带状疱疹患者外周血IL-18水平与带状疱疹后神经痛严重程度的相关性及早期预警价值

王静; 甘智慧; 王一丹; 王娟

doi:10.16766/j.cnki.issn.1674-4152.004032

带状疱疹患者外周血IL-18水平与带状疱疹后神经痛严重程度的相关性及早期预警价值

doi: 10.16766/j.cnki.issn.1674-4152.004032

王静¹,
甘智慧¹,
王一丹¹,
王娟^{1, 2, ,}

1.
蚌埠医科大学研究生院，安徽蚌埠 233030
2.
中国科学技术大学附属第一医院(安徽省立医院)皮肤科，安徽合肥 230001

基金项目:

安徽省教育厅高校科研项目 2024AH052041

详细信息

通讯作者:
王娟，E-mail: wangjuan_8282@mail.ustc.edu.cn

中图分类号: R752.12
计量
- 文章访问数: 22
- HTML全文浏览量: 11
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2024-12-09
- 网络出版日期: 2025-09-04

Association of peripheral blood IL-18 levels with the severity of postherpetic neuralgia in herpes zoster patients and its early predictive value

WANG Jing¹,
GAN Zhihui¹,
WANG Yidan¹,
WANG Juan^{1, 2
, ,}

1.
Graduate School of Bengbu Medical University, Bengbu, Anhui 233030, China

摘要

摘要: 目的探讨带状疱疹患者外周血中白细胞介素-18(IL-18)表达水平与带状疱疹后神经痛(PHN)严重程度的相关性并评估其对PHN的早期预警价值。方法选取2023年9月—2024年8月于安徽省立医院皮肤科就诊的403例带状疱疹患者作为观察组，同期226例体检者作为对照组。记录研究对象一般资料，3个月后随访评估带状疱疹患者PHN发生情况及严重程度，根据是否出现PHN分为PHN组(157例)和非PHN组(246例)，比较各组外周血IL-18水平的差异。采用单因素和多因素logistic回归分析筛选PHN的危险因素，采用Spearman等级相关分析法探讨PHN严重程度与IL-18的相关性，采用ROC曲线评价IL-18对PHN的预测价值。结果带状疱疹患者外周血IL-18水平显著高于对照组(P＜0.05)；随着PHN严重程度逐渐加重，外周血IL-18水平较非PHN组显著升高(P＜0.001)。多因素logistic回归分析结果显示，IL-18水平高、女性、年龄大、合并糖尿病、合并心血管疾病、急性期VAS评分高为PHN的独立危险因素，14 d内使用止痛药物为PHN的保护因素。Spearman分析显示，PHN严重程度与IL-18水平呈正相关关系(r=0.661，P＜0.001)。ROC曲线显示，IL-18预测PHN发生的AUC为0.857，灵敏度为83.9%，特异度为76.8%，最佳截断值为1 233.6 pg/mL。结论带状疱疹患者急性期外周血IL-18水平与PHN严重程度密切相关，IL-18水平高是PHN的危险因素之一，对PHN具有良好的早期预警价值。
- 带状疱疹 /
- 带状疱疹后神经痛 /
- 白细胞介素-18
Abstract: Objective To explore the correlation between the expression level of interleukin-18 (IL-18) in the peripheral blood of herpes zoster patients and the severity of postherpetic neuralgia (PHN) and to evaluate its early warning value for PHN. Methods A total of 403 herpes zoster patients who visited the Department of Dermatology at Anhui Provincial Hospital from September 2023 to August 2024 were selected as the observation group, and 226 physical examination subjects during the same period were selected as the control group. The patients were followed up for 3 months to evaluate the occurrence and severity of PHN. According to the presence or absence of PHN, the patients were divided into PHN group (n=157) and non-PHN group (n=246), and the difference in peripheral blood IL-18 levels between the two groups was compared. Univariate and multivariate logistic regression analysis were used to screen the risk factors of PHN. Spearman rank correlation analysis was used to explore the correlation between the severity of PHN and IL-18. ROC curve was used to evaluate the predictive value of IL-18 for PHN. Results The peripheral blood IL-18 level in the herpes zoster group was significantly higher than that in the healthy control group (P < 0.05). As the severity of PHN increased, IL-18 levels were significantly elevated compared to the non-PHN group (P < 0.001). Multivariate logistic regression analysis showed that high IL-18 level, female, old age, diabetes, cardiovascular disease, and high VAS score were independent risk factors for PHN. Use of analgesics within 14 days was a protective factor against PHN. Spearman ' s analysis showed a positive correlation between PHN severity and IL-18 levels (r=0.661, P < 0.001). The ROC curve showed that the AUC for IL-18 in predicting PHN was 0.857, with a sensitivity of 83.9%, specificity of 76.8%, and an optimal cutoff value of 1 233.6 pg/mL. Conclusion Peripheral blood IL-18 levels during the acute phase of herpes zoster are closely associated with the severity of PHN. IL-18 is one of the risk factors for PHN and has good early warning value for PHN.
- Herpes zoster /
- Postherpetic neuralgia /
- Interleukin-18

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图 1 外周血IL-18水平预测带状疱疹患者PHN的ROC曲线

Figure 1. The ROC curve of IL-18 level in peripheral blood for predicting PHN in patients with herpes zoster

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表 1 观察组和对照组一般资料及IL-18水平比较

Table 1. Comparison of general data and IL-18 levels between the observation group and the control group

组别	例数	性别[例(%)]		年龄 [M(P₂₅, P₇₅)，岁]	糖尿病 [例(%)]	心血管疾病 [例(%)]	肝肾功能损伤 [例(%)]	恶性肿瘤 [例(%)]	IL-18 (x±s，pg/mL)
组别	例数	女性	男性	年龄 [M(P₂₅, P₇₅)，岁]	糖尿病 [例(%)]	心血管疾病 [例(%)]	肝肾功能损伤 [例(%)]	恶性肿瘤 [例(%)]	IL-18 (x±s，pg/mL)
观察组	403	236(58.56)	167(41.44)	58(45.00, 68.00)	34(8.44)	45(11.17)	23(5.71)	43(10.67)	1 087.84±395.46
对照组	226	125(55.31)	101(44.69)	56(44.00, 68.00)	16(7.08)	29(12.83)	11(4.87)	33(14.60)	629.17±199.44
统计量		0.626^a		-1.184^b	0.364^a	0.387^a	0.200^a	2.107^a	16.308^c
P值		0.429		0.237	0.546	0.534	0.655	0.147	＜0.001
注: ^a为χ²值, ^b为Z值, ^c为t值。

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表 2 变量赋值情况

Table 2. Variable assignment

变量	赋值方法
性别	男性=1，女性=0
年龄	连续性变量，以实际值赋值
发病部位	肩颈部及上肢=1，头面部=2，胸背部=3，腰腹部及下肢=4
糖尿病	有=1，无=0
心血管疾病	有=1，无=0
肝肾功能损伤	有=1，无=0
恶性肿瘤	有=1，无=0
前驱痛	有=1，无=0
72 h内抗病毒治疗	是=1，否=0
14 d内止痛药物治疗	是=1，否=0
急性期VAS	连续性变量，以实际值赋值
IL-18	连续性变量，以实际值赋值

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表 3 PHN影响因素的单因素logistic回归分析

Table 3. Univariate logistic regression analysis of the influencing factors of PHN

变量	B	SE	Waldχ²	P值	OR值	95% CI
男性	-0.447	0.248	3.246	0.072	0.640	0.393~1.040
年龄	0.062	0.010	41.044	＜0.001	1.064	1.044~1.085
发病部位
头面部	-0.068	0.426	0.025	0.873	0.934	0.405~2.155
胸背部	-0.049	0.398	0.015	0.903	0.953	0.437~2.076
腰腹部及下肢	0.137	0.403	0.115	0.734	1.147	0.520~2.528
合并糖尿病	0.805	0.375	4.610	0.032	2.236	1.073~4.662
合并心血管疾病	0.922	0.331	7.775	0.005	2.516	1.315~4.811
合并肝肾功能损伤	1.203	0.436	7.630	0.006	3.331	1.418~7.824
合并恶性肿瘤	0.288	0.363	0.629	0.428	1.333	0.655~2.714
有前驱痛	0.559	0.238	5.515	0.019	1.750	1.097~2.791
72 h内使用抗病毒药物	-0.534	0.276	3.752	0.053	0.586	0.341~1.006
14 d内使用止痛药物	-0.825	0.290	8.079	0.004	0.438	0.248~0.774
急性期VAS评分	0.519	0.080	41.852	＜0.001	1.680	1.436~1.966
IL-18水平	0.004	＜0.001	73.181	＜0.001	1.004	1.003~1.005

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表 4 PHN影响因素的多因素logistic回归分析

Table 4. Multivariate logistic regression analysis of the influencing factors of PHN

变量	B	SE	Waldχ²	P值	OR值	95% CI
男性	-1.088	0.368	8.766	0.003	0.337	0.164~0.692
年龄	0.058	0.013	19.748	＜0.001	1.059	1.033~1.087
合并糖尿病	1.386	0.529	6.871	0.009	3.998	1.418~11.268
合并心血管疾病	1.065	0.505	4.442	0.035	2.900	1.077~7.807
合并肝肾功能损伤	0.669	0.600	1.245	0.265	1.952	0.603~6.325
72 h内使用抗病毒治疗	0.005	0.386	＜0.001	0.989	1.005	0.472~2.142
有前驱痛	0.364	0.340	1.144	0.285	1.439	0.739~2.803
14 d内使用止痛药物	-1.757	0.480	13.377	＜0.001	0.173	0.067~0.442
急性期VAS评分	0.325	0.111	8.520	0.004	1.384	1.113~1.722
IL-18水平	0.004	0.001	47.608	＜0.001	1.004	1.003~1.005

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