生蛇後遺症 隨時持續幾年?

帶狀疱疹 (俗稱生蛇),是由潛伏在患者體內的水痘帶狀疱疹病毒引起的疾病。患者的水痘康復後,帶狀疱疹病毒會潛伏在其體內,日後有機會造成生蛇。此外,患者多為年紀較大或免疫力低的人士。患者有機會在出水痘多年後,才出現帶狀疱疹。1

根據美國研究,

大約3人當中有1人

一生中有機會生蛇2

根據港大醫學院研究,

只有29.6%的50歲或以上受訪者

知道水痘與生蛇有關3

生蛇成因與風險因素

生蛇的成因

帶狀疱疹(Herpes Zoster)是由水痘帶狀疱疹病毒引起,與引致水痘的病毒相同。4,5身體受水痘帶狀疱疹病毒感染,首個引起的問題便是出水痘。6

水痘痊癒後,病毒會進入神經系統,繼而潛伏在神經組織,處於休眠狀態,並可潛伏多年。5,7一段時間後,病毒或會再次活躍,並沿着神經線進入患者的皮膚,導致生蛇。5 不過,並非每個出過水痘的人都會發展出帶狀疱疹。8 帶狀疱疹病毒再次活躍或與免疫力降低有關,因此生蛇在老年人和免疫系統較弱的人士中較爲常見。4

風險因素

以下的風險因素都會增加帶狀疱疹病毒再次被激活的機會:

  • 年齡:生蛇多發於50歲以上高齡人士5
  • 壓力9
  • 身體嚴重創傷9
  • 以下潛在疾病患者,其患上帶狀疱疹的風險會比平常人高。10
    • 免疫系統疾病及降低免疫力的疾病,如:紅斑狼瘡、類風濕性關節炎
    • 癌症
    • 心血管疾病
    • 腎功能衰竭
    • 高血壓
    • 糖尿病
      • 糖尿病患者免疫反應較低,患上帶狀疱疹風險增加11,12
      • 帶狀疱疹患者當中,不少是未確診的糖尿病患者。12
      • 二型糖尿病患者的發病風險較高11,13
      • 單獨接受胰島素或胰島素與其他抗糖尿病藥合用的糖尿病患者,其患上帶狀疱疹的風險顯著高於接受單一療法的患者。同時患有冠狀動脈疾病或微血管疾病的糖尿病患者,生蛇的風險相對較高11

生蛇症狀

  • 初期

會有類似感冒的症狀,例如頭痛、疲倦乏力、發燒及腸胃不適等。14

  • 發病後1-3日內

帶狀疱疹病毒會沿著脊髓神經到達連接的皮膚表面,形成紅疹。14 即使還沒有紅疹,患處也會出現疼痛、麻刺感、痕癢。15 通常發於背部及腰側。14

  • 幾天後

出現以上症狀的幾天後,患處會蔓延,呈帶狀的紅疹,甚至伴隨水泡。水泡會持續1-14日,期間可能會出現膿皰或血水,並於兩至三星期內乾水並結痂。14,16

  • 併發症
  1. 後遺神經痛可持續數年:

帶狀疱疹後遺神經痛是指病發數月,甚或數年後仍然感受到的疼痛,是最常見的生蛇後遺症。14,17這個後遺痛症往往難以控制,更有機會持續多年,對患者的身心健康和社交生活造成負面影響。21

本身患有糖尿病的生蛇患者較大機會出現後遺神經痛22,23

2. 色素沉澱或疤痕14

患處可能出現色素沉澱,令皮膚呈現瘀色,需要數個月才會消散,嚴重者可能會留下疤痕。

3. 影響視力24

若患處接近眼睛,眼內或眼周的帶狀疱疹 (眼部帶狀疱疹) 可以引起紅眼症(結膜炎)、葡萄膜炎或影響角膜等眼睛問題,或會導致視力受損。 此外,年長者因眼部帶狀疱疹而導致視力受損的機會比一般人較高。

4. 生蛇可導致糖尿病患者的血糖控制轉壞25

受帶狀疱疹影響,糖尿病患者可能會出現血糖水平升高,血糖控制轉差的情況。25

5. 生蛇或增加中風及心肌梗塞風險26,27

帶狀疱疹增加中風和心肌梗塞的風險分別為35%和59%。26 急性帶狀疱疹發作後第一年,中風的風險較高。27

position

生蛇的診斷和檢查28

診斷主要基於患者的病歷和其身體上的紅疹檢查結果進行。一般情況下,不會透過實驗室進行檢測確認。然而,醫生會為部分患者,尤其是免疫力低下的人士,進行額外檢測:

  • 直接螢光抗體(DFA)檢測
  • 聚合酶鏈鎖反應(PCR)測試
  • Tzanck smear抹片檢查

生蛇的治療

醫學界暫時未有根治生蛇的方法

現時主要依靠以下方式舒緩生蛇症狀:

  • 抗病毒藥物5

及時使用處方抗病毒藥物治療,可以減輕或預防劇烈疼痛,加速水泡癒合,減低併發症如後遺神經痛的風險。

  • 口服、外用及針劑止痛藥28-30

生蛇會引起劇烈疼痛,醫生可能會處方以下口服、外用和針劑藥物28-30

  • 消炎止痛藥
  • 含麻醉性口服鎮痛藥物
  • 舒緩帶狀疱疹急性疼痛的抗癲癇藥
  • 局部麻醉用注射針劑
  • 類固醇

預防生蛇

  • 接種疫苗

想要預防生蛇,可考慮諮詢醫生的意見,醫生或會建議你注射帶狀疱疹疫苗(俗稱蛇針)。

接種帶狀疱疹疫苗可減低曾患水痘人士患上生蛇的機會,以及減輕生蛇相關痛症。31美國疾病控制和預防中心 (CDC) 建議50歲或以上人士接種疫苗。32

接種疫苗後可能會出現輕微副作用,如接種部位會發紅、痠痛、腫脹、痕癢或頭痛;接種位置附近也可能會出類似生蛇的紅疹。其他副作用包括蕁麻疹、壞死性視網膜炎(正接受免疫抑制治療的人士)及吉巴氏綜合症等等。33

如對某種成分過敏、因疾病或藥物導致免疫系統虛弱、正在懷孕者33 切勿接種疫苗。

此外,市民應注意帶狀疱疹疫苗只用作預防生蛇,對於帶狀疱疹並沒有治療作用。

任何疫苗都有可能產生嚴重過敏反應,加上上述疫苗為處方藥物(即:須經註冊醫生處方),接種前請先諮詢醫生建議。

參考資料
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  33. Data on file, MSD.

本健康專題由MSD贊助。

本資訊僅作為公共健康教育用途,不應被視為或代替任何專業醫學建議,倘若閣下對本健康資訊內容有任何疑問,請向專業醫護人員查詢。

 

HK-CIN-00062 Mar/2021