26例特殊类型带状疱疹临床特点及治疗

Clinical characteristics and treatment of 26 cases of special herpes zoster

目的探讨特殊类型带状疱疹和带状疱疹的并发症的临床症状、体征、诊断要点、及发病的相关因素。方法回顾性分析取自2014年1月～2017年12月我科门诊26例患有免疫功能低下的基础性疾病并发带状疱疹患者的临床症状和体征。结果 26例患者中眼带状疱疹3例、Ramsay Hunt综合征5例、运动性麻痹13例、多发性外周神经根炎1例、合并格林巴利综合征1例、合并脊髓炎1例、合并脑膜脑炎2例;26例患者的临床表现、体征和实验室检查均符合其诊断标准;治疗以抗病毒、免疫治疗、营养神经、止痛、防止继发感染、防止合并症的发生为原则,26例患者均预后良好。结论在带状疱疹的发生,发展和愈合过程中,人体免疫力起着至关重要的作用,患者处于免疫功能低下状态时皮损更为广泛,神经受损更严重,可出现各种周围神经或中枢神经损害的临床表现,早期干预,可减少后遗症的发生及降低死亡率。

Objective To investigate special type herpes zoster and the clinical symptoms, signs, main points of diagnosis and related factors of the morbidity of herpes zoster. Methods Retrospective analysis of clinical symptoms and signs of 26 cases of herpes zoster complicated by underlying immunocompromised diseases from January 2014 to December 2017 in our outpatient department. Results Among 26 patients, there were 3 cases of ocular herpes, 5 cases of Ramsay Hunt syndrome, 13 cases of exercise paralysis, 1 case of multiple peripheral radiculitis, 1 case of combined Guillain-Barre syndrome, 1 case of combined myelitis, and 1 case of meninges. 2 cases of encephalitis; 26 cases of clinical manifestations, signs, and laboratory examinations are in line with its diagnostic criteria; treatment is based on the principle of antiviral, immunotherapy, nutritional nerves, analgesia, prevention of secondary infection, prevention of complications, All of 26 patients had a good prognosis. Conclusion In the course of occurrence, development and healing of herpes zoster, human immunity plays a crucial role. Patients with immunocompromised lesions have more extensive lesions and more severe neurological damage,various peripheral nerves or CNS may appear the clinical manifestations of damage, early intervention can reduce the incidence of sequelae and reduce mortality.