中国药物警戒 ›› 2024, Vol. 21 ›› Issue (12): 1337-1342.
DOI: 10.19803/j.1672-8629.20240660

• 猴痘临床研究及用药治疗分析专栏 • 上一篇    下一篇

某院皮肤科门诊猴痘患者临床特征与用药治疗分析

刘静1, 闫会文1, 赵兴云1, 袁柳凤1, 赵天威1, 张伟2,3,4#, 伦文辉1,*   

  1. 1首都医科大学附属北京地坛医院皮肤性病科,北京 100015;
    2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;
    3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;
    4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:2024-08-31 出版日期:2024-12-15 发布日期:2024-12-16
  • 通讯作者: *伦文辉,男,博士,主任医师,皮肤性病学。E-mail：lunwenhui@163.com, #为共同通信作者。
  • 作者简介:刘静,女,博士,副主任医师,皮肤性病学。
  • 基金资助:
    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）; 国家重点研发计划（2022YFF1203201）; 首都医科大学附属北京地坛医院研究者发起的临床研究项目（HX2024028）

Clinical Characteristics of Patients with Mpox in a Department of Dermatology

LIU Jing1, YAN Huiwen1, ZHAO Xingyun1, YUAN Liufeng1, ZHAO Tianwei1, ZHANG Wei2,3,4#, LUN Wenhui1,*   

  1. 1Department of Dermatology and Venereology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China;
    2National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China;
    3National Center for Infectious Diseases (Beijing), Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China;
    4Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
  • Received:2024-08-31 Online:2024-12-15 Published:2024-12-16

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摘要： 目的 分析北京市某医院皮肤科门诊诊断为猴痘（Mpox）患者的临床特征与用药治疗。方法 回顾性分析2023年6月1日至2024年6月15日在首都医科大学附属北京地坛医院皮肤科门诊诊断为猴痘的51例患者就诊情况,总结患者的临床特征及用药治疗。结果 51例猴痘患者均为男性,年龄18~57岁,年龄中位数为33（30,40）岁,发病前均有男男性接触史,患者潜伏期为1~30 d,中位数7 d,最常见临床表现为皮疹（51/51,100.00%）,其次为发热（31/51,60.78%）。原发皮疹为丘疱疹或脓疱样皮疹,主要表现为脓疱的中央坏死结痂,皮疹分布局限在生殖器、肛周的患者24例（24/51,47.06%）;首发皮疹为全身泛发的脓疱疹的12例（12/51,23.53%）;先局部发疹而后发展至全身的15例（15/51,29.41%）。51例患者中31例出现发热（31/51,60.78%）,20例未出现发热（20/51,39.22%）,患者发热与皮疹出现的先后顺序并不相同。在所有猴痘患者中,人类免疫缺陷病毒（HIV）阳性者32例（32/51,62.75%）,HIV阴性19例,HIV阳性者中处于获得性免疫缺陷综合征（AIDS）阶段（CD4+ T淋巴细胞<200个/μL）2例（2/51,3.92%）,其中1例死亡。梅毒血清学阳性25例（25/51,49.02%）。治疗以对症治疗为主,39例（39/51,76.47%）采用对症支持治疗,包括外用和口服抗感染药物（如夫西地酸乳膏、聚维酮碘溶液、伐昔洛韦、头孢丙烯等）,12例患者未应用任何药物治疗,除1例死亡外,大多数结局良好。结论 猴痘患者以男男性接触人群为主,临床表现以脓疱疹伴中央坏死结痂为主,部分患者伴有发热,AIDS患者合并猴痘可造成死亡,大部分患者采用抗感染药物对症治疗后预后良好。

关键词: 猴痘, 猴痘病毒, 皮疹, 发热, 男男性接触, 人类免疫缺陷病毒, 获得性免疫缺陷综合征（艾滋病）, 临床特征

Abstract: Objective To analyze the clinical characteristics and outcomes of Mpox patients in an outpatient department of dermatology at a hospital in Beijing. Methods A retrospective analysis was conducted of the clinical manifestations of 51 Mpox patients treated between June 1, 2023 and June 15, 2024 in the Department of the Dermatology, Beijing Ditan Hospital. The clinical characteristics were summarized. Results In this study, all the 51 patients with Mpox were males ages 18 to 57, with a median age of 32 years, all of whom had a history of intercourse with men before the onset of the disease, with an incubation period of 1-30 days and a median of 7 days. The most common clinical manifestations were rashes (51/51, 100%) and fever (31/51, 60.78%). The primary rash was papules or pustules with central necrotic crusting. All patients had skin rashes, 24 of whom (24/51, 47.06%) developed rashes that were limited to the genitals and perianal area, 12 (12/51, 23.53%) started with generalized pustules, and 15 (15/51, 29.41%) had rashes that were initially localized before being generalized. 31 cases (31/51, 60.78%) had fever, which did not necessarily follow the rash. There were 32 (32/51,62.75%) HIV-positive patients, 2 (2/51, 3.92%) were in the AIDS stage (CD4+ T lymphocytes < 200 cells·μL-١), and one died. There were 25 cases (25/51, 49.02%) with positive serological tests for syphilis. As symptomatic treatment, 39 patients (39/51, 76.47%) were treated with symptomatic supportive care, including topical and oral anti-infective drugs(such as fusidic acid cream, povidone iodine solution, valaciclovir and cefprozil), 12 patients received no medication, and most of the outcomes were good except for one death. Conclusion Patients during this Mpox epidemic were mostly men who had sex with men, and the clinical manifestations were primarily pustules with central necrotic scabs. Some patients were accompanied by fever, AIDS complicated with Mpox could cause death, and most patients had a good prognosis after symptomatic treatment.

Key words: Mpox, Monkeypox Virus, Rash, Fever, Men Who Have Sex With Men, AIDS, Clinical Manifestations

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