【摘要】 目的 探究影响带状疱疹后神经痛(PHN)发生的临床特征与治疗因素，构建预测模型并评估其诊断价值。方法 选取2023年1月至2025年1月本院收治的300例带状疱疹患者，根据病程3个月后是否发生PHN分为PHN组(n=76)和非PHN组(n=224)。收集患者临床资料、治疗措施及继发感染病原菌数据，通过单因素和多因素Logistic回归分析筛选独立危险因素，建立预测模型并采用ROC曲线评估效能。结果 300例患者中PHN发生率为25.33%(76/300);76例PHN患者中52例继发皮肤感染，检出病原菌68株，以革兰阴性菌为主(42株，61.76%);Logistic多因素分析显示，急性期VAS≥7分(OR=2.987)、抗病毒治疗延迟(OR=3.562)、未早期使用苯磺酸克力加巴林(OR=2.673)、合并革兰阴性菌感染(OR=2.154)是PHN独立危险因素(均P<0.05)。基于急性期VAS≥7分、抗病毒治疗延迟(>72 h)、未早期使用苯磺酸克力加巴林、合并革兰阴性菌感染的影响因素构建的预警模型如下：4.779+1.094×急性期VAS≥7分+1.270×抗病毒治疗延迟(>72 h)+0.983×未早期使用苯磺酸克力加巴林+0.768×合并革兰阴性菌感染；ROC曲线预测结果显示，预测模型AUC为0.841(95%CI:0.772～0.895),敏感度为84.21%,特异度为83.93%;与非感染PHN患者相比，革兰阴性菌感染组急性VAS评分、血清IL-6水平明显更高(t=4.271,P<0.01);Spearman分析显示，合并革兰阴性菌感染的PHN患者急性期VAS评分与IL-6水平呈正相关(r=0.638,P<0.01)。结论 带状疱疹患者PHN发生率较高，病原菌分布以革兰阴性菌为主，疼痛程度、治疗时机及感染类型是独立危险因素，基于独立危险因素建立的预测模型具有良好诊断价值。更多还原

【Abstract】 Objective To explore the clinical features and therapeutic factors influencing the occurrence of postherpetic neuralgia(PHN),and to construct a predictive model and evaluate its diagnostic value. Methods A total of 300 patients with herpes zoster were admitted to our hospital from January 2023 to January 2025 were selected and divided into PHN group(n=76) and non-PHN group(n=224) according to whether PHN occurred after 3 months of the course of disease. The clinical data, treatment measures and secondary infection pathogen data of the patients were collected. The independent risk factors were screened by univariate and multivariate Logistic regression analysis, and the predictive model was established and the ROC curve was used to evaluate the efficacy. Results The incidence of PHN in 300 patients was 25.33%(76/300). Of the 76 PHN patients, 52 had secondary skin infection, and 68 strains of pathogenic bacteria detected, mainly Gram-negative bacteria(42 strains, 61.76%);Logistic multivariate analysis showed that VAS≥7 points in the acute phase(OR=2.987),delayed antiviral treatment(OR=3.562),no early use of clegabalin besylate(OR=2.673),and Gram-negative bacterial infection(OR=2.154) were independent risk factors for PHN(all P<0.05). Based on the influencing factors of VAS≥7 in the acute phase, delayed antiviral treatment(>72 h),no early use of clegabalin besylate, and combined gram-negative bacterial infection, the early warning model was constructed as follows: 4.779+1.094× VAS≥7 in acute phase +1.270× delayed antiviral treatment(>72 h) +0.983× no early use of clegabalin besylate +0.768× Gram-negative bacterial infection. ROC curve prediction results showed that the AUC of the prediction model was 0.841(95%CI:0.772-0.895),the sensitivity was 84.21%,and the specificity was 83.93%. Compared with non-infected PHN patients, the acute VAS score and serum IL-6 level in the Gram-negative bacterial infection group were significantly higher(t=4.271,P<0.01). Spearman analysis showed that the VAS score of PHN patients with Gram-negative bacterial infection in the acute phase was positively correlated with the level of IL-6(r=0.638,P<0.01). Conclusion The incidence of PHN in patients with herpes zoster is high, and the distribution of pathogens is mainly Gram-negative bacteria. The degree of pain, the timing of treatment and the type of infection are independent risk factors. The prediction model based on independent risk factors has good diagnostic value.更多还原