带状疱疹后神经痛患者介入治疗预后不良的危险因素和预测模型构建  

Risk factors for poor prognosis following interventional treatment in patients with postherpetic neuralgia and construction of a predictive model

作　　者：俞又佳 袁俊鹏 徐慧婵 李艳[2] 宋绍永 金晓红[3] Yu Youjia;Yuan Junpeng;Xu Huichan;Li Yan;Song Shaoyong;Jin Xiaohong(Department of Pain Medicine,The Fourth Affiliated Hospital of Soochow University,Suzhou 215125,China;Department of Anesthesiology and Pain Medicine,Xiangcheng People′s Hospital,Suzhou 215131,China;Department of Pain Medicine,First Affiliated Hospital of Suzhou University,Suzhou 215006,China;Medical Center,Suzhou University,Suzhou 215125,China)

机构地区：[1]苏州大学附属第四医院疼痛科,苏州215125 [2]苏州市相城人民医院麻醉疼痛科,苏州215131 [3]苏州大学附属第一医院疼痛科,苏州215006 [4]苏州大学医学中心,苏州215125

出　　处：《中华麻醉学杂志》2024年第4期442-446,共5页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金(82001126);苏州市科技发展计划项目(SKYD2023249,SKYD2022082,SKJYD2021216)。

摘　　要：目的筛选带状疱疹后神经痛(PHN)患者介入治疗预后不良的危险因素并构建预测模型。方法回顾性收集2020年3月至2023年8月在苏州大学附属第一医院行介入治疗的PHN患者的病历资料,包括患者基本信息、既往病史和手术史、症状、药物治疗情况、临床疼痛评分、介入治疗前中性粒细胞/淋巴细胞比值(NLR)和介入治疗方法等。采用logistic回归分析筛选PHN患者介入治疗预后不良的危险因素,构建预后不良的列线图预测模型。采用C指数和Hosmer-Lemeshow检验评价列线图预测模型的区分度和校准度。绘制校准曲线和临床决策曲线进一步验证预测模型的准确性。结果多因素logistic回归分析结果显示:年龄增长、病程延长、NLR增高、使用免疫抑制剂和脉冲射频治疗是PHN患者介入治疗预后不良的独立危险因素(P<0.05)。基于此构建的PHN介入治疗预后不良列线图预测模型C指数为0.844;校准曲线显示:预测预后不良概率与实际预后不良发生率的一致性较好;临床决策曲线显示:在该预测模型中,准确性和净获益较好。结论年龄增长、病程延长、NLR增高、使用免疫抑制剂和脉冲射频治疗是PHN患者介入治疗预后不良的独立危险因素,基于此构建的列线图预测模型可有效预测PHN患者介入治疗预后不良的发生。Objective To identify the risk factors for poor prognosis following interventional treatment in the patients with postherpetic neuralgia(PHN)and construct a predictive model.Methods The medical records from patients with PHN undergoing interventional therapy at the First Affiliated Hospital of Soochow University from March 2020 to August 2023 were retrospectively collected,including basic characteristics,past medical and surgical history,symptoms,medication therapy,clinical pain score,neutrophil/lymphocyte ratio(NLR)before interventional treatment and interventional treatment methods.Logistic regression analysis was used to identify the risk factors associated with poor prognosis following interventional treatment in PHN patients,and a nomogram predictive model for poor prognosis was constructed.The discrimination and calibration of the nomogram predictive model were evaluated using the C-index and Hosmer-Lemeshow test.Calibration curves and clinical decision curves were drawn to further verify the accuracy of the predictive model.Results The results of the multivariate logistic regression analysis show that increasing age,prolonged disease duration,elevated NLR,use of immunosuppressants and use of pulsed radiofrequency were independent risk factors for poor prognosis following intervention treatment in PHN patients(P<0.05).The nomogram predictive model for poor prognosis following PHN interventional treatment constructed based on these factors had a C-index of 0.844.Calibration curves showed good consistency between predicted probability of poor prognosis and actual incidence of poor prognosis.Clinical decision curves indicated that the predictive model provided good accuracy and net benefit.Conclusions Increasing age,prolonged disease course,elevated NLR,use of immunosuppressants and use of pulsed radiofrequency are independent risk factors for poor prognosis following interventional treatment in the patients with PHN.The nomogram predictive model based on these factors can effectively predict the occurrence of

关 键 词：神经痛 带状疱疹后 预后 危险因素 预测 介入治疗 

分 类 号：R752.12[医药卫生—皮肤病学与性病学]