Galil K, Choo P W, Donahue J G, Platt R
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, Mass, USA.
Arch Intern Med. 1997 Jun 9;157(11):1209-13.
The last 40 years was a period during which the incidence of herpes zoster appears to have increased substantially.
To determine whether the risk of complications of herpes zoster has changed during the last 40 years.
The automated medical records of a health maintenance organization were screened for diagnosis codes suggesting herpes zoster and potentially complicated cases of zoster. The predictive value of a herpes zoster diagnosis was calculated from sampling full-text records. Records of all patients with codes suggesting complications were reviewed in full.
Of 859 individuals with herpes zoster who met the eligibility criteria, 101 were identified who experienced at least 1 complication, corresponding to a 60-day risk of 12%. Corrected for the sensitivity of the complication-finding strategy, the risk estimate was 14%. Risk increased markedly with age, with those older than 64 years having more than 6 times the risk of complications of those younger than 25 years (odds ratio, 8.3; 95% confidence interval, 2.5-29.3). Trigeminal distribution of rash and the presence of certain conditions associated with immune compromise appeared to increase risk.
The apparent increase in the incidence of herpes zoster was not accompanied by a change in the risk of specific or overall complications in a population-based sample. Advanced age and other conditions associated with waning cellular immunity may confer an increased risk of experiencing a complicated course of herpes zoster.
过去40年期间，带状疱疹的发病率似乎大幅上升。
确定过去40年中带状疱疹并发症的风险是否发生了变化。
对一家健康维护组织的自动化医疗记录进行筛查，以查找提示带状疱疹的诊断代码以及可能并发的带状疱疹病例。通过对全文记录抽样计算带状疱疹诊断的预测价值。对所有提示有并发症代码的患者记录进行全面审查。
在859名符合入选标准的带状疱疹患者中，有101名被确定至少经历了1种并发症，60天的风险为12%。校正并发症发现策略的敏感性后，风险估计为14%。风险随年龄显著增加，64岁以上人群发生并发症的风险是25岁以下人群的6倍多（比值比为8.3；95%置信区间为2.5 - 29.3）。皮疹的三叉神经分布以及与免疫功能低下相关的某些情况似乎会增加风险。
在基于人群的样本中，带状疱疹发病率的明显上升并未伴随着特定或总体并发症风险的变化。高龄以及与细胞免疫减弱相关的其他情况可能会增加带状疱疹出现复杂病程结果的风险。
