带状疱疹患者生活质量状况及影响因素分析  

Quality of life and risk factors in patients with herpes zoster

作　　者：张倩[1] 黄振水[2] 胡倩倩 秦伟 梁丽琳 崔峰[5] 王瑶 潘璠 刘新利 唐林 马超[1] 尹遵栋[1] 王富珍[1] Zhang Qian;Huang Zhenshui;Hu Qianqian;Qin Wei;Liang Lilin;Cui Feng;Wang Yao;Pan Fan;Liu Xinli;Tang Lin;Ma Chao;Yin Zundong;Wang Fuzhen(National Immunization Program,Chinese Center for Disease Control and Prevention,Beijing 100050,China;Department of Immunization Program,Zibo Municipal Center for Disease Control and Prevention,Zibo 255026,China;Department of Immunization Program,Lu′an Municipal Center for Disease Control and Prevention,Lu′an 237000,China;Department of Immunization Program,Tongchuan Municipal Center for Disease Control and Prevention,Tongchuan 727031,China;Zibo Municipal Center for Disease Control and Prevention,Zibo 255026,China;Tongchuan Municipal Center for Disease Control and Prevention,Tongchuan 727031,China)

机构地区：[1]中国疾病预防控制中心免疫规划中心,北京100050 [2]淄博市疾病预防控制中心免疫预防所,淄博255026 [3]六安市疾病预防控制中心免疫预防科,六安237000 [4]铜川市疾病预防控制中心免疫规划科,铜川727031 [5]淄博市疾病预防控制中心,淄博255026 [6]铜川市疾病预防控制中心,铜川727031

出　　处：《中华医学杂志》2022年第42期3395-3400,共6页National Medical Journal of China

基　　金：中国CDC公共卫生应急反应机制的运行(131031001000150001)。

摘　　要：目的调查医院就诊带状疱疹患者生活质量状况及其影响因素。方法纳入2021年10—12月在安徽省六安市、山东省淄博市和陕西省铜川市22家一、二、三级医院就诊的带状疱疹(HZ)患者332例,对所有患者开展问卷调查,采用《带状疱疹简明疼痛评估量表》和《欧洲五维健康量表》分析其疼痛程度和生活质量,采用截断最小绝对离差(CLAD)回归模型分析影响患者健康效用值变化的相关因素。结果332例患者中男性151例(45.5%),年龄M(Q1,Q3)为59(50,68)岁,所有HZ患者中报告调查时过去24 h内最严重疼痛程度为中至重度(≥5分)的占59.6%(198/332),在带状疱疹后神经痛(PHN)患者中占84.8%(39/46);所有HZ患者中分别有77.7%(258/332)、77.4%(257/332)和74.1%(246/332)报告疼痛对睡眠、情绪、一般活动等方面造成干扰。CLAD回归分析结果显示,年龄增长[40~49、50~59、60~69、70~90岁HZ患者的β值(95%CI)分别为-0.11(-0.15,-0.08)、-0.03(-0.05,0.00)、-0.09(-0.12,-0.06)、-0.16(-0.19,-0.12)]、工作状态为无业[农民、退休及在业的HZ患者β值(95%CI)为0.15(0.13,0.18)、0.21(0.18,0.24)、0.13(0.10,0.16)]、发生PHN或其他并发症[β值(95%CI)为-0.08(-0.13,-0.04)和-0.12(-0.15,-0.08)]、处于发病后≤30 d[(β值(95%CI)为-0.01(-0.03,0.01)]和已接受治疗[β值(95%CI)为-0.09(-0.11,-0.06)]是健康效用值下降的相关因素(均P<0.05)。结论超过50%的HZ患者过去24 h最严重疼痛程度为中至重度,对患者身心健康造成严重的负面影响;年龄较大、急性期、有并发症的患者的健康效用值更低,生活质量更差。建议适龄人群尽早接种HZ疫苗。Objective To evaluate the quality of life and influencing factors of patients with herpes zoster(HZ)seen in hospitals.Methods Based on Zoster Brief Pain Inventory(ZBPI)and Five-level EuroQol Five-dimensional Questionnaire(EQ-5D-5L),a cross-sectional survey was conducted to evaluate the pain severity and quality of life of 332 HZ cases seen in 22 hospitals of Lu′an City(Anhui Province),Zibo City(Shandong Province)and Tongchuan City(Shaanxi Province)from October to December 2021.The censored least absolute deviations(CLAD)model was used to analyze the related factors affecting the changes of patients′health utility values.Results The 45.5%of 332 HZ cases were male.The median(Q1,Q3)age was 59(50,68)years.59.64%of them assessed by ZBPI had moderate to severe pain in the past 24 hours(worst pain score≥5),and that of PHN cases was 84.8%(39/46).77.7%(258/332),77.4%(257/332)and 74.1%(246/332)of all patients reported that pain interfered with sleep,mood and general activities,respectively.Aging[β40-49y(95%CI)=-0.11(-0.15,-0.08);β50-59y(95%CI)=-0.03(-0.05,0.00);β60-69y(95%CI)=-0.09(-0.12,-0.06);β70-90y(95%CI)=-0.16(-0.19,-0.12)],working status(unemployed)[βfarmer(95%CI)=0.15(0.13,0.18);βretirees(95%CI)=0.21(0.18,0.24);βemployee(95%CI)=0.13(0.10,0.16)],complications[βPHN(95%CI)=-0.08(-0.13,-0.04);βother complications(95%CI)=-0.12(-0.15,-0.08)],within 30 days after onset[β(95%CI)=-0.01(-0.03,0.01)]and treatment[βother complications(95%CI)=-0.09(-0.11,-0.06)]were related factors for the decline of health utility value(all P values<0.05).Conclusions More than half of the patients with HZ had moderate to severe pain in the past 24 hours,which had a serious negative impact on the physical and mental health of the patients.Elderly patients,acute patients and patients with complications had lower health utility values and worse health status.We suggest that eligible people be vaccinated with HZ vaccine as soon as possible.

关 键 词：带状疱疹 神经痛 带状疱疹后 疼痛 生活质量 健康效用值 

分 类 号：R752.12[医药卫生—皮肤病学与性病学]