Fardet Laurence, Rybojad Michel, Gain Murielle, Kettaneh Adrien, Cherin Patrick, Bachelez Hervé, Dubertret Louis, Lebbe Celeste, Morel Patrice, Dupuy Alain
Université Paris 7-Diderot and Department of Dermatology, Assistance Publique-Hopitaux de Paris, Hopital Saint Louis, Paris, France.
Arch Dermatol. 2009 Aug;145(8):889-93. doi: 10.1001/archdermatol.2009.152.
Opportunistic infections have been reported in 15% to 21% of patients with inflammatory myositis. However, to our knowledge, no data are available regarding the incidence, risk factors, and severity of herpesvirus infections.
Retrospective inception cohort study.
Two departments in tertiary teaching hospitals. Patients All patients diagnosed as having dermatomyositis (DM) according to the criteria of Bohan and Peter seen during a 13-year period.
Cumulative incidence rates of herpesvirus infections using the Kaplan-Meier method and risk factors for herpesvirus infections during the first year of DM using Cox proportional hazards models.
A total of 121 patients met the inclusion criteria (mean [SD] age, 52 [15] years; 85 were women [70%]). Seventy-six percent had primary dermatomyositis, and 24% had dermatomyositis associated with a malignant neoplasm. The mean (SD) duration of follow-up was 42 (33) months. During follow-up, 20 patients developed a total of 22 herpesvirus infections (16 developed herpes zoster infections). The incidence rates for herpesvirus and for herpes zoster infections were 49 and 33 episodes per 1000 patient-years, respectively. In multivariate analysis, a positive association was noted between the risk of herpesvirus infection and use of systemic corticosteroid therapy (hazard ratio [HR], 3.71 [95% confidence interval {CI}, 1.02-13.41]; P = .04), lymphocyte count lower than 6000/microL (HR, 3.55 [95% CI, 1.00-12.65]; P = .05), and creatine phosphokinase level higher than 300 U/L (HR, 4.81 [95% CI, 1.28-18.06]; P = .02). Dermatomyositis associated with a malignant neoplasm tended to be negatively associated with the risk of herpesvirus infection (HR, 0.16 [95% CI, 0.02-1.29]; P = .08).
The risk of serious herpesvirus infections in patients with DM is high. Educational strategies and studies evaluating the risk-to-benefit and the cost-to-benefit balances of a prophylaxis with valacyclovir hydrochloride in selected patients with DM are warranted.
据报道，15%至21%的炎性肌炎患者会发生机会性感染。然而，据我们所知，尚无关于疱疹病毒感染的发病率、危险因素和严重程度的数据。
回顾性队列研究。
三级教学医院的两个科室。患者：所有根据博汉和彼得标准在13年期间确诊为皮肌炎（DM）的患者。
使用Kaplan-Meier方法计算疱疹病毒感染的累积发病率，以及使用Cox比例风险模型计算DM第一年期间疱疹病毒感染的危险因素。
共有121例患者符合纳入标准（平均[标准差]年龄，52[15]岁；85例为女性[70%]）。76%为原发性皮肌炎，24%为与恶性肿瘤相关的皮肌炎。平均（标准差）随访时间为42（33）个月。随访期间，20例患者共发生22次疱疹病毒感染（16例发生带状疱疹感染）。疱疹病毒感染和带状疱疹感染的发病率分别为每1000患者年49次和33次。在多变量分析中，发现疱疹病毒感染风险与全身皮质类固醇治疗的使用之间存在正相关（风险比[HR]，3.71[95%置信区间{CI}，1.02 - 13.41]；P = 0.04），淋巴细胞计数低于6000/μL（HR，3.55[95%CI，1.00 - 12.65]；P = 0.05），以及肌酸磷酸激酶水平高于300 U/L（HR，4.81[95%CI，1.28 - 18.06]；P = 0.02）。与恶性肿瘤相关的皮肌炎往往与疱疹病毒感染风险呈负相关（HR，0.16[95%CI，0.02 - 1.29]；P = 0.08）。
DM患者发生严重疱疹病毒感染的风险很高。有必要开展教育策略以及评估在特定DM患者中使用盐酸伐昔洛韦进行预防的风险效益和成本效益平衡的研究。
