糖尿病与焦虑交互作用对带状疱疹患者神经痛发生风险的影响

doi:10.3969/j.issn.1006-5725.2025.23.011

Abstract

Abstract:

Objective The aim of this study was to investigate the impact of the interaction between diabetes mellitus and anxiety on the risk of developing postherpetic neuralgia in patients with herpes zoster （HZ）. Methods The clinical data of 206 HZ patients admitted to our hospital from December 2020 to December 2024 were retrospectively collected. All patients were followed up for 6 months after treatment and then divided into the occurrence group （n = 47） and the non-occurrence group （n = 159） based on whether postherpetic neuralgia occurred. The clinical data between the two groups were compared. Multivariate Logistic regression analysis was used to explore the relationship between diabetes mellitus， anxiety and the risk of neuralgia in HZ patients. The Excel spreadsheet developed by Andersson was used to calculate the relative excess risk due to interaction （RERI）， attributable proportion due to interaction （AP）， and synergy index （S）. Receiver operating characteristic （ROC） curves were plotted to analyze the value of each indicator alone and in combination in predicting the risk of neuralgia in HZ patients. Results There were statistically significant differences between the two groups in terms of age， coexisting T2DM， skin lesion area， Generalised Anxiety Disorder-7 （GAD-7） score， and Patient Health Questionnaire-9 （PHQ-9） score （P < 0.05）. Multivariate logistic regression analysis revealed that both T2DM and GAD-7 scores were independent risk factors for neuropathic pain in HZ patients （P < 0.05）. Without adjusting for other variables， there was a multiplicative interaction between T2DM and GAD-7 scores ≥ 5 （P < 0.05）. However， after adjusting for confounding factors such as age， skin lesion area， and HAMD scores， no multiplicative interaction was observed between the two （P > 0.05）. There was an additive interaction between T2DM and a GAD-7 score ≥ 5； when both were present， the risk of neuropathic pain in HZ patients was significantly higher than in patients without T2DM and a GAD score < 5. The risk of neuropathic pain in HZ patients with both conditions was higher than the sum of the risks from either condition alone， with a synergistic effect 23.05 times greater than the sum of the effects of either condition alone； When both conditions coexist， 81.70% of the risk of neuropathic pain is attributable to their synergistic effect； the combined predictive value of diabetes and anxiety for the risk of neuropathic pain in HZ patients is higher than that of either condition alone （ZT2DM vs. combination = 2.230， ZGAD-7 score vs. combination = 3.088， P < 0.05）. Conclusion Diabetes mellitus and anxiety have an additive interaction. When both are present， the risk of neuralgia in HZ patients increases， and combined assessment can provide a certain reference for predicting neuralgia in HZ patients.

Key words: diabetes mellitus, anxiety, interaction, herpes zoster, neuralgia

CLC Number:

R752.1

Ling ZOU,Qian WEN,Jianqin. CHEN. The impact of the interaction between diabetes mellitus and anxiety on the risk of neuralgia in patients with herpes zoster[J]. The Journal of Practical Medicine, 2025, 41(23): 3704-3710.

Figures/Tables 7

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Fig.2

References 30

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因素	单因素分析			多因素分析
因素	OR	95%CI	P值	OR	95%CI	P值
年龄	2.003	1.007 ~ 3.985	0.048	1.876	0.864 ~ 4.074	0.112
合并T2DM	3.782	1.854 ~ 7.717	< 0.001	2.884	1.331 ~ 6.247	0.007
皮损面积	2.124	1.026 ~ 4.396	0.042	2.170	0.955 ~ 4.931	0.064
GAD-7评分	4.471	2.080 ~ 9.609	< 0.001	4.461	1.948 ~ 10.220	< 0.001
PHQ-9评分	2.284	1.174 ~ 4.444	0.015	1.882	0.898 ~ 3.944	0.094

自变量（交互项）	模型1		模型2
自变量（交互项）	OR（95%CI）	P值	OR（95%CI）	P值
合并T2DM	4.007（0.444 ~ 36.164）	0.116	1.884（0.129 ~ 27.507）	0.146
GAD-7评分≥ 5分	5.201（0.700 ~ 38.646）	0.109	4.798（0.588 ~ 39.159）	0.112
合并T2DM × GAD-7评分≥ 5分	5.844（1.059 ~ 32.251）	0.043	0.437（0.067 ~ 2.861）	0.068

合并T2DM	GAD-7评分	模型1		模型2
合并T2DM	GAD-7评分	OR（95%CI）	P值	OR（95%CI）	P值
否	< 5分	Ref.		Ref.
否	≥ 5分	1.680（0.743 ~ 3.798）	0.129	1.699（0.741 ~ 3.892）	0.134
是	< 5分	1.120（0.315 ~ 3.980）	0.357	0.791（0.105 ~ 3.728）	0.425
是	≥ 5分	9.786（3.893 ~ 24.598）	< 0.001	8.158（2.862 ~ 23.251）	0.002
RERI		7.986（-1.257 ~ 17.229）		6.668（-2.097 ~ 15.433）
AP		0.816（0.389 ~ 2.021）		0.817（0.553 ~ 2.187）
S		35.060（7.765 ~ 158.300）		23.053（3.211 ~ 165.500）

指标	AUC	标准误	95%CI	P值	约登指数	敏感度/%	特异度/%
合并T2DM	0.657^a	0.045	0.588 ~ 0.722	< 0.001	0.315	72.34	59.12
GAD-7评分	0.667^a	0.043	0.598 ~ 0.731	< 0.001	0.334	78.72	54.72
联合	0.759	0.037	0.694 ~ 0.815	< 0.001	0.382	59.57	78.62
Z_{合并T2DM~联合}	2.230
Z_{GAD-7评分~联合}	3.088

The impact of the interaction between diabetes mellitus and anxiety on the risk of neuralgia in patients with herpes zoster

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