CAJ | 학술논문

目的探讨慢性阻塞性肺疾病急性加重(AECOPD)患者住院期间继发带状疱疹(HZ)的临床特征、诊断、治疗及转归.方法回顾2008年8月至2011年7月AECOPD患者住院期间继发HZ的住院病历.结果 AECOPD住院患者中HZ发病率为0.44％(22/4276患者),男19例,年龄(69.5±7.79)岁,FEV1占预计值％为(32.73±6.07)％.15例患者AECOPD年发作次数≥2次且发病前3个月内曾口服糖皮质激素,9例合并糖尿病.临床诊断HZ前,患者已住院(15.9±4.02)d,强的松累积剂量(569.3±166.7)mg.患者均以与皮疹部位一致的急性疼痛为前驱症状,仅3例因特征性皮疹与疼痛同时出现及时诊断,19例因皮疹在疼痛(2,45±1.53)d后出现而延误诊断.本组病例均以单侧、与周围神经走向一致、呈带状分布的簇集性丘疱疹经皮肤科、耳鼻喉科会诊而临床诊断HZ.皮疹出现48～72 h内均给予阿昔洛韦或伐昔洛韦抗病毒治疗,疗程(6.5±0.85)d,显效率100％.止疼药物主要采用环氧合酶-2选择性抑制剂赛来昔布或帕瑞昔布.由于治疗及时,继发HZ的患者中仅5例再次出现AECOPD,但未出现肺性脑病等严重并发症.结论对于AECOPD患者住院期间出现的急性疼痛,鉴别诊断应考虑HZ,尤其对于AECOPD反复发作并接受全身糖皮质激素治疗的患者.根据特征性皮疹可临床诊断HZ.多学科协作是及时诊断、合理治疗继发于AECOPD的HZ的关键,阿昔洛韦或伐昔洛韦治疗反应良好.
목적 탐토만성조새성폐질병급성가중(AECOPD)환자주원기간계발대상포진(HZ)적림상특정、진단、치료급전귀.방법 회고2008년8월지2011년7월AECOPD환자주원기간계발HZ적주원병력.결과 AECOPD주원환자중HZ발병솔위0.44％(22/4276환자),남19례,년령(69.5±7.79)세,FEV1점예계치％위(32.73±6.07)％.15례환자AECOPD년발작차수≥2차차발병전3개월내증구복당피질격소,9례합병당뇨병.림상진단HZ전,환자이주원(15.9±4.02)d,강적송루적제량(569.3±166.7)mg.환자균이여피진부위일치적급성동통위전구증상,부3례인특정성피진여동통동시출현급시진단,19례인피진재동통(2,45±1.53)d후출현이연오진단.본조병례균이단측、여주위신경주향일치、정대상분포적족집성구포진경피부과、이비후과회진이림상진단HZ.피진출현48～72 h내균급여아석락위혹벌석락위항병독치료,료정(6.5±0.85)d,현효솔100％.지동약물주요채용배양합매-2선택성억제제새래석포혹파서석포.유우치료급시,계발HZ적환자중부5례재차출현AECOPD,단미출현폐성뇌병등엄중병발증.결론 대우AECOPD환자주원기간출현적급성동통,감별진단응고필HZ,우기대우AECOPD반복발작병접수전신당피질격소치료적환자.근거특정성피진가림상진단HZ.다학과협작시급시진단、합리치료계발우AECOPD적HZ적관건,아석락위혹벌석락위치료반응량호.
Objective To explore the clinical features,diagnosis,treatment and outcome of herpes zoster (HZ) in patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods Retrospective analysis of case records of patients diagnosed with HZ during hospitalization for AECOPD between August 2008 and July 2011.Results The incidence of HZ in patients hospitalized for AECOPD was 0.44％ (22/4276),19 males,aged (69.5± 7.79) years,average FEV1 ％pred (32.73±6.07) ％.15 patients had frequency of AECOPD exceeding twice annually,having taken oral prednisone within 3 months prior to onset of HZ.9 patients had diabetes mellitus.Prior to onset of HZ,the patients had been hospitalized for (15.9 ± 4.02) days,having taken prednisone or its equivalents amounting to (569.3 ± 166.7) mg.Acute pain localized in accordance with characteristic rashes was the predromal symptom of all the subjects.Clinical diagnosis of HZ was promptly made in 3 cases with simultaneous occurrence of acute pain and rashes,diagnosis of HZ was delayed in 19 patients with rashes occurred (2.45± 1.53) days after the onset of acute pain.Clinical diagnosis of HZ was made based upon the presence of unilateral,band-like grouped vesicles in the dermatome that corresponding to the affected nerve following consultation with dermatologists or ENT-physician.Acyclovir or valacyclovir antiviral therapy was initiated within 48 hrs following emergence of the characteristic skin lesions,given for (6.5±0.85) days and with clinical response rate of 100％.COX-2 inhibitors including celecoxib or palecoxib were used to control acute pains from HZ.Because the patients were treated promptly,only five cases of reemergence of AECOPD were recorded during hospitalization,no hypercapnic coma was observed in these patients.Conclusions For acute pain occurred in patients hospitalized with AECOPD,HZ should be included in the differential diagnosis,especially for patients with frequent exacerbations and prescription of oral corticosteroids.Characteristic rashes are often diagnostic,multidisciplinary approach is essential for prompt diagnosis and optimal management of HZ secondary to AECOPD,with good response to prompt antiviral therapy with acyclovir or valacyclovir.