Sayeeda Afsar, Al Arfaj Hussain, Khalil Najma, Al Arfaj A S
Division of Rheumatology, Department of Medicine, College of Medicine, King Saud University, P.O. Box 2925, Riyadh 11461, Riyadh, Saudi Arabia.
Autoimmune Dis. 2010 Sep 13;2011:174891. doi: 10.4061/2010/174891.
Patients with SLE carry an increased risk of infection that account for 11-23% of all hospitalized patients and 50% of all SLE patients develop major infections during the course of their disease. Globally Herpes Zoster has been reported as the most frequent viral infection in SLE patients. We determined the clinical spectrum, disease sequelae and the risk factors associated with the development of Herpes Zoster in patients with SLE and their outcomes. Retrospective case control study of Herpes Zoster infections was done in SLE patients between 1982 and 2006. Cases were matched 1:2 to controls for age, race, sex and duration of follow up. Clinical features of the cases from the time of lupus diagnosis to the time of Zoster were compared to their respective controls over similar time periods. Thirty two SLE cases were compared to sixty four controls. Cases were more likely to have received cyclophosphamide (P = .0223) and intravenous methylprednisolone pulse therapy (P = .0026), MMF (P < .02), had leucopenia (P = .0407) and hemolytic anemia (P = .0344). More cases than controls had lupus nephritis, cerebritis, thrombocytopenia but the differences did not reach statistical significance. The mean oral prednisolone dose and proportion of patients receiving immunosuppressives including pulse methylprednisolone therapy, IV Cyclophosphamide and mycophenolate was significantly higher in patients with active SLE compared to patients with SLE in remission at the time of Herpes Zoster (P < .05). Disseminated Zoster developed in patients with active SLE (7/9) compared to patients with SLE in remission (0/23). None of the patients had postherpetic neuralgia or bacterial super infection. Immunosuppressive medications were discontinued at the time of diagnosis of Zoster in 19 of 32 patients and all patients received antiviral medications.There were no permanent neurologic deficits or deaths. We conclude that Herpes Zoster infections occur at increased frequency among patients with SLE and carry significant morbidity. Immunosuppressive therapy and severe manifestations of lupus may be risk factors for the development of Herpes Zoster although not necessarily at the time of disease flare or immunosuppressive therapy. Our study suggests that although Herpes Zoster occurs frequently in patients with SLE, it has a relatively benign course.
系统性红斑狼疮（SLE）患者发生感染的风险增加，感染占所有住院患者的11%-23%，50%的SLE患者在病程中会发生严重感染。在全球范围内，带状疱疹被报道为SLE患者中最常见的病毒感染。我们确定了SLE患者带状疱疹发生的临床谱、疾病后遗症及相关危险因素及其转归。对1982年至2006年间SLE患者的带状疱疹感染进行回顾性病例对照研究。病例与对照按年龄、种族、性别和随访时间1:2匹配。比较病例从狼疮诊断到带状疱疹发作期间的临床特征与其在相似时间段内各自对照的情况。32例SLE病例与64例对照进行比较。病例更可能接受过环磷酰胺治疗（P = 0.0223）、静脉注射甲泼尼龙冲击治疗（P = 0.0026）、霉酚酸酯（MMF）治疗（P < 0.02），有白细胞减少（P = 0.0407）和溶血性贫血（P = 0.0344）。病例比对照有更多狼疮肾炎、脑炎、血小板减少症患者，但差异未达到统计学意义。与带状疱疹发作时处于缓解期的SLE患者相比，活动期SLE患者的口服泼尼松龙平均剂量以及接受包括甲泼尼龙冲击治疗、静脉注射环磷酰胺和霉酚酸酯在内的免疫抑制剂治疗的患者比例显著更高（P < 0.05）。活动期SLE患者发生播散性带状疱疹的有7/9例，而缓解期SLE患者为0/23例。所有患者均无带状疱疹后神经痛或细菌重叠感染。32例患者中有19例在诊断带状疱疹时停用了免疫抑制药物，所有患者均接受了抗病毒药物治疗。无永久性神经功能缺损或死亡。我们得出结论，SLE患者中带状疱疹感染发生率增加且有显著的发病率。免疫抑制治疗和狼疮的严重表现可能是带状疱疹发生的危险因素，尽管不一定在疾病发作或免疫抑制治疗时。我们的研究表明，虽然带状疱疹在SLE患者中频繁发生，但其病程相对良性。
