Table 3_Risk factors for postherpetic neuralgia: a meta-analysis based on demographic, clinical features, and treatment characteristics.docx

BackgroundThis study aims to comprehensively analyze the independent risk factors of postherpetic neuralgia (PHN) through a systematic evaluation, including demographic characteristics, clinical manifestations, treatment regimens, comorbidities, and virological factors, in order to provide evidence-based support for the early identification of high-risk patients and the optimization of preventive strategies in clinical practice.
MethodA systematic search of PubMed, Embase, and the Cochrane Library was conducted to identify studies reporting risk factors for PHN. After screening the literature according to predefined inclusion and exclusion criteria, effect size indicators such as odds ratios (OR) and 95% confidence intervals (95% CI) for each risk factor were extracted. Meta-analyses were performed using RevMan 5.4 and Stata 15.0 software, with a random-effects model applied to pool effect sizes. Publication bias was assessed using Egger’s test, and sensitivity analysis was conducted by sequentially removing individual studies to verify the robustness of the result.
ResultsAge (≥60 years), severe rash manifestations, prodromal pain symptoms, smoking history, alcohol abuse, immunosuppressive status, and comorbidities including diabetes mellitus, chronic obstructive pulmonary disease (COPD), hypertension, malignant tumors, or chronic kidney disease, along with high viral load, have been identified as independent risk factors for the development of PHN(p<0.05). In contrast, gender differences and socioeconomic status were not significantly associated with PHN incidence, with insufficient evidence observed (I²>50%, p>0.05).
ConclusionThis meta-analysis confirms that older age (≥60 years), severe rash, prodromal pain, immunosuppressive therapy, and smoking are significant risk factors for PHN. Furthermore, it identifies alcohol abuse, T2DM, COPD, hypertension, cancer, high pain scores (as measured by VAS or NRS), and high HZ viral load as additional risk factors. COVID-19 may represent a potential risk factor that must be further investigated. The association between socioeconomic status and PHN remains inconclusive, while antibody levels against varicella-zoster virus (VZV) may serve as a protective factor.
Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42025629699.

背景 本研究旨在通过系统评价全面分析带状疱疹后神经痛（postherpetic neuralgia, PHN）的独立危险因素，涵盖人口统计学特征、临床表现、治疗方案、合并症及病毒学因素，以期为临床实践中高危患者的早期识别与预防策略优化提供循证依据。

方法 系统检索PubMed、Embase及Cochrane图书馆数据库，以筛选报道PHN危险因素的相关研究。依据预先设定的纳入与排除标准对文献进行筛查后，提取各危险因素的效应量指标，包括比值比（odds ratios, OR）及95%置信区间（95% confidence intervals, 95% CI）。采用RevMan 5.4与Stata 15.0软件开展荟萃分析，运用随机效应模型合并效应量。采用Egger检验评估发表偏倚，并通过逐一剔除单项研究进行敏感性分析，以验证结果的稳健性。

结果 年龄≥60岁、严重皮疹表现、前驱疼痛症状、吸烟史、酒精滥用、免疫抑制状态，以及糖尿病、慢性阻塞性肺疾病（chronic obstructive pulmonary disease, COPD）、高血压、恶性肿瘤、慢性肾脏病等合并症，联合高病毒载量，均被确定为PHN发生的独立危险因素（p<0.05）。与之相反，性别差异与社会经济地位与PHN发生率无显著关联，现有证据尚不充分（I²>50%，p>0.05）。

结论 本项荟萃分析证实，高龄（≥60岁）、严重皮疹、前驱疼痛、免疫抑制治疗及吸烟是PHN的重要危险因素。此外，本研究还明确了酒精滥用、2型糖尿病（Type 2 Diabetes Mellitus, T2DM）、COPD、高血压、恶性肿瘤、以视觉模拟评分法（Visual Analogue Scale, VAS）或数字疼痛评分法（Numerical Rating Scale, NRS）评估的高疼痛评分，以及高带状疱疹（Herpes Zoster, HZ）病毒载量为额外危险因素。新型冠状病毒肺炎（COVID-19）或为潜在危险因素，有待进一步研究。社会经济地位与PHN的关联仍不明确，而水痘-带状疱疹病毒（varicella-zoster virus, VZV）抗体水平或可作为保护因素。

系统评价注册：https://www.crd.york.ac.uk/PROSPERO/，注册号CRD42025629699。