带状疱疹(专业版)
带状疱疹是一种可导致神经和皮肤疼痛的病毒感染,是由水痘-带状疱疹病毒引起的急性感染性皮肤病。一般有单侧性和按神经节段分布的特点,由集簇性的疱疹组成及伴有疼痛。
英文名称:Shingles,Herpes Zoster
定义
带状疱疹是一种可导致神经和皮肤疼痛的病毒感染,是由水痘-带状疱疹病毒引起的急性感染性皮肤病。一般有单侧性和按神经节段分布的特点,由集簇性的疱疹组成及伴有疼痛。年龄愈大,神经痛感愈重。本病多发于成人,随年龄增长而发病率越高,且以春秋季节多见。病因
带状疱疹是由水痘-带状疱疹病毒引起的,这是引起水痘的同一类病毒。带状疱疹可发生在有过水痘的人。在第一次水痘感染后,病毒没有完全排出体外,而剩下的一些病毒潜伏于脊髓神经根附近。在免疫低下或劳累、感冒后,病毒易被激活,并沿神经通路的地方传播,它可导致皮疹和疼痛。风险因素
带状疱疹在女性以及50岁以上的中老年人中发病率更高,且年龄越大发病风险越高。其他可能增加带状疱疹的风险因素包括如下:
- 由某些健康状况导致的免疫系统改变或受损,例如HIV感染、淋巴瘤和白血病等
- 自体免疫性疾病,如类风湿性关节炎、红斑狼疮等
- 放射治疗
带状疱疹通常不会人对人传播。但如果没有接种过水痘疫苗的人,就有可能被其他人传染。
用绷带覆盖带状疱疹疮,可降低传输带状疱疹给他人的风险。
症状
带状疱疹可引起如下症状:- 皮疹:
- 红色,有轻微隆起的带状或斑块,通常有多个小的充满液体的水泡,在几天内干燥并结伽。
- 在身体的一侧发生,但通常不穿过中线。
- 主要影响面部和躯干。
- 在严重的情况下,眼睛可受到影响,这可能威胁到视力。
- 引起皮疹部位的敏感和疼痛,疼痛可能很严重。
- 皮肤刺痛或发痒,这可能开始于出现皮疹的前几天
- 发烧
- 头痛
- 疲劳
并发症
带状疱疹的并发症包括:- 带状疱疹后遗神经痛。
- 视力丧失:眼内或眼周的带状疱疹(眼科带状疱疹)可引起眼部感染和疼痛,甚至可能导致视力丧失。
- 神经障碍:取决于受到影响的神经,如脑炎、面部麻痹、听力问题等。
- 皮肤感染。
疗法
带状疱疹无法治愈。治疗的重点是:- 缓解症状
- 加速康复
- 防止带状疱疹后遗神经痛PHN
调整饮食与生活方式
- 健康饮食,丰富蔬菜、水果等。
- 劳逸结合,学习放松技巧如瑜伽、冥想、缓解各种压力。
- 坚持适当运动锻炼,以提高抗病力。
- 保持充足睡眠。
营养与草本综合干预
以下是基于循证医学和循证营养学有关文献综合的结果。
有助于防控带状疱疹的营养和草本补充剂,主要包括如下:
尽管尚无有效的治疗疱疹病毒感染的方法,但几种自然干预措施可能有助于降低病毒感染的频率和严重程度。当免疫系统无法阻止潜伏的病毒感染重新激活时,带状疱疹都会表现出来。因此,维持免疫系统健康的自然干预措施可能有助于预防疫情爆发。
1.维生素C:
维生素C是一种具有天然抗病毒特性的强效抗氧化剂1,2。体外实验室研究发现,维生素C及其一些代谢产物可能在一定程度上抑制HSV-1的复制1,3。然而,探索维生素C用于治疗人类疱疹感染的研究有限,并且在很大程度上依赖于自我报告的结果4。最近一项针对单纯疱疹角膜炎患者的回顾性研究发现,与不治疗相比,抗坏血酸(2000mg/天)可将复发风险降低近50%;然而,使用阿昔洛韦(800mg/天)仍然是优越的5。虽然探索使用维生素C减轻HSV感染症状的研究的早期结果是有希望的,但还需要进一步的测试。
维生素C还可以缓解带状疱疹引起的神经疼痛2,6。维生素C被发现具有镇痛(止痛)特性7。研究人员发现,每天补充200mg至1500mg的维生素C有助于减轻带状疱疹的疼痛和皮肤症状,并防止带状疱疹后神经痛的发展7。特别适用于对标准止痛药过敏或耐药的个体8-10。在带状疱疹患者中进行的安慰剂对照试验发现,维生素C是否能降低自发性疼痛的频率或严重程度的结果相互矛盾。然而,带状疱疹后神经痛可以通过静脉注射维生素C来预防11,12。与此一致,维生素C的摄入与带状疱疹后神经痛的风险降低有关10,13。这些结果表明,维生素C可能有助于降低带状疱疹爆发相关的长期疼痛风险,但有必要对人类进行进一步研究。
2. 锌:
锌在免疫系统的许多方面发挥作用,锌缺乏与免疫功能障碍和病毒感染风险增加有关14。研究表明,锌水平往往随着年龄的增长而下降,同时免疫功能下降15。血清锌浓度低与疱疹后神经痛风险增加有关10。
锌参与破坏HSV-1和HSV-2复制的几乎所有方面14。在实验室研究中,硫酸锌对HSV-1复制的抑制率高达99.8%16。此外,发现氧化锌可有效防止HSV-1和HSV-2进入细胞17,18。动物模型还表明,锌溶液可预防阴道或直肠HSV-2感染,并降低病毒脱落率19-21。含有氧化锌的外用软膏已成功用于缩短人类生殖器和口腔疱疹爆发的持续时间22-24。锌和石榴皮提取物中的一种成分安石榴甙(Punicalagin)联合用药,最近被认为是疱疹感染的一种潜在的局部治疗方法,在细胞和动物模型中取得了有希望的早期结果25,26。
3.维生素A:
维生素A及其前体β-胡萝卜素可能有助于调节免疫功能27-29。血清维生素A水平可能在HSV的脱落中发挥作用,因为据报道,未怀孕或服用激素避孕药的女性宫颈病毒脱落与维生素A水平低或缺乏有关30。这表明保持足够的维生素A摄入可能有助于防止疱疹传播给他人,但还需要研究来探索这种特定关系。
此外,β-胡萝卜素可以对太阳的紫外线辐射提供低水平的保护29。鉴于尽量减少阳光照射有助于预防疱疹的爆发31,32,摄入足够的β-胡萝卜素和维生素A可能会对疱疹起到保护作用。重要的是,过量摄入预先形成的维生素A可能是有毒的。
4.维生素D:
虽然在过去,维生素D因其在维持骨骼健康方面的作用而受到赞赏,但最近的证据表明,它可能也是一种有效的免疫调节剂33-35。维生素D缺乏与免疫功能受损和易受感染有关33。
一些证据表明,维生素D可能有助于对抗疱疹和带状疱疹的爆发36,37。在细胞培养模型中,补充维生素D显著降低了HSV-1的病毒载量38。对接受透析的患者的研究发现,血清维生素D水平与水痘-带状疱疹病毒的免疫力有关,补充维生素D与患带状疱疹的几率显著降低有关39,40。类似地,研究发现,反复发作口腔疱疹的患者血清维生素D水平低于对照组患者41。一项针对多发性硬化症儿童患者的研究还发现,血液中维生素D水平越高,抗HSV-2抗体水平也越高42。这表明维生素D水平的提高可能使免疫系统对感染有更好的反应。
维生素D的抗HSV活性可能是其能够增加一种名为免疫抗菌肽(Cathelicidin)水平的结果,该肽对HSV-1和其他病毒具有抗病毒特性43。在细胞培养模型中,Cathelicidin诱导抗病毒干扰素的表达并显著抑制HSV-1的产生44,45。在小鼠模型中,Cathelicidin肽LL-37也抑制HSV-2的复制,并且在散发性HSV感染患者中观察到较低水平的Cathelicidin蛋白表达46。
5. 维生素E:
一项针对89名单纯性生殖器疱疹或带状疱疹受试者的开放标签对照临床试验研究了单独使用阿昔洛韦或阿昔洛韦与90天疗程的营养品配方(由维生素E、辅酶Q10、硒和L-蛋氨酸组成)对病毒相关生物标志物和损伤愈合率的影响与单独使用阿昔洛韦相比,营养制剂加阿昔洛韦产生更快的愈合率和更少的复发47。此外,这些结果与病毒载量降低和抗病毒细胞因子水平升高的实验室发现一致;营养制剂组的血浆抗氧化活性也较高。在非对照试验中,局部应用维生素E油有助于缓解与口腔疱疹性病变相关的疼痛,并加快病变愈合。一些局部维生素E的研究每天使用一次,而另一些研究每天使用多次48,49。
一个小鼠模型表明,维生素E缺乏会损害对中枢神经系统HSV-1感染的免疫反应50。另一项小鼠研究提供了额外的证据,表明维生素E缺乏症会损害对HSV-1感染免疫反应。然而,这项研究表明,高剂量的膳食补充剂(10倍于足够摄入量)并不能进一步增强免疫反应。这一发现表明,避免维生素E缺乏对该小鼠模型的充分免疫反应很重要,但超过足够摄入量的大量补充维生素E剂量并不能提供进一步的保护51。
6. 赖氨酸和精氨酸:
多年来发表的几项小型且通常低质量的研究提供了初步证据,证明补充L-赖氨酸和/或限制饮食摄入L-精氨酸可能是有效的抗HSV策略。精氨酸是HSV复制所必需的,L-赖氨酸潜在的抗HSV作用被认为是由精氨酸活性的阻断引起的。然而,从整体上看,临床证据是混合的52,53。
一项对12项赖氨酸补充治疗或预防疱疹爆发的研究的综述发现,除非与低精氨酸饮食相结合,否则低于1g/天的剂量是无效的。一项小型随机对照试验发现,赖氨酸剂量大于每天3g可以降低复发率,改善患者自我报告的症状。需要以至少1.2g/天的剂量使用赖氨酸进行更长时间的对照试验,才能得出关于该疗法的任何确切结论53。
赖氨酸和精氨酸治疗HSV的个体结果可能有所不同。鉴于赖氨酸在典型剂量下几乎没有潜在的副作用54,并且精氨酸限制性饮食在营养上是完全的,HSV患者可能希望考虑每天补充1-3g或更多的L-赖氨酸与低精氨酸饮食相结合的疗法。
7. 蜂胶:
蜂胶是含有多种化合物的混合物,包括类黄酮和多酚,其中许多具有抗HSV-1活性55,56。它对免疫系统的多种作用,加上它的抗炎特性,可能使它能够帮助身体更有效地对抗感染57。
已发现蜂胶可显著抑制细胞培养中HSV-1和HSV-2的复制56,58,59。此外,含有蜂胶提取物的软膏和润唇膏已在临床试验中进行了测试,并发现可提高口腔和生殖器疱疹病变的愈合率,甚至表现出优于标准阿昔洛韦治疗的优势60-63。观察到的效果可以扩展到其他蜂产品,最近的一项随机安慰剂对照试验发现,与单独服用阿昔洛韦的儿童相比,每天四次服用1ml蜂蜜的儿童口腔疱疹症状的持续时间显著缩短64。一项对涉及蜂产品的九项临床试验的系统综述表明,蜂产品可能是治疗疱疹的有效补充65。
8. 灵芝:
灵芝是一种在亚洲国家具有数百年药用历史的真菌66,67。灵芝的一些成分似乎具有抗病毒特性68。研究人员在灵芝中发现了几种化合物,这些化合物在体外对HSV-1和HSV-2都表现出很强的抗病毒活性69-73。
灵芝制剂在早期临床研究中也显示出有希望的结果。在一项针对五名日本带状疱疹患者的试验中,含有灵芝和其他植物成分的配方能够迅速缓解疼痛并缓解症状74。另一项涉及疱疹感染患者的研究发现,与未经治疗的对照患者相比,使用草药混合物也能缩短口腔和生殖器疱疹的症状缓解时间75。
灵芝的大部分好处可能是由于它能够对抗免疫衰老和促进健康的免疫系统。许多研究发现,灵芝蘑菇中的化合物具有免疫调节活性,并促进免疫细胞(如巨噬细胞和T细胞)的激活和抗体的分泌76-79。这些活性共同帮助实现促进对病毒、细菌或真菌感染的健康免疫反应的双重目标,同时抑制威胁长期健康的过度或慢性炎症。
9. 乳铁蛋白:
乳铁蛋白具有天然的抗菌特性,能够帮助保护身体免受细菌、真菌、寄生虫和病毒感染80-82。特别是,许多临床前研究表明,乳铁蛋白能够抑制HSV-1和HSV-2的复制,并通过与细胞表面的硫酸乙酰肝素相互作用阻止病毒进入细胞81,83-86。尽管需要在人体中进行临床试验来证实这些发现,但乳铁蛋白似乎是一种很有前途的潜在治疗HSV感染的药物。
10. 姜黄素:
姜黄素被认为有助于身体对抗许多感染,包括由病毒引起的感染,部分原因是其抗炎和抗氧化特性87。含有姜黄素的局部乳膏已在印度传统医学中用于治疗引起水泡的疾病88,姜黄素也已被证明在细胞培养中提供对HSV-1和HSV-2感染的保护89-91。姜黄素对HSV-1的活性与其阻止病毒表达感染和复制所需基因的能力有关90。姜黄素还被发现抑制促进生殖器上皮细胞中HSV复制的炎症过程,导致HSV-2的复制减少92。虽然姜黄素的使用仍需要动物和人类试验,但这些结果突出了姜黄素作为有用的抗HSV剂的潜力。
11. 岩藻糖胶:
岩藻糖胶(或称褐藻糖胶)是在可食用海藻和其他一些海洋来源中发现的天然糖聚合物,可以刺激免疫系统93。许多褐藻糖脂对几种常见病毒具有强大的抗病毒活性,包括HSV-1和HSV-293-96。动物模型已经发现褐藻糖胶通过直接抑制病毒复制和刺激人体对病毒的免疫反应的组合来保护人体免受HSV-1感染95。
褐藻聚糖在皮肤中吸收良好,表明局部应用可能是一种可行的应用方式97。一项病例报告研究表明,4%褐藻糖胶乳膏可缩短与口腔疱疹爆发相关的愈合时间。在这项研究中,使用褐藻糖胶乳膏治疗的病例系列患者在平均五天内严重疼痛的口腔疱疹症状得到缓解98。
12.香蜂草:
香蜂草传统上用于治疗包括疱疹爆发在内的多种疾病99。多项实验室研究表明,香蜂草提取物对HSV-1和HSV-2都具有多种抗病毒活性100-105。临床试验评估了局部香蜂草制剂的疗效,并显示出积极的结果。在一项试验中,与安慰剂相比,香蜂草软膏在五天内每天使用四次,可以改善口腔疱疹症状;香蜂草治疗也阻止了病毒的传播,作者认为香蜂草可能会延长再次爆发之间的时间106。另外两项试验还发现,用香蜂草提取物进行局部治疗可以有效缓解口腔疱疹症状107。
13.甘草:
甘草已证明对几种病毒具有抗病毒活性(包括HSV-1)108,109。在单纯疱疹病毒性脑炎的动物模型中,甘草根提取物使HSV-1病毒在大脑中的复制减少了45%,并显著提高了治疗动物的存活率110。最近的一项研究表明,含有甘草提取物的草药凝胶混合物可用于治疗口腔疱疹,这表明它有助于减少炎症并缩短症状持续时间111。这项研究的结果可能有助于了解甘草对人类疱疹影响的未来试验。
更多内容可点击其个性化综合干预方案如下:
以及参阅专文了解更多有关的内容:
医疗干预
抗病毒药物:可控制带状疱疹。抗病毒治疗可以缩短带状疱疹发作,但必须在症状发作后48-72小时之间使用,尤其适应免疫系统被抑制的患者。
眼睛上的带状疱疹处理:如果脸上出现带状疱疹,可能使用处方药物,如类固醇治疗。如果不进行治疗,可能导致眼睛永久的损伤,包括青光眼、疤痕和失明。
家庭护理
以下措施将有助于减轻疼痛和缓解症状:
- 炉甘石洗剂
- 湿敷
- 经常使用燕麦浴
- 非处方OTC止痛药
- 皮肤外用止痛药
预防
两种疫苗可能有助于预防带状疱疹:- 水痘疫苗,通常用于儿童,但也可以给未曾发生水痘的成人。
- 带状疱疹疫苗:建议年龄在60岁以上的人,该疫苗可降低带状疱疹发病,并且能降低PHN的严重性。
- 用绷带覆盖所有的水泡,直到它们干燥结痂。
- 如果是医护人员,应休假在家直到水泡干燥结痂。
- 避免接触易产生水痘的人群:
- 孕妇
- 早产儿
- 免疫系统受损的人
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参考来源:
美国梅奥诊所
www.mayoclinic.org
美国国立神经疾病和中风研究所
http://www.ninds.nih.gov
美国国立疱疹基金会
http://www.vzvfoundation.org
美国国立卫生研究院公众健康网
www.medlineplus.gov
加拿大家庭医生网
http://www.cfpc.ca
其他参考文献:详见具体的综合干预方案
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