193例带状疱疹临床分析

发布时间：2018-11-07 14:55

【摘要】：背景:带状疱疹(herpes zoster,HZ)是由水痘-带状病毒(VZV)引起的急性、炎症性、病毒性皮肤病。多发于春秋两季,主要特征是群集性水疱、带状疱疹神经痛及疱疹后遗神经痛(postherpetic neuralgia,PHN)。带状疱疹的发病多数与感冒、过度疲劳、精神紧张、外伤、肿瘤、各种感染、系统性疾病等诱发因素致使机体的免疫力降低有关。免疫力低下的人群中初次感染VZV后,临床上表现为水痘或隐性感染,之后,此病毒进入皮肤的感觉神经末梢,且沿着脊髓后根或三叉神经节的神经纤维向中心移动,持久地潜伏于脊髓后根神经节的神经元中,在各种诱发刺激的作用下使之活动,潜伏的病毒再次激活,生长繁殖,导致被侵袭的神经节发炎坏死,产生神经疼痛。目的:本文对带状疱疹住院患者的一般资料及临床特点进行分析,探讨带状疱疹的可能病因及相关因素。方法:本研究对2009～2010年的193例带状疱疹患者进行回顾性分析,总结发病年龄、发病诱因、季节特点、皮损分布、病情分型、自觉症状、实验室检查、并发症、治疗情况等。结果: 1、一般资料:符合诊断的带状疱疹患者193例,其中男性82例,女性111例,男女比例为0.74:1。16～45岁37例,46～60岁43例,61～90岁113例。发病以春秋两季居多。 2、发病诱因:发病前有疲劳、情绪波动、精神紧张、工作压力大等情况24例,生活不规律者9例,有上呼吸道感染史者4例,曾施行手术者16例,有肺部疾病(如肺炎)病史者6例,并发两种以上疾病者14例。住院期间查出伴发泌尿系肿瘤4例。30例无明确的诱因。 3、临床特点: 1)皮损分布特点面三叉神经分布区44例,胸肋神经分布区56例,腰腹神经分布区50例,颈肩、上肢区28例,臀部、下肢区15例。 2)临床分型寻常型169例、大疱型带状疱疹7例、泛发型带状疱疹5例、眼带状疱疹5例、耳带状疱疹2例、出血型带状疱疹5例。 3)自觉症状自觉疼痛患者148例,56例严重影响睡眠。30岁以下患者多为轻度疼痛,31至50岁患者多为轻中度疼痛,50岁以上患者疼痛较为剧烈。先有神经痛后起疱疹者114例,先有发疹后出现神经痛者43例,发疹和疼痛同时出现者36例。 4)实验室检查白细胞计数不同程度的降低和(或)淋巴细胞比例升高108例,单核细胞升高55例。7例患者行外周血T淋巴细胞亚群检测,异常6例。其中CD4下降4例、CD8升高2例,CD4/CD8均有下降。 5)34例患者有不同程度的发热。6例皮损部位并发感染。3例并发口周病毒性疱疹,1例皮损侧并发青光眼,4例并发眼部病毒性结膜炎,2例为Ramsay-Hunt综合征。82例患者有不同程度的心脑血管疾病。4例患者在入院期间行腹部及泌尿系超声查出泌尿系肿瘤。 4、治疗:给予常规抗病毒、营养神经、调节免疫力、局部外用药、微波、针灸、拔罐等治疗。疱疹较重、疼痛剧烈患者加用重组人干扰素α-2b注射液日一次肌注,如无持续高热可连用七天。对于年龄稍大、头面部、面积较大、疼痛明显的带状疱疹患者查无激素应用禁忌症早期加用地塞米松(5～10mg)静点,神经痛缓解后减量。结论:带状疱疹为常见病毒性皮肤疾病,好发于春秋两季,带状疱疹发病率随年龄增大而增加。临床表现多样,症状轻重与年龄及体质有关。对明确诊断为带状疱疹的患者应尽早治疗。对头面部或重症老年带状疱疹患者应早期少量使用糖皮质激素能减轻炎症和神经痛及预防带状疱疹后遗神经痛的发生。同时进行系统检查,排除或发现其它慢性消耗性疾病如肿瘤等可能性。
[Abstract]:BACKGROUND: The herpes zoster (HZ) is acute, inflammatory and viral skin disease caused by varicella-like virus (VZV). The main characteristics of the two seasons in the spring and autumn are cluster blisters, herpetic neuralgia and postherpetic neuralgia (PHN). The incidence of herpes zoster is related to the reduction of the immunity of the body due to the factors such as common cold, excessive fatigue, mental stress, trauma, tumor, various infections and systemic diseases. After the initial infection of VZV in the low-immunity population, the clinical performance is varicella or recessive infection, after which the virus enters the sensory nerve terminal of the skin and moves to the center along the nerve fiber of the posterior root or the trigeminal ganglion of the spinal cord, Lasting in the neurons of the root ganglion of the spinal cord, the latent virus is activated again under the action of various induced stimulation, and the latent virus is activated again, and the growth and reproduction result in the inflammation and necrosis of the affected ganglion and the generation of nerve pain. Objective: In this paper, the general data and clinical characteristics of the patients with herpes zoster are analyzed, and the possible causes and related factors of herpes zoster are discussed. Methods: A retrospective analysis of 193 patients with herpes zoster from 2009 to 2010 was carried out in this study. The age of the onset, the cause of the occurrence, the characteristics of the season, the distribution of the lesions, the classification of the disease, the symptoms of the disease, the laboratory examination and the complications were summarized. treatment Results: 1. General data: 193 cases of patients with herpes zoster, including 82 males and 111 females, with a male ratio of 0.74: 1.16 to 45, and 43 in 46 to 60 years of age., 61 to 90, 113 2. The onset of the disease was the most frequent in the Spring and Autumn period. 2. The cause of the disease: there were 24 cases of fatigue, emotional fluctuation, mental stress, high working pressure, 9 cases of non-regular life, 4 cases of upper respiratory tract infection, 16 cases of operation, and 16 cases of operation. Medical history of pulmonary disease (e.g., pneumonia) 6 14 patients with more than two diseases. Urinary system was found during the hospitalization. 4 cases of tumor 30 3. Clinical characteristics: 1) The distribution of the skin lesions: 44 cases of the trigeminal distribution area, 56 cases of the thoracic rib nerve distribution area and 50 cases of the lumbar and abdominal nerve distribution area. (2) There were 169 cases of common type, 7 cases of blister type, 5 cases of pan-type herpes zoster, and 4 eyes. 5 cases of herpes simplex, 2 cases of ear herpes zoster, 5 cases of blood type herpes zoster. 3) 148 cases of self-conscious patients with self-conscious pain and 56 serious effects on sleep. The patients under 30 years of age were mild pain and 31 to 31. The 50-year-old patients have mild and moderate pain, and the pain of the patients over 50 years of age is more severe. The number of white blood cells in the laboratory was decreased and/ or the proportion of lymphocytes increased in 108 cases, and the mononuclear cells were fine. The peripheral blood T-lymphocyte subgroup was detected in the peripheral blood of 7 patients and abnormal in 6 cases. Among them, CD4 decreased in 4, CD8 increased in 2, and CD4/ CD8 were all decreased. 5) 34 patients had different degrees of fever. nt-syndrome. 82 of the 82 patients had different degrees. the treatment of cardiovascular and cerebrovascular diseases in 4 patients with abdominal and urinary system ultrasound during the hospital admission. 4. Treatment: It can be used for the treatment of conventional anti-virus, nutritional nerve, regulating immunity, topical external use, microwave, acupuncture, cupping, etc. The recombinant human interferon-2b-2b injection daily intramuscular injection, such as the non-persistent hyperpyrexia, can be used for seven days. For patients with a slightly larger age, head face, large area, and obvious pain, the patients with herpes zoster The contraindications for hormone-free application were treated with dexamethasone (5-10 mg) in the early stage, and decreased after the neuralgia was relieved. Conclusion: Herpes zoster is a common viral skin disease, which is good for spring and autumn The incidence of herpes zoster increased with age in both seasons. The clinical manifestations are various and the severity of the symptoms is related to the age and body constitution. The patients who are clearly diagnosed as herpes zoster should be treated as soon as possible. Patients should use a small amount of corticosteroids early in order to reduce inflammation and neuralgia and to prevent the occurrence of herpes zoste
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R752.12

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