带状疱疹急性期临床症状与皮损区病理性改变的相关性研究  

Study on relationship between clinical symptoms and pathological changes in skin lesions of patients with herpes zoster in acute phase

作　　者：高月[1] 季凤清[2] 李彦平[3] 孙海梅[2] 张乐辉[4] 

机构地区：[1]首都医科大学附属北京友谊医院综合科,北京100050 [2]首都医科大学基础医学院,北京100069 [3]首都医科大学附属北京友谊医院疼痛科,北京100050 [4]首都医科大学附属北京友谊医院医务处,北京100050

出　　处：《临床和实验医学杂志》2013年第1期1-3,6,共4页Journal of Clinical and Experimental Medicine

基　　金：首都医科大学基础-临床科研合作基金资助项目(09JL21)

摘　　要：目的观察带状疱疹急性期临床症状与皮损区病理性改变的相关关系,以及皮损区早期应用抗免疫炎性治疗对病程转归的影响。方法①基础研究部分:选取临床确诊的带状疱疹病人3例,取疱疹下或疼痛区皮肤组织,HE染色及S-100染色下观察皮损区组织病理切片中淋巴细胞异常浸润及神经末梢损害情况。②临床研究部分:皮神经阻滞组18例(n=18),应用腺苷钴胺0.5 mg+甲强龙40 mg+0.3%利多卡因,总量约10～15 ml,于皮肤损伤最严重或感觉疼痛最明显的区域,自神经分布近端至远端进行皮下阻滞。药物治疗组18例(n=18),常规口服抗病毒药物+维生素B12+镇痛药物,并且在皮损区辅助应用外用药物。评价疗效。结果①基础研究部分:活体中带状疱疹受累处皮肤存在中重度免疫炎性反应。②临床研究部分:皮神经阻滞组的结痂时间较药物治疗组缩短,疼痛缓解程度较药物治疗组明显,且差异具有统计学意义(P<0.05)。结论①在带状疱疹病毒受累皮肤区,周围神经周围有大量的免疫细胞浸润,神经轴突的完整性遭到破坏,存在免疫炎性反应,这是带状疱疹产生疼痛的重要病理学因素。②皮神经阻滞治疗方法可以通过有效的抑制带状疱疹皮损区免疫炎性反应,更快的促进局部皮损结痂愈合且明显减低带状疱受累区的疼痛程度。Objective To observe the relationship between clinical symptoms and pathological changes in skin lesions of patients with herpes zoster in acute phase, and the effect of early application of anti - inflammatory and immune therapy for skin lesions on the course of disease. Methods There were two stages in this study. In the first stage, skin tissues under herpes or in pain locations of 3 patients with definite diagnosis of herpes zoster were taken and prepared for conventional slices with HE staining and S - 100 staining. Abnormal lymphocytes infiltration and nerve ending lesions in these sections were observed. In the second stage, 36 patients with herpes zoster in acute phase were randomly assigned to two groups. Patients in nerve block group （ n = 18 ） receiving subcutaneous block by injection of solution （ 10 - 15 ml in volume） containing 0.3 % lidocaine, O. 5rag cobamamide and 40 mg methylprednisolone into skin where the most severe skin lesions or the most intense pain occurred from proximal to distal part according to the nerve distribution. Patients in medicine group （ n = 18 ） receiving conventional therapy by taking oral antiviral agents, vitamin B12, analgesics, and applying topical agents in skin lesions. The difference in duration of healing of skin lesions and reduction of pain intensity in the acute phase between these two different therapeutic methods was observed. Results Epidermal atrophy and partial basal ceils liquidation were found in skin lesions. A moderate number of lymphoidocytes and plasmocytes were peripherally infiltrated the dO ermis and blood vessels. Mild edema was found in the superficial layer of dermis. Injured peripheral nerve, damaged axons, and infiltration of a small number of lymphocytes were observed in immunohistochemical staining sections. Patients with the same skin lesions had shorter time for incrustation in nerve block group than that of medicine group （ P 〈 0.05 ）. Pain intensity of patients in nerve block group was reduced more than that in medicine

关 键 词：带状疱疹 皮损区免疫炎性反应 皮神经阻滞 

分 类 号：R752.12[医药卫生—皮肤病学与性病学]