Balshi Alexandra, Saart Emma, Pandeya Sarbesh, Dempsey John, Baber Ursela, Sloane Jacob A
Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA.
Mult Scler. 2023 Oct;29(11-12):1465-1470. doi: 10.1177/13524585231189641. Epub 2023 Aug 12.
Dimethyl fumarate (DMF) depletes CD8+ and CD4+ T cells, and cases of herpes zoster (HZ) in patients with multiple sclerosis (MS) on DMF have been documented.
To evaluate lymphocyte subsets in patients with MS who developed HZ on DMF (Tecfidera) compared to matched controls who did not develop HZ.
We used linear mixed-effects models to test for differences in white blood cell count, lymphocyte percentage, absolute lymphocyte count, CD3+ percentage, absolute CD3+ count, CD4+ percentage, absolute CD4+ count, CD8+ percentage, absolute CD8+ count, and CD4+:CD8+ ratio over time in HZ and non-HZ groups.
Eighteen patients developed HZ while on DMF. The linear mixed-effects model for CD4+:CD8+ ratio showed a significant difference between the HZ and non-HZ groups ( = 0.033). CD4+:CD8+ ratio decreased over time in the HZ group and increased over time in the non-HZ group.
Patients with MS who develop HZ while on DMF have high CD4+:CD8+ ratios, suggesting an imbalance of CD4+ and CD8+ cells that may put a patient at risk for developing HZ while on DMF. This result emphasizes the need for lymphocyte subset monitoring (including CD4+:CD8+ ratios) on DMF, as well as vaccination prior to DMF initiation.
富马酸二甲酯（DMF）会消耗CD8 +和CD4 + T细胞，并且已经有文献记载了使用DMF治疗的多发性硬化症（MS）患者发生带状疱疹（HZ）的病例。
评估在使用DMF（特立氟胺）治疗期间发生HZ的MS患者与未发生HZ的匹配对照组患者的淋巴细胞亚群。
我们使用线性混合效应模型来测试HZ组和非HZ组中白细胞计数、淋巴细胞百分比、绝对淋巴细胞计数、CD3 +百分比、绝对CD3 +计数、CD4 +百分比、绝对CD4 +计数、CD8 +百分比、绝对CD8 +计数以及CD4 +：CD8 +比值随时间的差异。
18例患者在使用DMF期间发生了HZ。CD4 +：CD8 +比值的线性混合效应模型显示HZ组和非HZ组之间存在显著差异（P = 0.０33）。HZ组中CD4 +：CD8 +比值随时间下降，而非HZ组中该比值随时间增加。
在使用DMF期间发生HZ的MS患者具有较高的CD4 +：CD8 +比值，这表明CD4 +和CD8 +细胞失衡，这可能使患者在使用DMF时发生HZ的风险增加。这一结果强调了在使用DMF时监测淋巴细胞亚群（包括CD4 +：CD8 +比值）以及在开始使用DMF之前进行疫苗接种的必要性。
