中国药物警戒 ›› 2024, Vol. 21 ›› Issue (12): 1350-1356.
DOI: 10.19803/j.1672-8629.20240046

• 猴痘临床研究及用药治疗分析专栏 • 上一篇    下一篇

以外阴、肛周病变为主的猴痘临床治疗与用药分析

包蕾1, 李继科2,3, 唐容3, 张玲1, 程德云4, 张伟5,6,7#, 罗槑2,*   

  1. 1成都市公共卫生临床医疗中心内二科,四川 成都 610061;
    2成都市公共卫生临床医疗中心中医药防治传染病重点研究室,四川 成都 610061;
    3成都市公共卫生临床医疗中心中西医结合科,四川 成都 610061;
    4四川大学华西医院呼吸与危重症科,四川 成都 610061;
    5传染病溯源预警与智能决策全国重点实验室,首都医科大学附属北京地坛医院,北京 100015;
    6国家传染病医学中心（北京）,首都医科大学附属北京地坛医院,北京 100015;
    7首都医科大学附属北京地坛医院感染性疾病中心,北京 100015
  • 收稿日期:2024-01-19 出版日期:2024-12-15 发布日期:2024-12-16
  • 通讯作者: *罗槑,女,博士,主任技师,传染病基础研究。E-mail：phccidel@sina.com,#共同通信作者。
  • 作者简介:包蕾,女,本科,副主任医师,呼吸与感染性疾病。
  • 基金资助:
    国家重点研发计划（2022YFF1203201）; 陈定潜全国名老中医药专家传承工作室建设项目; 四川省中医药管理局中医药科研专项课题（2024MS129）; 四川省名中医叶庆工作室建设项目; 成都市公共卫生临床医疗中心院内课题（2023Y-61）; 北京市高层次公共卫生技术人才建设项目培养计划（学科骨干-02-31）

Clinical Treatment and Medications for Monkeypox with Vulva and Perianal Lesions

BAO Lei1, LI Jike2,3, TANG Rong3, ZHANG Ling1, CHENG Deyun4, ZHANG Wei5,6,7#, LUO Mei2,*   

  1. 1Second Department of Internal Medicine, Public Health Clinical Center of Chengdu, Chengdu Sichuan 610061, China;
    2Key Research Laboratory of Traditional Chinese Medicine in the Prevention and Treatment of Infectious Diseases, Public Health Clinical Center of Chengdu, Chengdu Sichuan 610061, China;
    3Department of Integrated Traditional Chinese and Western Medicine, Public Health Clinical Center of Chengdu, Chengdu Sichuan 610061,China;
    4Department of Respiratory and Critical Care, West China Hospital, ChengduSichuan 610061, China;
    5National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China;
    6National Center for Infectious Diseases(Beijing), Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China;
    7Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
  • Received:2024-01-19 Online:2024-12-15 Published:2024-12-16

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摘要： 目的 研究以外阴、肛周病变为主的猴痘病例临床特征及中西医结合临床治疗的疗效,并进行用药分析。方法 回顾性分析2023年6月29日至2023年7月31日在成都市公共卫生临床医疗中心住院治疗并康复出院的以外阴、肛周病变为主的43例猴痘患者临床资料。结果 共收治猴痘患者56例,其中43例患者以外阴、肛周病变为主,均为男性,平均年龄（31.37±5.47）岁（19岁~42岁）,其中35例（81.40%）为男男性行为者,6例（13.95%）为双性性行为者,2例（4.65%）为正常男女性行为者;16例（37.21%）为人类免疫缺陷病毒（HIV）感染者,27例（62.79%）未感染HIV;33例（76.74%）首发皮疹在会阴、肛周,其中27例疱疹数量大于10个;C反应蛋白明显升高[平均为（30.43±25.23）mg·L-1];经中西医结合临床治疗后平均住院时间（8.98±2.72）天;疱液吸收时间平均为（4.44±1.86）天、痂皮完全脱落时间（8.95±2.73）天,19例（44.19%）遗留瘢痕。进一步比较HIV感染者与非HIV感染者临床资料发现,HIV感染者中疱疹数目更多,C反应蛋白更高,CD3+CD4+ T淋巴细胞计数更低[(431.40±220.67) vs (719.58±274.04),P<0.01],使用抗生素比例更高（15/1 vs 18/9,P<0.05）。结论 同性性行为或双性性行为者在目前猴痘患者中所占比例高,首发皮疹多在会阴、肛周,伴HIV感染的患者病情相对非HIV 感染者较重、恢复较慢,对以生殖器、肛周皮疹或溃疡就诊的患者应重视猴痘筛查,根据患者皮疹伴皮肤感染、皮疹伴肛周脓肿、皮疹伴肛周溃疡或感染、皮疹伴痔疮伴感染、皮疹伴扁桃体炎、皮疹伴支气管炎或肺炎等情况制定适宜的用药计划,采用中西医结合治疗猴痘可取得较好疗效。

关键词: 猴痘, 外阴, 肛周, 男男性行为者, 人类免疫缺陷病毒, 获得性免疫缺陷综合征（艾滋病）

Abstract: Objective To analyze the clinical characteristics of cases of monkeypox mostly with vulva and perianal lesions and the clinical efficacy of integrated Chinese and Western medicine. Methods The clinical data of 43 patients with vulvar and perianal lesions hospitalized and discharged from Chengdu Public Health Clinical Medical Center between June 29, 2023 and July 31, 2023 was retrospectively analyzed. Results A total of 56 monkeypox patients were admitted in this space of time, 43 of whom had vulvar and perianal lesions, All these patients were males, with a mean age of (31.37 ± 5.47) years (ranging from 19 to 42 years), Among these patients, 35 (81.40%) were MSM, six (13.95%) were bisexual, 16 (37.21%) were infected with HIV, 33 (76.74%) started with perineal and perianal rashes, and 27 had more than 10 herpes. Levels of C reactive protein were significantly elevated [(30.43 ± 25.23) mg·L-1] Their hospital stay averaged (8.98 ± 2.72) days after treatment. The average absorption time of blister fluid was (4.44 ± 1.86) days while complete shedding of the scab skin took (8.95 ± 2.73) days. Nineteen of these cases (44.19%) left scars. A comparison of clinical data between HIV-and non-HIV-infected patients showed that HIV patients had more herpes, higher C-reactive protein levels, lower CD3+ CD4+ T lymphocyte count [(431.40 ± 220.67) vs (719.58 ± 274.04), P<0.01], and a higher proportion of antibiotic use (15/1 vs 18/9, P <0.05). Conclusion Individuals engaging in homosexual or bisexual behavior account for a high proportion among current monkeypox patients, with initial rashes around the perineum and perianal areas. Patients with HIV infections tend to have more severe conditions and recover more slowly than non-HIV infected individuals. For patients presenting with genital or perianal rashes or ulcers, monkeypox screening is recommended. Based on patients' conditions, appropriate medication plans should be formulated. Monkeypox can be effectively treated by combining traditional Chinese and Western medicine.

Key words: Monkeypox, Vulvar, Anal, Men Who Have Sex with Men, HIV, AIDS

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