郭晓楠 郑雯 彭琳琳

[摘要] 目的 分析三維皮肤CT检查在纠正水痘误诊中的作用，减少误诊误治，采用中西医结合方法治疗误诊水痘病例。 方法 回顾性分析2019年1—12月大连市第六人民医院和大连市皮肤病医院门诊16例误诊为其他疾病的水痘临床资料。三维皮肤CT对皮疹进行检查; 中西医结合方法治疗：口服伐昔洛韦片和连花清瘟胶囊、外用喷昔洛韦膏联合重组人干扰素α2b凝胶治疗。 结果 ①三维皮肤CT：16例患者临床表现不典型，但其皮肤CT检测均能发现并提示特异的病理学改变，从而辅助临床诊断。②疗效：16例患者一疗程痊愈11例，痊愈率为68.75%，好转5例，总有效率100.00%;二疗程痊愈16例，痊愈率100.00%。③不良反应：轻微。 结论 皮肤CT检查可以纠正水痘误诊，在诊治水痘中有重要作用;中西医结合方法治疗水痘安全高效。

[关键词] 皮肤CT;水痘;误诊;中西医结合

[中图分类号] R752.12          [文献标识码] B          [文章编号] 1673-9701（2021）07-0103-04

Three-dimensional skin CT for the correction of 16 misdiagnosis cases of varicella and integrated traditional Chinese and western medicine treatment

GUO Xiaonan1   ZHENG Wen2   PENG Linlin3

1.Intensive Care Unit，Dalian Sixth People's Hospital， Dalian  116031， China; 2.Dermatology Clinic， Dalian Dermatosis Hospital， Dalian   116021， China; 3.Department of Pathology， Dermatology Clinic， Dalian Dermatosis Hospital， Dalian   116021， China

[Abstract] Objective To analyze the role of three-dimensional skin CT examination in correcting the misdiagnosis of varicella to reduce misdiagnosis and mistreatment，and to analyze the combined Chinese and Western medicine to treat misdiagnosed varicella cases. Methods The clinical data of 16 cases of varicella misdiagnosed as other diseases in the outpatient clinic （Dalian Sixth People's Hospital， Dalian Dermatosis Hospital） from January to December 2019 were retrospectively analyzed. Three-dimensional skin CT was used to check the rash. They were treated with integrated traditional Chinese and western medicine：oral valacyclovir tablets and Lianhua Qingwen Capsules， combined with topical penciclovir ointment recombinant human interferon α2b gel treatment. Results ①Three-dimensional skin CT： Although the clinical manifestations of 16 patients were atypical， their skin CT examinations could find and suggest specific pathological changes， thereby assisting clinical diagnosis. ②Curative effect： 11 cases in 16 patients were cured in one course of treatment （the cure rate was 68.75%）， and 5 cases were improved（total effective rate was 100.00%）; 16 patients were cured in the second course of treatment（the cure rate was 100.00%）. ③The adverse reactions were mild. Conclusion Skin CT examination can correct the misdiagnosis of chickenpox and play a significant role in the diagnosis and treatment of chickenpox. The combination of Chinese and western medicine is safe and effective in treating chickenpox.

[Key words] Confocal laser scanning microscopy; Varicella; Misdiagnose; Integrated traditional Chinese and western medicine

水痘是由水痘-带状疱疹病毒初次感染引起的急性传染病，主要为呼吸道飞沫和接触传染，潜伏期 10～24 d、发病前 1～2 d至皮疹干燥结痂期均有传染性[1]，皮肤科和传染病门诊冬春两季十分多见。本病一般儿童多发，近年来成人水痘显著增多，其皮疹以皮肤黏膜分批出现斑丘疹、水疱和结痂，各期皮疹同时存在为特点[2]，初起皮疹不典型或原有其他皮肤病皮损干扰诊断（如传染性软疣等），临床诊断时易与脓疱疮、软疣、多形红斑、荨麻疹等混淆，引起误诊、耽误病情。本研究通过三维皮肤CT对皮疹进行检查，及时纠正误诊并予以中西医结合抗病毒（口服、外用）治疗，现报道如下。……