소아 대상포진 환자의 면역상태에 따른 임상양상
Clinical Features of Herpes Zoster in Children according to Immune Status
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목적: 소아 대상포진 환자는 점차 늘어나고 있고, 면역저하 환자에서는 심각한 합병증을 초래할 수 있다. 이에 본 연구는 단일 기관에서 대상포진으로 내원한 소아청소년의 임상양상을 조사하였고, 면역상태에따라 이를 비교하였다. 방법: 1996년 7월부터 2017년 5월까지 인하대 병원에서 대상포진을진단받은 18세 미만의 소아청소년 환자를 대상으로 의무기록을 후향적으로 조사하였고 전형적인 피부 증상의 기록이 부족한 환자는 제외 하였고 이들을 면역 상태에 따라 두 군으로 나누어 임상 양상, 치료 기간및 합병증을 비교 하였다. 결과: 전체 307명 환자들의 평균 연령은 10.2세 였고 남성은 151명(49.2%), 여성은 156명(50.8%) 이었다. 80명(28.3%)의 환자가 입원 치료를 받았고 그 외 220명(71.7%)의 환자가 외래 또는 응급실에서 치료를받았고 대부분의 환자들이 항바이러스제 치료를 받았다. 피부 병변의분포는 흉부 신경절(49.7%)에서 가장 많이 발생하였고, 그 뒤로 삼차(30.4%), 요추 및 천골(12.5%), 경부 신경절(7.4%) 순으로 나타났다. 면역약화군은 21명이었고 이중 15명은 혈액학적 질환을 가진 환자였다. 면역약화군에서 면역적격군에 비해 입원률(71.4% vs 25.2%, P<0.001), 수두 병력(28.6% vs 8.4%, P =0.1), 평균 치료 기간(8.3일 vs 6.3일, P=0.003)이 유의하게 높았다. 두 군간의 성별, 연령, 병변이 발생한 피부 신경절의 위치 및 합병증은 두 군간의 유의한 차이가 없었다. 합병증은50례가 관찰되었으며 그 중 절반 이상이 눈대상포진 이었으며 그 다음으로는 Ramsay-Hunt 증후군, 수막염 및 피부 감염이었다. 결론: 소아 대상포진의 환자의 성별, 연령, 병변이 발생한 피부 신경절의 위치, 합병증은 면역상태에 따른 두 군간의 차이가 없었지만 면역약화군에서 항바이러스제를 이용한 치료 기간이 더 길었으며 과거에수두에 걸린 비율이 더 높았다.
Abstract
Purpose: Herpes zoster appears in all ages and its incidence progressively increase. It is more common in elderly people or immunocompromised people and can be accompanied by serious complications. This study was performed to investigate the clinical manifestation of herpes zoster according to immune status in children. Methods: This study was retrospectively included 307 children under 18 years who were diagnosed and treated with herpes zoster at Inha University Hospital from 1997 to 2017 based on medical records. These patients were divided into two groups according to their immunity and their clinical features were compared. Results: The mean age of the total 307 patients was 10.2 years, 151 (49.2%) in males. Eighty-seven patients were hospitalized and 220 patients were treated in an outpatient clinic. Most patients received antiviral treatment. The most common dermatomal distribution of the skin lesion was the thoracic region, followed by trigeminal, lumbar and sacral, cervical region. Twenty-one patients were immunocompromised and fifteen of them were hematologic disorders. Admission rate, history of chickenpox and mean duration of treatment were significantly higher in immunocompromised group (P<0.05). There was no significant difference in age, dermatomal distribution and complication between the two groups. Complications were observed in 50 cases and more than half of them were zoster ophthalmicus. Another complication was Ramsay-Hunt syndrome, meningitis and skin infection. Conclusion: Immunocompromised patients had a longer duration of treatment and a higher history of chickenpox. The incidence of complications, dermatomal distribution and age did not differ from that of immunocompetent children.
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