帶狀皰疹 Shingles

英文條目:https://en.wikipedia.org/wiki/Shingles

Wikipedia:WikiProject Medicine/Translation task force/RTT/Simple herpes zoster

中文條目:https://zh.wikipedia.org/wiki/%E5%B8%A6%E7%8A%B6%E7%96%B1%E7%96%B9

2016-11-19 整合完畢

中文原始引言可參酌參考

帶狀皰疹是由水痘帶狀皰疹病毒(Varicella zoster virus,VZV)引起的急性炎症性皮膚病,中醫稱為纏腰火龍纏腰火丹,俗稱蜘蛛瘡生蛇皮蛇白蛇飛蛇。其主要特點為簇集水泡,沿一側周圍神經作群集帶狀分布,伴有明顯神經痛。初次感染表現為水痘,以後病毒可長期潛伏在脊髓後根神經節,免疫功能減弱可誘發水痘帶狀皰疹病毒可再度活動,生長繁殖,沿周圍神經波及皮膚,發生帶狀皰疹。帶狀皰疹患者一般來說可獲得對該病毒的終生免疫。

<!-- 定義與症狀 -->

’’’帶狀皰疹’’’({{lang-en|herpes zoster、shingles、zoster、或zona}})中醫又稱’’’纏腰火龍’’’、’’’纏腰火丹’’’,俗稱’’’蜘蛛瘡’’’、’’’生蛇’’’、’’’皮蛇’’’、’’’白蛇’’’、’’’飛蛇’’’,是一種 {{tsl|en|viral disease|病毒性疾病|病毒性疾病}},局部出現強烈[[疼痛]]的群聚皮膚[[水疱]]為其特徵<ref name=CDC2014Sym/><ref>{{cite book|title=Shafer’s textbook of oral pathology|date=2014|isbn=9788131238004|page=351|edition=Seventh edition.|url=https://books.google.ca/books?id=WnhtAwAAQBAJ&pg=PA351}}</ref> ,典型病徵為在身體左側或右側或臉部呈現帶狀的水痘<!-- <ref name=Pink2015/> --> 。水痘出現後二至四天會出現{{tsl|en|paresthesia|刺痛|麻刺感}}或局部疼痛<ref name=Pink2015/><ref name=Ga2016>{{cite journal|last1=Gagliardi|first1=AM|last2=Andriolo|first2=BN|last3=Torloni|first3=MR|last4=Soares|first4=BG|title=Vaccines for preventing herpes zoster in older adults.|journal=[[Cochrane Database of Systematic Reviews]]|date=3 March 2016|volume=3|pages=CD008858|doi=10.1002/14651858.CD008858.pub3|pmid=26937872|url=http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008858.pub3/full}}</ref>,除此之外還有幾項典型病徵<ref name=Pink2015/>。通常二到四週內疹子會痊癒<ref name=CDC2014Sym>{{cite web|title=Shingles (Herpes Zoster) Signs & Symptoms|url=http://www.cdc.gov/shingles/about/symptoms.html|accessdate=26 May 2015|date=May 1, 2014}}</ref>,然而有些患者會發展出長達數月或數年的[[神经病 (神经系统疾病)|神經疼痛]],或稱{{tsl|en|postherpetic neuralgia|帶狀疱疹後的神經痛|帶狀疱疹後的神經痛}}<!-- <ref name=Pink2015/> -->[[免疫抑制]]的患者身上可能{{tsl|Shingles#Disseminated||疹子會散佈較廣的範圍}}<ref name=Pink2015/>;如果疹子擴散到眼部,可能導致[[視力障礙|視力減損]]<ref name=CDC2014Sym/>

<!-- Definition and symptoms -->

Shingles, also known as herpes zoster, is a viral disease characterized by a painful skin rash with blisters in a localized area.[1][2] Typically the rash occurs in a single stripe either on the left or right of the body or face.[3] Two to four days before the rash occurs there may be tingling or local pain in the area.[3][4] Otherwise there are typically few symptoms.[3] The rash usually heals within two to four weeks;[1] however, some people develop ongoing nerve pain which can last for months or years, a condition called postherpetic neuralgia. In those with poor immune function the rash may occur widely.[3] If the rash involves the eye, vision loss may occur.[1]

<!-- 成因、機制、與診斷 -->

帶狀皰疹通常是因人體對[[水痘帶狀皰疹病毒]]({{lang-en|Varicella zoster virus,VZV}})有所反應而引起。Chickenpox是VZV初期感染引發,水痘一經痊癒,病毒會留在nerve cells轉為inactive[3] ,當病毒再度轉為活性,便會經由神經行遍全身造成疹子[4],引起病毒活性化的危險因子包含上了年紀、poor immune function、以及未滿18個月得水痘。病毒何以滯留於人體或再次活性化的成因尚且不明。未得過水痘的患者會在暴露於疹子病毒的情況下得水痘,但不會引起帶狀皰疹。診斷結果通常因個人體徵或症狀而異。雖然同屬family of viruses,VZV與herpes simplex virus並不相同[7]

<!-- Cause, mechanism, and diagnosis -->

Shingles is due to a reactivation of varicella zoster virus (VZV) within a person’s body. Chickenpox is due to an initial infection with VZV. Once chickenpox has resolved, the virus may remain inactive in nerve cells.[3] When it reactivates it travels from the nerve body to the endings in the skin producing blisters.[4] Risk factors for reactivation include older age, poor immune function, and having had chickenpox before 18 months of age. How the virus remains in the body or subsequently re-activates, is not well understood.[3] Exposure to the virus in the blisters can cause chickenpox in someone who has not had it before but will not trigger shingles.[5] Diagnosis is typically based on a person’s signs and symptoms.[6] Varicella zoster virus is not the same as herpes simplex virus; however, they belong to the same family of viruses.[7]

<!-- 預防與治療 -->

帶狀皰疹疫苗會有助於降低50-80歲施打者的得病機率於一半,也有助於降低帶狀疱疹後的神經痛,或再發時的嚴重度。疫苗對80歲以上施打者仍然有效,只是效力較弱。帶狀皰疹疹疫苗包含水痘疫苗類似成分,只是劑量較高。當帶狀皰疹發病的最初72小時內,antiviral medications像是aciclovir可緩和病情和簡短病期,目前尚無證據顯示抗病藥物或類固醇對帶狀疱疹後的神經痛有所影響[8][9]ParacetamolNSAIDs,或opioids有助緩和劇痛。

<!-- Prevention and treatment -->

The shingles vaccine decreases the chance of shingles by about half in those between the ages of 50 and 80. It also decreases rates of postherpetic neuralgia, and if an outbreak occurs, its severity. After 80 the vaccine is still effective, just less so. It contains the same material as the varicella vaccine, just at a higher dose.[3] If shingles develops, antiviral medications such as aciclovir can reduce the severity and duration of disease if started within 72 hours of the appearance of the rash.[6] Evidence does not show a significant effect of antivirals or steroids on rates of postherpetic neuralgia.[8][9] Paracetamol, NSAIDs, or opioids may be used to help with the acute pain.[6]

<!-- 流行病學與歷史 -->

據估計約三分之一的人一生中可能得到帶狀皰疹,常見於年長者或兒童;number of new cases per year顯示一千位健康者中約有1.2-3.4位得病,到65歲以上年長者,一千人中達3.9–11.8位患病。85歲以上高齡者約將近一半至少發病一次,其中低於5%的人會發病一次以上。帶狀皰疹被認為是歷史悠久的疾病.[3],在阿拉伯語中被稱為"火之腰帶(belt of fire)",西班牙語中稱為"小蛇(small snake)",印地語中稱為"起大疹(big rash)"[12]

<!-- Epidemiology and history -->

It is estimated that about a third of people develop shingles at some point in their life.[3] While more common among older people, children may also get the disease.[7] The number of new cases per year ranges from 1.2–3.4 per 1,000 among healthy individuals to 3.9–11.8 per 1,000 among those older than 65 years of age.[10] About half of those living to age 85 will have at least one attack, and less than 5% will have more than one attack.[3][11] The disease has been recognized since ancient times.[3] In Arabic its name means "belt of fire", while in Spanish it means "small snake", and in Hindi it means "big rash".[12]