193例帶狀皰疹臨床分析
發(fā)布時間：2018-11-07 14:55
【摘要】：背景:帶狀皰疹(herpes zoster,HZ)是由水痘-帶狀病毒(VZV)引起的急性、炎癥性、病毒性皮膚病。多發(fā)于春秋兩季,主要特征是群集性水皰、帶狀皰疹神經(jīng)痛及皰疹后遺神經(jīng)痛(postherpetic neuralgia,PHN)。帶狀皰疹的發(fā)病多數(shù)與感冒、過度疲勞、精神緊張、外傷、腫瘤、各種感染、系統(tǒng)性疾病等誘發(fā)因素致使機體的免疫力降低有關(guān)。免疫力低下的人群中初次感染VZV后,臨床上表現(xiàn)為水痘或隱性感染,之后,此病毒進入皮膚的感覺神經(jīng)末梢,且沿著脊髓后根或三叉神經(jīng)節(jié)的神經(jīng)纖維向中心移動,持久地潛伏于脊髓后根神經(jīng)節(jié)的神經(jīng)元中,在各種誘發(fā)刺激的作用下使之活動,潛伏的病毒再次激活,生長繁殖,導(dǎo)致被侵襲的神經(jīng)節(jié)發(fā)炎壞死,產(chǎn)生神經(jīng)疼痛。 目的:本文對帶狀皰疹住院患者的一般資料及臨床特點進行分析,探討帶狀皰疹的可能病因及相關(guān)因素。 方法:本研究對2009～2010年的193例帶狀皰疹患者進行回顧性分析,總結(jié)發(fā)病年齡、發(fā)病誘因、季節(jié)特點、皮損分布、病情分型、自覺癥狀、實驗室檢查、并發(fā)癥、治療情況等。 結(jié)果: 1、一般資料:符合診斷的帶狀皰疹患者193例,其中男性82例,女性111例,男女比例為0.74:1。16～45歲37例,46～60歲43例,61～90歲113例。發(fā)病以春秋兩季居多。 2、發(fā)病誘因:發(fā)病前有疲勞、情緒波動、精神緊張、工作壓力大等情況24例,生活不規(guī)律者9例,有上呼吸道感染史者4例,曾施行手術(shù)者16例,有肺部疾病(如肺炎)病史者6例,并發(fā)兩種以上疾病者14例。住院期間查出伴發(fā)泌尿系腫瘤4例。30例無明確的誘因。 3、臨床特點: 1)皮損分布特點面三叉神經(jīng)分布區(qū)44例,胸肋神經(jīng)分布區(qū)56例,腰腹神經(jīng)分布區(qū)50例,頸肩、上肢區(qū)28例,臀部、下肢區(qū)15例。 2)臨床分型尋常型169例、大皰型帶狀皰疹7例、泛發(fā)型帶狀皰疹5例、眼帶狀皰疹5例、耳帶狀皰疹2例、出血型帶狀皰疹5例。 3)自覺癥狀自覺疼痛患者148例,56例嚴重影響睡眠。30歲以下患者多為輕度疼痛,31至50歲患者多為輕中度疼痛,50歲以上患者疼痛較為劇烈。先有神經(jīng)痛后起皰疹者114例,先有發(fā)疹后出現(xiàn)神經(jīng)痛者43例,發(fā)疹和疼痛同時出現(xiàn)者36例。 4)實驗室檢查白細胞計數(shù)不同程度的降低和(或)淋巴細胞比例升高108例,單核細胞升高55例。7例患者行外周血T淋巴細胞亞群檢測,異常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發(fā)熱。6例皮損部位并發(fā)感染。3例并發(fā)口周病毒性皰疹,1例皮損側(cè)并發(fā)青光眼,4例并發(fā)眼部病毒性結(jié)膜炎,2例為Ramsay-Hunt綜合征。82例患者有不同程度的心腦血管疾病。4例患者在入院期間行腹部及泌尿系超聲查出泌尿系腫瘤。 4、治療:給予常規(guī)抗病毒、營養(yǎng)神經(jīng)、調(diào)節(jié)免疫力、局部外用藥、微波、針灸、拔罐等治療。皰疹較重、疼痛劇烈患者加用重組人干擾素α-2b注射液日一次肌注,如無持續(xù)高熱可連用七天。對于年齡稍大、頭面部、面積較大、疼痛明顯的帶狀皰疹患者查無激素應(yīng)用禁忌癥早期加用地塞米松(5～10mg)靜點,神經(jīng)痛緩解后減量。 結(jié)論:帶狀皰疹為常見病毒性皮膚疾病,好發(fā)于春秋兩季,帶狀皰疹發(fā)病率隨年齡增大而增加。臨床表現(xiàn)多樣,癥狀輕重與年齡及體質(zhì)有關(guān)。對明確診斷為帶狀皰疹的患者應(yīng)盡早治療。對頭面部或重癥老年帶狀皰疹患者應(yīng)早期少量使用糖皮質(zhì)激素能減輕炎癥和神經(jīng)痛及預(yù)防帶狀皰疹后遺神經(jīng)痛的發(fā)生。同時進行系統(tǒng)檢查,排除或發(fā)現(xiàn)其它慢性消耗性疾病如腫瘤等可能性。
[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
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R752.12
本文編號：2316714
[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
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R752.12
【參考文獻】
相關(guān)期刊論文 前10條
1 昂正斌;;100例帶狀皰疹臨床分析[J];安徽醫(yī)藥;2008年09期
2 龍曉燕;卡介菌多糖核酸在帶狀皰疹治療中的作用[J];華夏醫(yī)學(xué);2004年01期
3 申文江;放射治療與帶狀皰疹[J];國外醫(yī)學(xué)(腫瘤學(xué)分冊);1981年04期
4 孫廣州;;中醫(yī)辨證治療帶狀皰疹64例[J];河南中醫(yī)學(xué)院學(xué)報;2006年06期
5 王敬東,雷蕾,劉玉芳;西米替丁治療病毒感染性疾病現(xiàn)狀[J];遼寧醫(yī)學(xué)雜志;1997年06期
6 王芳;457例帶狀皰疹臨床分析[J];中國麻風皮膚病雜志;2003年02期
7 徐春興,蔣誠,邱國強,吳浩清;帶狀皰疹患者外周血T淋巴細胞亞群及NK細胞分析[J];皮膚病與性病;2000年02期
8 王棟華;;龍膽瀉肝湯加減治療肝膽濕熱型帶狀皰疹[J];山西中醫(yī);2007年01期
9 仲立軍,劉淑延,劉洪慶;轉(zhuǎn)移因子治療帶狀皰疹50例分析[J];社區(qū)醫(yī)學(xué)雜志;2004年05期
10 曹淑芳;高錳酸鉀液外涂治療帶狀皰疹[J];山西護理雜志;1999年04期
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