带状疱疹相关神经痛患者的心理状态与病毒负荷评估及其与疼痛感知的相关性研究  

Assessment of psychological state and viral load in postherpetic neuralgia patients and their correlation with pain perception

作　　者：王亚 陈国强[2] 孙辉[2] 华益民 张馨月 毛源莹 WANG Ya;CHEN Guoqiang;SUN Hui;HUA Yimin;ZHANG Xinyue;MAO Yuanying(School of Psychology,Xinxiang Medical College,Nanyang First People's Hospital,Nanyang 473000,Henan,China;Nanyang First People's Hospital)

机构地区：[1]新乡医学院心理学院南阳市第一人民医院,河南南阳473000 [2]南阳市第一人民医院

出　　处：《中国病原生物学杂志》2025年第5期597-601,605,共6页Journal of Pathogen Biology

摘　　要：目的探讨带状疱疹相关神经痛(Postherpetic neuralgia,PHN)患者的心理状态和病毒负荷的分布特征,分析两者与疼痛感知的相关性及其潜在交互作用,为综合管理PHN患者提供依据。方法纳入2023年7月至2024年7月于本院确诊的67例PHN患者,根据病毒负荷分为低负荷组(<10~3/mL,n=21)、中负荷组(10~3~10~5/mL,n=26)和高负荷组(>10~5/mL,n=20)。通过医院焦虑与抑郁量表(HADS)评估患者心理状态,采用视觉模拟评分(VAS)评估疼痛感知强度,同时检测血液中水痘-带状疱疹病毒(VZV)拷贝数和炎症因子(IL-6、TNF-α)。通过单因素分析、相关性分析和多元线性回归模型,探讨心理状态、病毒负荷与VAS评分的关系,并进一步评估心理状态在病毒负荷与疼痛感知之间的中介和交互效应。结果病毒负荷和心理状态均显著影响VAS评分。高负荷组VAS评分显著高于低负荷组(7.7±1.1 vs.5.1±1.2,P<0.001),中负荷组介于两者之间(6.5±1.0,P<0.001)。中重度心理问题患者(HADS-A和HADS-D评分≥11分)的VAS评分显著高于正常心理状态患者(8.0±1.2和7.2±1.3 vs.5.0±1.1,P<0.001)。相关性分析显示,病毒负荷、HADS评分(HADS-A和HADS-D)、IL-6、TNF-α和病程与VAS评分显著正相关(P<0.05)。多元线性回归分析表明,病毒负荷(β=0.34,P<0.001)、HADS-A评分(β=0.23,P=0.006)、HADS-D评分(β=0.28,P=0.002)是VAS评分的独立影响因素。此外,炎症因子IL-6、TNF-α对VAS评分也有影响显著(P<0.05)。中介效应分析显示,HADS-D部分中介了病毒负荷与VAS评分之间的关系,中介效应占总效应的41.7%(P=0.002),HADS-A中介效应占总效应的39.5%(P=0.003)。交互效应分析表明,病毒负荷与HADS-D评分的交互项对VAS评分的影响显著(交互项β=0.18,P=0.004),提示高病毒负荷联合中重度抑郁会显著加剧疼痛感知,抑郁评分每增加1分,VAS评分升高18.0%。结论PHN患者的疼痛感知受病毒负荷和心理状态的双重调控,心理状态在病毒负Objective To investigate the distribution characteristics of psychological status and viral load in patients with Postherpetic Neuralgia(PHN),and to analyze the correlation and potential interaction between these factors and pain perception.This study aims to provide a basis for the comprehensive management of PHN patients.Methods A total of 67 PHN patients diagnosed at our hospital between July 2023 and July 2024 were enrolled.Based on viral load,patients were divided into three groups:low viral load(<10^(3)/mL,n=21),medium viral load(10^(3)-10^(5)/mL,n=26),and high viral load(>10^(5)/mL,n=20).Psychological status was assessed using the Hospital Anxiety and Depression Scale(HADS),and pain perception was evaluated using the Visual Analog Scale(VAS).Blood samples were collected to determine the varicella-zoster virus(VZV)copy number and inflammatory cytokines(IL-6,TNF-α).Univariate analysis,correlation analysis,and multiple linear regression models were used to explore the relationships between psychological status,viral load,and VAS scores.Furthermore,the mediation and interaction effects of psychological status on the relationship between viral load and pain perception were evaluated.Results Both viral load and psychological status significantly influenced VAS scores.The high viral load group had significantly higher VAS scores compared to the low viral load group(7.7±1.1 vs.5.1±1.2,P<0.001),and the medium viral load group showed intermediate values(6.5±1.0,P<0.001).Patients with moderate to severe psychological issues(HADS-A and HADS-D scores≥11)had significantly higher VAS scores than those with normal psychological status(8.0±1.2 and 7.2±1.3 vs.5.0±1.1,P<0.001).Correlation analysis showed significant positive correlations between viral load,HADS scores(HADS-A and HADS-D),IL-6,TNF-α,disease duration,and VAS scores(P<0.05).Multiple linear regression analysis indicated that viral load(β=0.34,P<0.001),HADS-A score(β=0.23,P=0.006),and HADS-D score(β=0.28,P=0.002)were independent factors affecting VAS

关 键 词：带状疱疹相关神经痛 心理状态 病毒负荷 疼痛感知 中介效应 交互效应 

分 类 号：R749.92[医药卫生—神经病学与精神病学]