Herpes Zoster
Herpes Zoster
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DOI：
10.7326/l18-0557
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发表时间：
2018-12
影响因子：
39.2
通讯作者：
M. Goldstein;L. Mascitelli
中科院分区：
文献类型：
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作者：
M. Goldstein;L. Mascitelli
致编辑：Schmader (1) 指出带状疱疹 (HZ) 的发病率正在增加。作者讨论了导致这种情况的几个危险因素，包括年龄增长、免疫抑制、化疗、放疗、类固醇使用、艾滋病毒/艾滋病、糖尿病、癌症、女性、白种人、带状疱疹家族史以及 1 岁前感染水痘。然而，他汀类药物治疗也可能代表带状疱疹的危险因素 (2, 3) 并对老年人群具有重要影响 (3) 却没有被提及。在一项大型观察性试验中，70 岁以上的他汀类药物使用者的 HZ 风险比未接受他汀类药物的年龄匹配组高 39% (P= 0.003) (3)。他汀类药物已被证明可以在多个水平上调节免疫反应 (4)，其免疫抑制作用可能解释了其与带状疱疹风险增加的关联。临床医生面临越来越大的压力，需要开出更高剂量的他汀类药物，以进一步降低低密度脂蛋白胆固醇水平，以降低残余心血管疾病的风险 (5)。他汀类药物治疗的累积剂量效应和 HZ 风险也存在显着趋势 (3)。因此，高剂量他汀类药物的广泛使用，特别是在老年人中，可能部分解释了过去几十年带状疱疹发病率不断增加的原因。临床医生应意识到这种关联，并积极建议接受这些药物的老年患者接种带状疱疹疫苗，这些患者由于年事已高，免疫功能相对受到抑制。
TO THE EDITOR: Schmader (1) notes that the incidence of herpes zoster (HZ) is increasing. The author discussed several risk factors for this condition, including advancing age, immunosuppression, chemotherapy, radiotherapy, steroid use, HIV/AIDS, diabetes, cancer, female sex, white race, a family history of HZ, and having varicella infection before 1 year of age. However, statin therapywhich could also represent a risk factor for HZ (2, 3) and has important implications in the geriatric population (3)was not mentioned. In a large observational trial, statin users older than 70 years had a 39% higher risk for HZ than an age-matched group who did not receive statins (P= 0.003) (3). Statins have been shown to modulate the immune response at several levels (4), and their immunosuppressive actions probably explain their association with an increased risk for HZ. Clinicians face increasing pressure to prescribe higher doses of statins for further reduction of low-density lipoprotein cholesterol levels with the goal of lowering risk for residual cardiovascular disease (5). There is also a significant trend in the cumulative dose effect of statin therapy and risk for HZ (3). Widespread use of statins at higher doses, particularly in elderly persons, thus might partly explain the increasing incidence of HZ over the past several decades. Clinicians should be aware of this association and diligently recommend HZ vaccination to elderly patients receiving these agents, who are already relatively immunosuppressed because of their advanced age.