Zamora Leonid D, Collante Ma Theresa M, Navarra Sandra V
Section of Rheumatology, University of Santo Tomas, Manila, Philippines.
Int J Rheum Dis. 2020 Feb;23(2):197-202. doi: 10.1111/1756-185X.13725. Epub 2019 Nov 6.
To identify clinical risk factors associated with herpes zoster (HZ) infections in systemic lupus erythematosus (SLE).
A case-control study of HZ infection was performed in SLE patients seen at the University of Santo Tomas Lupus Clinics from 2009-2014. Cases were matched 1:2 to SLE controls without HZ infection for age, sex, and disease duration. Clinical characteristics, SLE disease activity, and immunosuppressive use were compared.
Sixty-five SLE patients (61, 93.8% female) who developed HZ were matched with 130 SLE patients without HZ. Mean age was 36.75 years (±1.35; P = 1.00) for the case group; mean SLE disease duration at first HZ infection was 6.1 years (±3.3; P = .919). Four patients had more than 1 episode of HZ. There was localized HZ in 63/65 (97%), and 2 (3%) disseminated HZ infections. The case group received higher doses of prednisone 64/65 (P = .012), mean prednisone dose 18.62 mg/d (±1.48, P < .001) and more were exposed to cyclophosphamide (Cyc) (19/65; P < .001) compared to the control group's mean prednisone dose of 11.73 mg/d (±1.16); there was Cyc use in 7/130 patients. Cyc in addition to mycophenolate mofetil (MMF) use among lupus nephritis patients conferred the highest risk for HZ infection occurrence. Hydroxychloroquine (HCQ) use reduced the risk for HZ by 87% (adjusted odds ratio 0.13, P = .003).
Immunosuppressives and corticosteroid use are risk factors associated with the development of HZ in SLE. The risk for HZ increases among patients given intravenous Cyc and MMF for lupus nephritis. SLE disease activity did not show a direct association with HZ occurrence. HCQ use appeared to have a protective role against HZ infection.
确定系统性红斑狼疮（SLE）中与带状疱疹（HZ）感染相关的临床危险因素。
对2009年至2014年在圣托马斯大学狼疮诊所就诊的SLE患者进行HZ感染的病例对照研究。病例与无HZ感染的SLE对照按年龄、性别和病程进行1:2匹配。比较临床特征、SLE疾病活动度和免疫抑制剂的使用情况。
65例发生HZ的SLE患者（61例，93.8%为女性）与130例无HZ的SLE患者进行匹配。病例组的平均年龄为36.75岁（±1.35；P = 1.00）；首次发生HZ感染时SLE的平均病程为6.1年（±3.3；P = 0.919）。4例患者有不止1次HZ发作。63/65（97%）为局限性HZ，2例（3%）为播散性HZ感染。与对照组平均泼尼松剂量11.73 mg/d（±1.16）相比，病例组接受更高剂量的泼尼松64/65（P = 0.012），平均泼尼松剂量18.62 mg/d（±1.48，P < 0.001），且更多患者使用环磷酰胺（Cyc）（19/65；P < 0.001）；130例患者中有7例使用Cyc。狼疮肾炎患者在使用霉酚酸酯（MMF）的基础上联合使用Cyc发生HZ感染的风险最高。使用羟氯喹（HCQ）可使HZ风险降低87%（校正比值比0.13，P = 0.003）。
免疫抑制剂和糖皮质激素的使用是SLE患者发生HZ的危险因素。狼疮肾炎患者静脉使用Cyc和MMF时HZ风险增加。SLE疾病活动度与HZ发生无直接关联。使用HCQ似乎对HZ感染有保护作用。
