Herpes zoster is associated with an increased risk of subsequent lymphoid malignancies - a nationwide population-based matched-control study in Taiwan.
Herpes zoster is associated with an increased risk of subsequent lymphoid malignancies - a nationwide population-based matched-control study in Taiwan.
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带状疱疹与随后的淋巴恶性肿瘤的风险增加有关，这是一项全国性基于人群的基于人群的匹配控制研究。
DOI：
10.1186/1471-2407-12-503
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发表时间：
2012-10-31
期刊：
影响因子：
3.8
通讯作者：
Lin SF
中科院分区：
文献类型：
--
作者：
Liu YC;Yang YH;Hsiao HH;Yang WC;Liu TC;Chang CS;Yang MY;Lin PM;Hsu JF;Chang PY;Lin SF
感染因子已被证明有助于淋巴恶性肿瘤的发展。淋巴恶性肿瘤在亚洲和西方人群中的不同分布表明亚洲人群中可能存在不同的病因。带状疱疹感染，常见于免疫功能低下的人，已被报道与淋巴恶性肿瘤在回顾性病例对照研究，从西方人群，但结果是有争议的，缺乏大规模的前瞻性研究，从亚洲人群。本研究以1996年至2007年国民健康保险研究资料库为基础，以台湾病患为研究对象，进行一项全国性的配对对照前瞻性研究。带状疱疹和恶性肿瘤由兼容的ICD-9-CM（国际疾病分类，第9次修订，临床修改）代码定义。排除了带状疱疹前诊断为任何恶性肿瘤、已知病毒感染（包括人类免疫缺陷病毒）以及带状疱疹至诊断为恶性肿瘤的持续时间小于6个月的患者。在42，498例诊断为恶性肿瘤前患有带状疱疹的患者中，淋巴系统恶性肿瘤的累积发生率为0.11%（n = 48），而在169，983例年龄和性别匹配的对照组中，淋巴系统恶性肿瘤的累积发生率为0.06%（n = 106）（单变量风险比（HR）：1.82，95%CI：1.29-2.55）。最常见的淋巴系统恶性肿瘤是非霍奇金淋巴瘤（60.4%，n = 29），其次是多发性骨髓瘤（27.1%，n = 13）。带状疱疹患者发生淋巴系统恶性肿瘤的风险显著更高（对数秩P = 0.005）。在使用考克斯比例风险回归对Charlson合并症指数、疱疹组的时间依赖性协变量和收入类别中存在的任何合并症进行校正后，带状疱疹患者发生淋巴系统恶性肿瘤的风险增加（校正HR：1.68，95%CI：1.35-2.42，P = 0.0026），但发生非淋巴恶性肿瘤的风险未增加（校正HR：1.00，95%CI：0.91-1.05，P = 0.872）。在台湾受试者中，先前带状疱疹感染是后续淋巴恶性肿瘤的独立风险标志。在亚洲人群中的发病机制探索和预防策略需要进一步的研究。
Infectious agents have been shown to contribute to the development of lymphoid malignancies. The different distribution of lymphoid malignancies in Asian and Western populations suggests possibly different etiologies in Asian populations. Herpes zoster infection, commonly seen in immunocompromised persons, has been reported to be associated with lymphoid malignancies in retrospective case–control studies from Western populations, but the results are controversial and large-scale prospective studies from Asian populations are lacking. A nationwide population-based matched-controlled prospective study on Taiwanese patients was performed using the National Health Insurance Research Database from 1996 to 2007. Herpes zoster and malignancies were defined by compatible ICD-9-CM (International Classification of Disease, 9th Revision, Clinical Modification) codes. Patients who had been diagnosed with any malignancies before herpes zoster, with known viral infections including human immunodeficiency virus, and duration from herpes zoster to diagnosis of malignancies less than 6 months were excluded. Of 42,498 patients with herpes zoster prior to the diagnosis of any malignancies, the cumulative incidence for lymphoid malignancies was 0.11% (n = 48), compared with 0.06% (n = 106) in 169,983 age- and gender-matched controls (univariate hazard ratio (HR): 1.82, 95%CI: 1.29-2.55). The most common lymphoid malignancy was non-Hodgkin’s lymphoma (60.4%, n = 29), followed by multiple myeloma (27.1%, n = 13). Risk for developing lymphoid malignancies is significantly higher in herpes zoster patients (log rank P = 0.005). After adjusting for presence of any comorbidities in Charlson comorbidity index, time-dependent covariate for herpes group, and income category using Cox proportional hazard regressions, herpes zoster patients had an increased risk of developing lymphoid malignancies (adjusted HR: 1.68, 95%CI: 1.35-2.42, P = 0.0026), but did not have an increased risk of developing non-lymphoid malignancies (adjusted HR: 1.00, 95%CI: 0.91-1.05, P = 0.872). Preceding herpes zoster infection is an independent risk marker for subsequent lymphoid malignancies in Taiwanese subjects. Further studies are warranted for pathogenesis exploration and preventive strategies in Asian populations.
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