Renal Division, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
Eur J Intern Med. 2012 Dec;23(8):711-5. doi: 10.1016/j.ejim.2012.08.005. Epub 2012 Sep 6.
Herpes zoster (HZ) reactivation is common in immunocompromised patients. Advanced renal failure is also reportedly associated with impairment of cellular immunity. There is not any study yet assessing risk factors of HZ reactivation in hemodialysis patients.
All patients undergoing maintenance hemodialysis for more than 3 months and who developed HZ between 2000/01/01 and 2009/12/31 in a tertiary referral medical center were identified, and matched 1:1 to hemodialysis patients without HZ by age and gender. Multivariate-adjusted conditional logistic regression model was constructed to determine possible risk factors.
Out of a total of 126 maintenance hemodialysis patients (65.3% female), 63 belonged to the HZ reactivation group and 63 to the age/sex matched control patients. Conditional logistic regression model linked corticosteroid use with heightened risk (odds ratio [OR] 20.2, 95% confidence interval [CI] 3.5-125.6; p=0.002), while iron therapy and 1α-hydroxylated vitamin D were associated with significantly lower likelihood of developing HZ (OR 0.12, 95%CI 0.0-0.6; p=0.01, and OR 0.06, 95% CI 0.0-0.4; p=0.005 respectively).
Use of iron preparations and 1α-hydroxylated vitamin D is potentially associated with less risk of developing HZ reactivation in maintenance hemodialysis patients.
带状疱疹（HZ）再激活在免疫功能低下的患者中很常见。据报道，终末期肾病也与细胞免疫功能受损有关。目前尚无研究评估血液透析患者 HZ 再激活的危险因素。
在一家三级转诊医疗中心，我们确定了所有接受维持性血液透析治疗超过 3 个月且在 2000/01/01 至 2009/12/31 期间发生 HZ 的患者，并按年龄和性别与未发生 HZ 的血液透析患者 1:1 匹配。采用多变量调整条件逻辑回归模型来确定可能的危险因素。
在总共 126 名维持性血液透析患者（65.3%为女性）中，63 名患者属于 HZ 再激活组，63 名患者为年龄/性别匹配的对照组患者。条件逻辑回归模型表明，皮质类固醇的使用与风险增加相关（比值比 [OR] 20.2，95%置信区间 [CI] 3.5-125.6；p=0.002），而铁剂治疗和 1α-羟化维生素 D 与发生 HZ 的可能性显著降低相关（OR 0.12，95%CI 0.0-0.6；p=0.01，OR 0.06，95%CI 0.0-0.4；p=0.005）。
铁制剂和 1α-羟化维生素 D 的使用可能与维持性血液透析患者发生 HZ 再激活的风险降低相关。
