, 2.985; 95% confidence interval, 1.449-6.148; = 0.003), disease duration >3 months (odds ratio, 3.135; 95% confidence interval, 1.685-5.832; < 0.001), head and face pain (odds ratio, 3.140; 95% confidence interval, 1.557-6.330; = 0.001), use of immunosuppressants (odds ratio, 2.737; 95% confidence interval, 1.168-6.416; = 0.021), higher NLR (odds ratio, 1.454; 95% confidence interval, 1.233-1.715; < 0.001), PRF (st-NES as reference) (odds ratio, 2.324; 95% confidence interval, 1.116-4.844; = 0.024) and RF-TC (st-NES as reference) (odds ratio, 5.028; 95% confidence interval, 2.139-11.820; < 0.001) were found to be independent risk factors for poor prognosis in patients with ZAN who underwent interventional pain management.
CONCLUSION
Age ≥ 65 years (odds ratio, 2.985; 95% confidence interval, 1.449-6.148; = 0.003), disease duration >3 months (odds ratio, 3.135; 95% confidence interval, 1.685-5.832; < 0.001), head and face pain (odds ratio, 3.140; 95% confidence interval, 1.557-6.330; = 0.001), immunosuppressants use (odds ratio, 2.737; 95% confidence interval, 1.168-6.416; = 0.021), higher NLR (odds ratio, 1.454; 95% confidence interval, 1.233-1.715; < 0.001), PRF (odds ratio, 2.324; 95% confidence interval, 1.116-4.844; = 0.024) and RF-TC (odds ratio, 5.028; 95% confidence interval, 2.139-11.820; < 0.001) were identified as independent risk factors for poor prognosis in patients with ZAN who underwent interventional pain management.
背景
带状疱疹相关性神经痛（ZAN）被认为是一种具有挑战性的神经痛，在接受介入性疼痛管理的患者中往往预后较差。早期识别风险因素可使临床医生制定个性化治疗方案；然而，该领域的研究有限。
方法
我们回顾性筛查了2022年1月1日至2023年8月31日在苏州大学第一附属医院疼痛科接受介入治疗的所有ZAN患者。收集患者的人口统计学数据、病史、中性粒细胞与淋巴细胞比值（NLR）、临床评分和治疗方法。介入治疗包括短期神经电刺激（st-NES）、脉冲射频（PRF）和射频热凝（RF-TC）。根据出院后3个月的结果将患者分为预后不良组和对照组。采用多因素logistic回归分析确定预后不良的危险因素。
结果
最终分析纳入282例患者。预后不良率为32.6%（92/282）。多因素logistic回归分析显示，年龄≥65岁（比值比，2.985；95%置信区间，1.449-6.148；P=0.003）、病程>3个月（比值比，3.135；95%置信区间，1.685-5.832；P<0.001）、头面部疼痛（比值比，3.140；95%置信区间，1.557-6.330；P=0.001）、使用免疫抑制剂（比值比，2.737；95%置信区间，1.168-6.416；P=0.021）、较高的NLR（比值比，1.454；95%置信区间，1.233-1.715；P<0.001）、PRF（以st-NES为参照）（比值比，2.324；95%置信区间，1.116-4.844；P=0.024）和RF-TC（以st-NES为参照）（比值比，5.028；95%置信区间，2.139-11.820；P<0.001）是接受介入性疼痛管理的ZAN患者预后不良的独立危险因素。
结论
年龄≥65岁（比值比，2.985；95%置信区间，1.449-6.148；P=0.003）、病程>3个月（比值比，3.135；95%置信区间，1.685-5.832；P<0.001）、头面部疼痛（比值比，3.140；95%置信区间，1.557-6.330；P=0.001）、使用免疫抑制剂（比值比，2.737；95%置信区间，1.168-6.416；P=0.021）、较高的NLR（比值比，1.454；95%置信区间，1.233-1.715；P<0.001）、PRF（比值比，2.324；95%置信区间，1.116-4.844；P=0.024）和RF-TC（比值比，5.028；95%置信区间，2.139-11.820；P<0.001）被确定为接受介入性疼痛管理的ZAN患者预后不良的独立危险因素。
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