急性带状疱疹患者并发中枢神经系统感染的危险因素分析  

Risk factors for central nervous system infections in acute herpes zoster patients

作　　者：王美娣[1] 王俊 张艳[1] 吴珠娟 严永兴[1] 刘慧丽[1] Wang Meidi;Wang Jun;Zhang Yan;Wu Zhujuan;Yan Yongxing;Liu Huili(Department of Neurology,Hangzhou Third People's Hospital,Hangzhou 310009,China)

机构地区：[1]杭州市第三人民医院神经内科,杭州310009

出　　处：《中华危重症医学杂志(电子版)》2024年第6期458-464,共7页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：杭州市卫生科技重点项目(ZD20210010);杭州市科技局自主引导项目(20211231Y034);杭州市生物医药和健康产业发展扶持科技专项(2021WJCY054)。

摘　　要：目的分析急性带状疱疹患者并发中枢神经系统(CNS)感染的危险因素,为水痘-带状疱疹病毒(VZV)相关CNS感染的预防和早期诊治提供参考。方法前瞻性纳入2021年1月至2022年12月在杭州市第三人民医院住院的1059例急性带状疱疹患者,根据是否并发CNS感染将其分为带状疱疹组(1020例)和带状疱疹CNS感染组(39例)。分析两组患者的临床特征及血清标记物水平差异。应用多因素logistic回归分析筛选患者并发CNS感染的独立危险因素。结果与带状疱疹患者相比,带状疱疹相关CNS感染患者发病至治疗的间隔时间延长、疱疹主要位于头颈部、发病年龄较轻、好发于男性、血氯和总蛋白水平降低、C反应蛋白和谷氨酰转肽酶水平增高(P均<0.05)。以是否并发CNS感染为因变量,二元logistic回归分析发现发病至治疗的间隔时间[比值比(OR)=1.165,95%置信区间(CI)(1.012,1.341),P=0.034]、疱疹部位(头颈部)[OR=2.059,95%CI(1.192,3.555),P=0.010]、C反应蛋白[OR=1.017,95%CI(1.001,1.033),P=0.041]均是带状疱疹并发CNS感染的独立危险因素,总蛋白含量[OR=0.947,95%CI(0.900,0.995),P=0.032]是其保护性因素。结论识别VZV再激活导致CNS感染的危险因素,有助于颅内感染的早期筛查。临床医师应该重视对于疱疹发生在头颈部、血C反应蛋白增高、总蛋白水平降低的急性带状疱疹患者,早期干预可能减少并发CNS感染的发生率。Objective To analyze the risk factors of central nervous system(CNS)infections in acute herpes zoster patients,and to provide reference for the prevention and early diagnosis and treatment of varicella-zoster virus(VZV)related CNS infections.Methods A total of 1059 patients with acute herpes zoster admitted to the Hangzhou Third People&apos;s Hospital from January 2021 to December 2022 were prospectively included.They were divided into a herpes zoster group(1020 cases)and a herpes zoster-CNS infection group(39 cases)based on whether they had concurrent CNS infections.The differences in clinical characteristics and serum marker levels between the two groups were analyzed.Multiple logistic regression analysis was applied to screen independent risk factors for concurrent CNS infections in herpes zoster patients.Results Compared with the herpes zoster group,patients in the herpes zoster-CNS infection group had a longer interval from onset to treatment,younger age,lower blood chloride and total protein levels,and higher C-reactive protein(CRP)and glutamyltranspeptidase levels,with herpes mainly located in the head and neck and infection prevailing in males(all P<0.05).Using the concurrent CNS infection as the dependent variable,binary logistic regression analysis found that the interval from onset to treatment[odds ratio(OR)=1.165,95%confidence interval(CI)(1.012,1.341),P=0.034],herpes site(head and neck)[OR=2.059,95%CI(1.192,3.555),P=0.010],and CRP[OR=1.017,95%CI(1.001,1.033),P=0.041]were independent risk factors for acute herpes zoster patients complicating CNS infections,while the total protein content[OR=0.947,95%CI(0.900,0.995),P=0.032]was a protective factor.Conclusions Identifying the risk factors for CNS infections caused by reactivation of VZV is helpful for early screening of intracranial infections.Clinicians should pay attention to the acute herpes zoster patients who experience herpes in the head and neck and have elevated CRP levels and decreased total protein levels.Early intervention may reduce the inc

关 键 词：水痘-带状疱疹病毒 带状疱疹 中枢神经系统 感染 危险因素 

分 类 号：R75[医药卫生—皮肤病学与性病学]