Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy.
Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy.
Public Health. 2024 Apr;229:80-83. doi: 10.1016/j.puhe.2024.01.024. Epub 2024 Feb 26.
The aim of this study was to investigate the shape of the time-varying relationship between herpes zoster infection, nominally shingles, and the occurrence of stroke.
Retrospective cohort study.
Using the Italian Health Search Database, a cohort of patients aged ≥18 years who were registered between 2002 and 2021 was selected. In this cohort, a nested case-control analysis was used to model the time-varying distance (in months) between the dates of shingles and post-herpetic stroke, using a regression cubic spline, based on the odds of the occurrence of stroke compared with those without shingles.
The dataset comprised 42,513 cases (51.1% males; mean age [stanndard deviation {SD}]: 71.0 [11.8] years) and 425,124 related controls (51.1% males; mean age [SD]: 70.9 [12] years). In the first 12 months following shingles diagnosis, a rapid increase in the risk of stroke was observed, reaching an odds ratio of 1.31 (95% confidence interval: 1.21-1.41); subsequently, there was some risk reduction and a new symmetric increase within the first 4.2 years of follow-up, thus shaping a bimodal distribution. Then, a new increase in the stroke risk was reported, although less steep, which was followed by a regular risk reduction (still 10% higher compared with those without shingles), resulting in a right-skewed relationship between the time from the shingles diagnosis and the occurrence of stroke. This association was no longer statistically significant 13.1 years after shingles diagnosis.
This study demonstrated that the risk of post-herpetic stroke has a short- and long-term association according to a risk continuum relationship. These findings confirm the relevance of vaccination coverage for herpes zoster.
本研究旨在探讨带状疱疹感染（俗称带状疱疹）与中风发生之间时变关系的形状。
回顾性队列研究。
使用意大利健康搜索数据库，选择了 2002 年至 2021 年期间注册的年龄≥18 岁的患者队列。在该队列中，使用回归三次样条基于与没有带状疱疹的患者相比发生中风的几率，对带状疱疹和疱疹后中风之间的时间变化距离（以月为单位）进行嵌套病例对照分析。
数据集包括 42513 例病例（51.1%为男性；平均年龄[标准差]：71.0[11.8]岁）和 425124 例相关对照（51.1%为男性；平均年龄[标准差]：70.9[12]岁）。在带状疱疹诊断后的头 12 个月内，观察到中风风险迅速增加，比值比达到 1.31（95%置信区间：1.21-1.41）；随后，风险有所降低，并在随访的前 4.2 年内再次对称增加，从而形成双峰分布。然后，报告了中风风险的再次增加，尽管幅度较小，随后风险逐渐降低（与没有带状疱疹的患者相比仍高 10%），导致带状疱疹诊断与中风发生之间的关系呈右偏态。这种关联在带状疱疹诊断后 13.1 年不再具有统计学意义。
本研究表明，疱疹后中风的风险存在短期和长期关联，呈风险连续体关系。这些发现证实了带状疱疹疫苗接种覆盖率的重要性。
