获得性免疫缺陷综合征合并头面部带状疱疹病毒感染临床分析

AIDS-related varicella-zoster virus infection in the head and face area

目的总结获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)患者头面部带状疱疹感染的临床特点及转归。方法将2017年4月~2018年1月在北京地坛医院住院的39例AIDS合并头面部带状疱疹病例作为AIDS组,22例不合并AIDS的带状疱疹病例作为对照组,对其发病年龄、临床表现、实验室检查和转归进行比较。结果 20%患者在未知AIDS感染的情况下因带状疱疹症状就诊。AIDS患者的发病年龄(44±12.64)岁显著低于对照组(55.13±16.44)岁。AIDS组耳廓皮肤黏膜均受累,面瘫20例(51%)皮肤黏膜泛发14例(35%)复发12例(30%),显著高于单纯带状疱疹组。皮疹发生时CD4阳性淋巴细胞均值为(96.30±130.08)个/μl。单纯带状疱疹患者CD4阳性淋巴细胞均值为(601.13±257.27)个/μl。两者间具有显著差异且均显著低于健康人群。AIDS患者28.20%同时伴有真菌感染、43.59%同时伴有结核感染、28.20%巨细胞病毒或/和单纯疱疹病毒的多发病毒感染,与对照组具有显著差异。两组带状疱疹后神经痛的发病率未见显著差异。除A I DS组1例死亡外,其余患者全部治疗好转出院。结论带状疱疹感染的AIDS患者总体处于AIDS发病期的早期阶段,相对单纯带状疱疹患者,AIDS患者发病年龄低,感染呈泛发性和复发性,常合并其他机会性感染,抗病毒治疗条件下,也可因病毒内脏播散导致死亡,但总体死亡率与对照组无显著差异。带状疱疹后神经痛的发病率未见增加。

OBJECTIVE To summarize the clinical features of herpes zoster infection in head and face area in patients with acquired immunodeficiency syndrome(AIDS).METHODS From April 2017 to January 2018, 39 cases of AIDS complicated with herpes zoster infection in head and face area treated Beijing Ditan Hospital were taken as AIDS group and 22 cases of herpes zoster infection without AIDS as control group. Clinical symptom, laboratory examination and outcome were retrospectively analyzed. RESULTS Twenty percent of patients were diagnosed as herpes zoster infection with unknown AIDS infection. The onset age of AIDS patients was significantly lower than that of the control group(average age 44±12.64 vs 55.13±16.44). In AIDS group,facial paralysis were found in 20 cases(51%),generalized skin and mucosal infection in 14 cases(35%)and recurrence in 12 cases(30%), which was significantly higher than that in control group. The mean value of CD4 positive lymphocytes in patients with AIDS was(96.30±130.08)/μl and(601.13±257.27)/μl in controls. There was a significant difference between the two groups and both were significantly lower than the healthy population.28.20% of AIDS patients were accompanied with fungal infection, 43.59% with tuberculosis infection, and 28.20%with multiple virus infection(cytomegalovirus or/and herpes simplex virus), which was significantly different from the control group. There was no significant difference in the incidence of neuralgia after treatment between the two groups. With the exception of one death in the AIDS group,all the patients were cured and discharged. CONCLUSION AIDS patients with Varicella-zoster virus infection are in the early stage of the onset of AIDS. Compared with the patients without AIDS, the AIDS patients have a younger onset age, with generalized and recurrent infections, and are often associated with other opportunistic infections. Under antiviral treatment, death can also be caused by the spread of the virus to undefined viscera. There was no increase in the incidence of postherpetic neuralgia.