老年带状疱疹患者临床特点分析

Analysis of clinical characteristics of elderly patients with herpes zoster

目的分析老年带状疱疹患者的临床特征,为老年带状疱疹的预防和治疗提供依据。方法采用回顾性分析方法,对2018年1月—2023年8月复旦大学附属华山医院皮肤科收治的260例老年带状疱疹患者的临床资料进行分析。结果260例患者中,最常见的诱发因素是劳累,共45例(17.31%);最易发病部位为三叉神经支配区域,共100例(38.46%);疼痛性质多种多样,急性期疼痛以中重度疼痛为主,共169例(65.00%),其中139例(53.46%)患者皮疹发生前已感受到疼痛;合并症主要有高血压106例(40.77%)、糖尿病39例(15.00%)和恶性肿瘤17例(6.54%);8例患者早期被误诊,误诊率为3.08%;最常见且最严重的并发症为后遗神经痛,共51例(19.62%)。进一步分析发现,患者的年龄、急性疼痛的程度、发疹后启动治疗的时间、合并恶性肿瘤是老年人后遗神经痛发生的独立危险因素(P均<0.05)。结论老年带状疱疹患者发病率高、症状重、合并症多,容易发生后遗神经痛,应尽早进行诊断和个体化治疗,减少并发症发生,提高生活质量。

Objective To analyze the clinical characteristics of elderly patients with herpes zoster,and provide a basis for the prevention and treatment of herpes zoster.Methods A retrospective analysis method was used to analyze the clinical data of 260 elderly patients with herpes zoster admitted to Department of Dermatology of Huashan Hospital Affiliated to Fudan University from January 2018 to August 2023.Results Among 260 patients,the most common triggering factor was fatigue,with a total of 45 cases(17.31%);the most susceptible site of the disease was the area innervated by the trigeminal nerve,with a total of 100 cases(38.46%).The nature of pain was diverse.The degree of pain was mainly moderate to severe during the acute phase,with a total of 169 cases(65.00%),of which 139 cases(53.46%)had already felt pain before the onset of rash.The main complications included 106 cases of hypertension(40.77%),39 cases of diabetes(15.00%)and 17 cases of malignant tumors(6.54%).8 patients were misdiagnosed early,and the misdiagnosis rate was 3.08%.The most common and severe complication was postherpetic neuralgia,with a total of 51 cases(19.62%).Further analysis showed that the age,degree of acute pain,time to initiate treatment after rash onset,and concomitant malignant tumor were independent risk factors for the occurrence of posthumous neuralgia in the elderly(all P<0.05).Conclusion Elderly patients with herpes zoster have a high incidence,severe symptoms and more complications,and they are prone to posthumous neuralgia.Therefore,early diagnosis and individualized treatment should be carried out to reduce the occurrence of complications and improve quality of life.