肾移植术后并发带状疱疹的临床分析  

Clinical Analysis of Herpes Zoster After Renal Transplantation

作　　者：张蓬杰[1] 石斌娅[1] 杜鹏[1] 樊小宝 段斌[1] 丁通[1] ZHANG Peng-jie;SHI Bin-ya;DU Peng;FAN Xiao-bao;DUAN Bin;DING Tong(The Center of Kidney Diseases and Hemodialysis,Shanxi Provincial People＇s Hospital,Xi＇an 710068,China)

机构地区：[1]陕西省人民医院肾病血透中心,西安710068

出　　处：《临床肾脏病杂志》2018年第9期551-554,共4页Journal Of Clinical Nephrology

基　　金：陕西省社会发展科技攻关项目(No.2016SF-013)

摘　　要：目的分析肾移植术后患者并发带状疱疹的发病特点,探讨诊治方法。方法回顾性分析陕西省人民医院肾病血透中心2014年6月至2017年12月期间29例肾移植术后带状疱疹病例的临床资料,分析发病特点,对其诊治进行临床总结。结果 29例带状疱疹患者发病时间为肾移植术后4～84个月,平均(45. 2±30. 6)个月,其中术后36个月内发病者为22例(占75. 86%)。出疱疹前病变部位有不同程度针刺样或烧灼样疼痛感24例(占82. 76%),伴轻度发热7例(占24. 14%)。23例表现为寻常型(占79. 31%),6例为特殊型(占20. 69%),4例合并局部细菌感染(占13. 79%)。根据患者的临床表现及体征即可诊断带状疱疹,必要时可取水疱液检查。所有患者均应用更昔洛韦注射液抗病毒治疗,并应用维生素C注射液协助抗病毒感染、维生素B12营养神经及外用炉甘石洗剂辅助治疗,20例给予减少免疫抑制剂用量,4例同时应用抗感染药物治疗。所有患者皮肤疱疹恢复良好,随访6个月无复发。结论肾移植术后患者免疫力低下,带状疱疹病毒感染多发生在术后3年内,多数患者出疱疹前感病变部位不适,少数伴轻度发热,疱疹以寻常型表现为主,诊断以临床表现和体征为主,治疗上以静脉使用更昔洛韦注射液,适当调整免疫抑制剂剂量,辅以对症治疗,可有效治疗肾移植术后带状疱疹。Objective To analyze the clinical characteristics,diagnosis and treatment of herpes zoster after renal transplantation. Methods The clinical data of 29 patients with herpes zoster after renal transplantation admitted to our department from June 2014 to December 2017 were retrospectively analyzed, and the clinical diagnosis and treatment were summarized. Results The time of onset was 4 to 84 months after kidney transplantation and the median time was（45.2±30.6） months. Herpes zoster occurred within 36 months after kidney transplantation in 22 cases（75.86%）. There were 23 cases of common clinical type, 6 cases of special type and 4 cases of herpes zoster complicated with local bacterial infections. Antiviral treatment with ganciclovir in combination with external use of calamine lotion was given in all patients. The dosage of immunosuppressants was reduced in 20 cases at the same time,and antibiotics were applied to control the complicated infections in 4 cases.Postherpetic neuralgia occurred in 3 cases. All the patients were cured and there was no recurrence during the follow-up period of 6 months. Conclusions Opportunistic infection may occur in patients with herpes zoster after renal transplantation due to over immunosuppressive drug therapy.Rational adjustment of the immunosuppressant and use of intravenous gancilovir therapy are effective in the treatment of herpes zoster after renal transplantation.

关 键 词：肾移植 带状疱疹 临床分析 

分 类 号：R699.2[医药卫生—泌尿科学] R752.12[医药卫生—外科学]