Prevalence and risk factors of herpes zoster infection in patients with biopsy proven lupus nephritis undergoing immunosuppressive therapies
Prevalence and risk factors of herpes zoster infection in patients with biopsy proven lupus nephritis undergoing immunosuppressive therapies
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DOI：
10.1177/0961203320923739
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发表时间：
2020-05-14
期刊：
影响因子：
2.6
通讯作者：
Ho Ling Yin
中科院分区：
文献类型：
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作者：
Mok Chi Chiu;Tse Sau Mei;Ho Ling Yin
ObjectivesTo study herpes zoster infection in patients with biopsy confirmed lupus nephritis undergoing immunosuppressive therapies.MethodsPatients who have histologically active lupus nephritis between 2004 and 2018 were retrospective reviewed.收集了基线和治疗后六个月的临床和实验室数据。计算狼疮性肾炎治疗两年内带状疱疹复发的发生率。带状疱疹再激活的危险因素进行了研究logistic regression.ResultsPatients（N = 251）与311例狼疮性肾炎进行了研究（92%的妇女;年龄34.2 +/- 14.2岁;组织学分级III/IV +/- V（69%））。在治疗的两年内，55例（18%）狼疮性肾炎并发带状疱疹感染（发病率8.84/100患者年）。14例（25%）带状疱疹患者在医院接受了静脉抗病毒药物治疗，但未报告播散性疾病或死亡。在9%的发作中出现了明显的带状疱疹后神经痛。带状疱疹再激活的患者与无带状疱疹再激活的患者相比，更可能首次出现肾脏疾病，狼疮性肾炎的系统性红斑狼疮持续时间也比无带状疱疹再激活的患者短。疾病活动，治疗反应和其他临床/实验室参数之间没有显着差异，带状疱疹复发和未复发的患者。带状疱疹感染的患者接受了明显更高剂量的泼尼松龙作为诱导治疗。Logistic回归分析显示，首次肾脏疾病，每日高峰剂量霉酚酸酯和诱导治疗期间的累积环磷酰胺剂量显着相关带状疱疹reactivation.ConclusionsHerpes带状疱疹再激活是常见的狼疮性肾炎患者，但不可预测的临床参数。虽然带状疱疹感染的不良结局并不常见，但在诱导治疗期间使用最低有效剂量的吗替麦考酚酯和环磷酰胺可能有助于降低带状疱疹感染的风险。
ObjectivesTo study the prevalence of herpes zoster infection in patients with biopsy-confirmed lupus nephritis undergoing immunosuppressive therapies.MethodsPatients who had histologically active lupus nephritis between 2004 and 2018 were retrospectively reviewed. Clinical and laboratory data at baseline and six months post-therapy were collected. The incidence of herpes zoster reactivation within two years of lupus nephritis treatment was calculated. Risk factors for herpes zoster reactivation were studied by logistic regression.ResultsPatients (N = 251) with 311 episodes of lupus nephritis were studied (92% women; age 34.2 +/- 14.2 years; histological classes III/IV +/- V (69%)). Within two years of therapy, 55 (18%) episodes of lupus nephritis were complicated by herpes zoster infection (incidence 8.84/100 patient-years). Fourteen episodes (25%) of herpes zoster were treated by intravenous anti-viral drugs in hospital but disseminated disease or mortality was not reported. Significant post-herpetic neuralgia developed in 9% of the episodes. Patients with herpes zoster reactivation, compared with those without, were more likely to have first-time renal disease and a shorter systemic lupus erythematosus duration at lupus nephritis than those without. Disease activity, treatment response and other clinical/laboratory parameters were not significantly different between patients with and without herpes zoster reactivation. Herpes zoster-infected patients had been treated with a significantly higher dose of prednisolone as induction therapy. Logistic regression revealed that first-time renal disease, peak daily mycophenolate mofetil dose and cumulative cyclophosphamide dose during induction therapy were significantly associated with herpes zoster reactivation.ConclusionsHerpes zoster reactivation is common in lupus nephritis patients but unpredictable from clinical parameters. Although adverse outcomes of herpes zoster infection are uncommon, using the minimally effective doses of mycophenolate mofetil and cyclophosphamide during induction therapy may help reduce the risk of herpes zoster infection.