Manzi S, Kuller L H, Kutzer J, Pazin G J, Sinacore J, Medsger T A, Ramsey-Goldman R
Department of Medicine, Graduate School of Public Health, Pittsburgh, PA, USA.
J Rheumatol. 1995 Jul;22(7):1254-8.
To define the clinical spectrum and disease sequelae of herpes zoster and to determine the risk factors associated with the development of herpes zoster in patients with systemic lupus erythematosus (SLE).
Retrospective matched case control study in a consecutive series of patients with SLE first evaluated between 1979 and 1989. Patients were classified as cases if their first episode of zoster occurred after lupus diagnosis. Lupus patients who never had zoster were eligible as controls and were matched 2:1 to cases for age, race, sex, and survival status. Clinical features of the cases from the time of lupus diagnosis to the time of zoster were compared to their respective controls over similar time periods.
Forty eight (15%) of 321 patients were classified as cases. Cases were more likely to have received cyclophosphamide (p = 0.03), and azathioprine (p = 0.006). More cases had lupus nephritis (p = 0.02), and a concurrent or previous malignancy (p = 0.01) than their controls. Seven cases had cutaneous dissemination. Seven patients had postherpetic neuralgia > 2 months and in only 2 patients symptoms persisted for > 12 months' duration. Only 3 of 36 patients had immunosuppressive medication discontinued at the time of diagnosis of zoster, and 10 cases received acyclovir for the zoster infection. There were no permanent neurologic deficits or death.
Immunosuppressive therapy, specifically cyclophosphamide and azathioprine, lupus nephritis, and a concurrent or previous malignancy may be risk factors for the development of herpes zoster infections in patients with SLE. Our study suggests that although herpes zoster occurs frequently in patients with SLE, it has a relatively benign course. Discontinuing needed immunosuppressive therapy in patients with SLE may be unnecessary in the setting of a zoster infection. With the current emphasis on reduction in medical costs, both by limiting inpatient admissions and eliminating unneeded medications, it is necessary to identify which patients require more intensive therapy with antiviral medications and/or hospitalization and which are likely to have a benign, self-limited course without intervention.
明确带状疱疹的临床谱及疾病后遗症，并确定系统性红斑狼疮（SLE）患者发生带状疱疹的相关危险因素。
对1979年至1989年间首次评估的一系列连续性SLE患者进行回顾性匹配病例对照研究。若患者在狼疮诊断后首次发生带状疱疹，则分类为病例组。从未患过带状疱疹的狼疮患者作为对照组，按年龄、种族、性别和生存状态以2:1的比例与病例组匹配。将病例组从狼疮诊断至带状疱疹发生期间的临床特征与其在相似时间段内各自的对照组进行比较。
321例患者中有48例（15%）被分类为病例组。病例组更有可能接受过环磷酰胺治疗（p = 0.03）和硫唑嘌呤治疗（p = 0.006）。与对照组相比，更多病例组患者患有狼疮性肾炎（p = 0.02）以及同时存在或既往有恶性肿瘤（p = 0.01）。7例病例出现皮肤播散。7例患者发生带状疱疹后神经痛超过2个月，仅2例患者症状持续超过12个月。36例患者中只有3例在带状疱疹诊断时停用了免疫抑制药物，10例病例因带状疱疹感染接受了阿昔洛韦治疗。未出现永久性神经功能缺损或死亡。
免疫抑制治疗，特别是环磷酰胺和硫唑嘌呤、狼疮性肾炎以及同时存在或既往有恶性肿瘤可能是SLE患者发生带状疱疹感染的危险因素。我们的研究表明，尽管带状疱疹在SLE患者中频繁发生，但其病程相对良性。在带状疱疹感染的情况下，SLE患者停用必要的免疫抑制治疗可能没有必要。鉴于当前强调通过限制住院次数和停用不必要药物来降低医疗成本，有必要确定哪些患者需要更强化的抗病毒药物治疗和/或住院治疗，以及哪些患者在无干预情况下可能有良性、自限性病程。
