The short- and long-term risk of stroke after herpes zoster - a nationwide population-based cohort study.
The short- and long-term risk of stroke after herpes zoster - a nationwide population-based cohort study.
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DOI：
10.1371/journal.pone.0069156
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Melbye M
中科院分区：
文献类型：
--
作者：
Sreenivasan N;Basit S;Wohlfahrt J;Pasternak B;Munch TN;Nielsen LP;Melbye M
水痘带状疱疹病毒 (VZV) 已知会引起 VZV 血管病变，可能与中风有关。最近的一项研究发现，带状疱疹一年内中风的风险增加。我们的目的是研究带状疱疹对中风风险的短期和长期影响。利用丹麦国家登记册，我们构建了一个由 1995 年至 2008 年间所有 18 岁以上丹麦成年人组成的队列（n=460 万人；随访人年=5290 万人）。有关带状疱疹抗病毒治疗处方和中风诊断的个人信息是从国家登记册中获得的。我们通过泊松回归比较了接受特定剂量的阿昔洛韦治疗带状疱疹的人和从未接受过抗病毒治疗的人的中风风险。在随访期间，2.5% 的人接受了带状疱疹治疗，5.0% 的人被诊断出患有中风。接受药物治疗的个体在前两周的风险增加了 127% (95% CI 83–182%)，两周至一年期间风险增加了 17% (CI 9–24%)，第一年后风险增加了 5% (2–9%)。最年轻年龄组（<40 岁）的风险增加最大。为了控制就医行为，我们进行了平行分析，调查带状疱疹后特定骨折的风险，发现没有类似的风险增加。这项大型全国性队列研究发现，带状疱疹治疗后中风的风险增加。虽然短期风险特别高，但我们不能排除存在较小但重要的长期风险的可能性。
Varicella zoster virus (VZV) is known to cause VZV vasculopathy, which may be associated with stroke. A recent study found an increased risk of stroke within one year of herpes zoster. We aimed to investigate the short and long-term effects of herpes zoster on the risk of stroke. Using Danish national registers, we constructed a cohort consisting of all Danish adults ≥18 years old between 1995 and 2008 (n = 4.6 million; person-years of follow-up = 52.9 million). Individual-level information on prescriptions for herpes zoster antiviral treatment and diagnoses of stroke was obtained from national registers. We compared the risk of stroke in persons who had received the specific dosage of acyclovir for herpes zoster with persons who had never received antiviral treatment by Poisson regression. During follow-up, 2.5% received treatment for herpes zoster and 5.0% were diagnosed with stroke. Individuals who had received medication had a 127% (95% CI 83–182%) increased risk the first two weeks, 17% (CI 9–24%) between two weeks and one year, and 5% (2–9%) after the first year. The increased risk was greatest in the youngest age group (<40). To control for healthcare-seeking behaviour, we conducted parallel analyses investigating the risk of selected fractures after herpes zoster and found no similar increased risks. This large nationwide cohort study found an increased risk of stroke after treatment for herpes zoster. Although the short-term risk was particularly high, we cannot rule out the possibility of a small but important long-term risk.