Wu Chieh-Hsin, Chai Chee-Yin, Tung Yi-Ching, Lu Ying-Yi, Su Yu-Feng, Tsai Tai-Hsin, Tzou Rong-Dar, Lin Chih-Lung
Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University Department of Pathology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University Institute of Biomedical Sciences, National Sun Yat-Sen University Department of Public Health and Environmental Medicine, College of Medicine, Kaohsiung Medical University Department of Dermatology, Kaohsiung Veterans General Hospital Cosmetic Applications and Management Department, Yuh-Ing Junior College of Health Care and Management Department of Neurosurgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Medicine (Baltimore). 2016 Jun;95(25):e3943. doi: 10.1097/MD.0000000000003943.
The objective of this study was to investigate the risk of osteoporosis in patients with herpes zoster (HZ) infection using a nationwide population-based dataset. The Taiwan National Health Insurance Research Database was used to compare data between 11,088 patients aged 20 to 49 years diagnosed with HZ during 1996 to 2010 and a control group of 11,088 patients without HZ. Both cohorts were followed up until the end of 2010 to measure the incidence of osteoporosis. Cox proportional-hazards regression and Kaplan-Meier analyses were used to calculate hazard ratio and cumulative incidences of osteoporosis, respectively. The overall risk of osteoporosis was 4.55 times greater in the HZ group than in the control group (2.48 vs. 0.30 per 1000 person-years, respectively) after adjusting for age, gender, Charlson Comorbidity Index, and related comorbidities. Compared with controls, patients with HZ and subsequent postherpetic neuralgia had a 4.76-fold higher likelihood of developing osteoporosis (95% confidence interval: 2.44-9.29), which was a statistically significant difference (P <0.001). Osteoporosis risk factors included female gender, age, advanced Charlson Comorbidity Index, depression, and postherpetic neuralgia. This study identified HZ is associated with an increased osteoporosis risk. Further evaluation of the value of bone mineral density test in detecting osteoporosis after HZ may be suggested. HZ vaccination could also be evaluated to lower the incidence of HZ and possibly subsequent osteoporosis. Physicians should be alerted to this association to improve early identification of osteoporosis in patients with HZ.
本研究的目的是利用全国性的基于人群的数据集，调查带状疱疹（HZ）感染患者患骨质疏松症的风险。台湾国民健康保险研究数据库用于比较1996年至2010年间诊断为HZ的11088例20至49岁患者与11088例无HZ的对照组患者的数据。两个队列均随访至2010年底，以测量骨质疏松症的发病率。分别采用Cox比例风险回归和Kaplan-Meier分析来计算骨质疏松症的风险比和累积发病率。在调整年龄、性别、Charlson合并症指数和相关合并症后，HZ组骨质疏松症的总体风险比对照组高4.55倍（分别为每1000人年2.48例和0.30例）。与对照组相比，患有HZ及随后发生带状疱疹后神经痛的患者发生骨质疏松症的可能性高4.76倍（95%置信区间：2.44 - 9.29），这是一个具有统计学意义的差异（P<0.001）。骨质疏松症的风险因素包括女性性别、年龄、较高的Charlson合并症指数、抑郁症和带状疱疹后神经痛。本研究发现HZ与骨质疏松症风险增加有关。可能建议进一步评估骨密度检测在检测HZ后骨质疏松症中的价值。还可以评估HZ疫苗接种以降低HZ的发病率，并可能降低随后骨质疏松症的发病率。医生应警惕这种关联，以改善对HZ患者骨质疏松症的早期识别。
