基于倾向值匹配法分析带状疱疹并发面瘫的危险因素-东南大学学报医学版

基于倾向值匹配法分析带状疱疹并发面瘫的危险因素

单位：1. 安庆市中医医院介入疼痛科, 安徽安庆 246052;
2. 安庆市中医医院神经外科, 安徽安庆 246052;
3. 安庆市中医医院皮肤科, 安徽安庆 246052

分类号：R752.12

出版年·卷·期（页码）：2023·42·第四期（627-632）

摘要：

目的:基于倾向值匹配法探讨带状疱疹并发面瘫的危险因素。方法:回顾性分析2018年5月至2022年7月本院收治的371例带状疱疹患者临床资料,根据是否并发面瘫将其分为并发组(n=63)与未并发组(n=308)。采用倾向值匹配法对两组患者(性别、年龄等)进行1：1匹配。比较匹配前、匹配后两组患者一般资料,采用单因素及多因素Logistic回归分析法分析匹配后带状疱疹患者并发面瘫的危险因素。结果:经1：1倾向值匹配法匹配,共有55对成功配对,匹配后并发组与未并发组性别、年龄、发病至入院时间、入院时疼痛视觉模拟量表(VAS)评分、高血压、糖尿病、高脂血症、吸烟史、饮酒史比较差异均无统计学意义(P＞0.05),并发组耳带状疱疹占比、入院时疱液水痘-带状疱疹病毒(VZV) DNA载量及入院时血清P物质(SP)、白细胞介素(IL)-1β、IL-6、肿瘤坏死因子α(TNF-α)、基质金属蛋白酶9(MMP-9)水平均高于未并发组(P＜0.05),入院时免疫球蛋白E(IgE)水平低于未并发组(P＜0.05);经Pearson相关性分析,匹配后血清SP与IL-1β、IL-6、TNF-α呈正相关(P＜0.05),血清IL-1β与IL-6、TNF-α呈正相关(P＜0.05),血清IL-6与TNF-α呈正相关(P＜0.05);经单因素分析,耳带状疱疹、入院时疱液VZV DNA载量及入院时血清SP、IL-1β、IL-6、TNF-α、MMP-9均是带状疱疹患者并发面瘫的危险因素(P＜0.05),IgE是其保护因素(P＜0.05);经多因素Logistic回归分析,耳带状疱疹、入院时疱液VZV DNA载量及血清TNF-α、MMP-9均是带状疱疹患者并发面瘫的独立危险因素(OR值分别为4.716、3.466、3.401、2.447,均P＜0.05),而IgE是其独立保护因素(OR=0.435,P＜0.05)。结论:耳带状疱疹、入院时疱液VZV DNA载量及血清TNF-α、MMP-9均是带状疱疹并发面瘫的独立危险因素,IgE是独立保护因素,应加强相关指标的监测及对应干预。

Objective: To explore the risk factors of herpes zoster complicated with facial paralysis based on propensity value matching method. Methods: The clinical case data of 371 patients with herpes zoster admitted to our hospital from May 2018 to July 2022 were retrospectively analyzed, and they were divided into a concurrent group(n=63) and a non-concurrent group(n=308) according to whether complicated with facial paralysis. The patients(gender, age, etc.) in the concurrent group and non-concurrent group were matched 1:1 by propensity value matching method. The general data of patients in the two groups before and after matching were compared, and univariate and multivariate logistic regression analysis methods were used to analyze the risk factors of facial paralysis in matched patients with herpes zoster. Results: After 1:1 propensity value matching method, 55 pairs were successfully matched. After matching, there was no significant difference in gender, age, time from onset to admission, visual analogue scale(VAS) score of pain at admission, hypertension, diabetes, hyperlipidemia, smoking history and drinking history between the concurrent group and non-concurrent group(P>0.05), but the proportion of herpes zoster oticus, DNA load of varicella zoster virus(VZV) in vesicular fluid at admission and levels of serum substance P(SP), interleukin(IL)-1β, IL-6, tumor necrosis factor α(TNF-α) and matrix metalloproteinase 9(MMP-9) at admission of the concurrent group were higher than those in the non-concurrent group(P<0.05), and the level of immunoglobulin E(IgE) at admission was lower than that in the non-concurrent group(P<0.05). Pearson correlation analysis showed that serum SP was positively correlated with IL-1β, IL-6 and TNF-α after matching(P<0.05), and serum IL-1β was positively correlated with IL-6 and TNF-α(P<0.05), and serum IL-6 was positively correlated with TNF-α(P<0.05). By univariate analysis, the herpes zoster oticus, VZV DNA load in vesicular fluid at admission and serum SP, IL-1β, IL-6, TNF-α and MMP-9 at admission were risk factors for facial paralysis in herpes zoster patients(P<0.05), and IgE was a protective factor for it(P<0.05). By multivariate Logistic regression analysis, herpes zoster oticus, VZV DNA load in vesicular fluid at admission and serum TNF-α and MMP-9 at admission were independent risk factor for facial paralysis in herpes zoster patients(OR=4.716, 3.466, 3.401, 2.447, P<0.05), while IgE was an independent protective factor(OR=0.435, P<0.05). Conclusion: Herpes zoster oticus, VZV DNA load in vesicular fluid at admission and serum TNF-α and MMP-9 are independent risk factor for herpes zoster complicated with facial paralysis, while IgE is an independent protective factor. The monitoring of relevant indicators and corresponding intervention should be strengthened.

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