Table_1_Herpes zoster in lupus nephritis: experience on 292 patients followed up for 15 years.docx

ObjectivesTo evaluate the prevalence, incidence, and predictors of herpes zoster (HZ) development in lupus nephritis (LN).
MethodsThis retrospective study included 292 LN patients to determine HZ incidence during the last decades and its correlation with LN activity. LN patients with HZ were matched with LN patients without HZ in a 1:2 ratio based on sex, age, year of LN diagnosis, and LN histological class at kidney biopsy to assess HZ risk factors. Statistical tests included t-test, U-test, and Fisher’s test. Univariate and multivariate logistic regression analyses were conducted to identify potential risk factors.
ResultsHZ occurred after LN diagnosis in 66 patients (prevalence 22.6%) with an average of 8.7 years (range 0.2–28.4 years). Although with the potential limitations of the retrospective nature and the extensive duration of the study, the incidence of HZ was 15.6/1,000 person-years, increasing from 6.9 before 1980 to 16.0 in the 1990s and 43.9 after 2010. HZ onset was unrelated to LN activity. LN was active in 43% of cases and quiescent in the other 57% of cases at HZ diagnosis. The percentage of patients who developed lupus flares during the year after HZ (18.9%) was not different from that which occurred during the year before HZ (17.2%, p = 0.804). After excluding confounding factors through matching, the univariate analysis suggested that cyclosporin during induction therapy (p = 0.011) and higher cumulative doses of glucocorticoids (GCs; >50 g, p = 0.004), cyclophosphamide (CYC; >5 g, p = 0.001), and mycophenolate mofetil (MMF > 1,000 g, p = 0.007) predisposed patients to HZ. Univariate and multivariate analyses revealed a protective role of azathioprine (p = 0.008) and methylprednisolone pulses (p = 0.010) during induction therapy.
ConclusionsHZ occurs unpredictably throughout the course of LN, underscoring the importance of continuous monitoring for these patients. In addition, the incidence of HZ seems to have increased in recent decades. Induction therapy with azathioprine and methylprednisolone pulses appears to provide protection, while higher cumulative doses of GCs, CYC, and MMF increase susceptibility.

研究目的：评估狼疮肾炎（Lupus Nephritis, LN）患者带状疱疹（Herpes Zoster, HZ）的患病率、发病率及发病预测因素。
研究方法：本回顾性研究纳入292例狼疮肾炎（Lupus Nephritis, LN）患者，以明确近数十年间带状疱疹（Herpes Zoster, HZ）的发病率及其与LN疾病活动度的相关性。按1:2的比例，将发生HZ的LN患者与未发生HZ的LN患者进行匹配，匹配因素包括性别、年龄、LN确诊年份及肾活检时的LN病理分型，以评估HZ的危险因素。统计学检验方法包括t检验、U检验及Fisher确切概率法。采用单因素及多因素logistic回归分析筛选潜在危险因素。
研究结果：66例患者在LN确诊后发生HZ（患病率为22.6%），平均发病间隔为8.7年（范围0.2~28.4年）。尽管本研究存在回顾性设计及研究周期跨度较大的局限性，但HZ的发病率为15.6/1000人年，从1980年前的6.9升至1990年代的16.0，2010年后达43.9。HZ发病与LN疾病活动度无关：在HZ确诊时，43%的患者LN处于活动期，其余57%处于缓解期。HZ发生后1年内出现狼疮发作的患者比例（18.9%）与HZ发生前1年内的比例（17.2%）无显著差异（p=0.804）。通过匹配排除混杂因素后，单因素分析显示诱导治疗期间使用环孢素（p=0.011）、更高累积剂量的糖皮质激素（Glucocorticoids, GCs；>50g，p=0.004）、环磷酰胺（Cyclophosphamide, CYC；>5g，p=0.001）及麦考酚酸莫酯（Mycophenolate mofetil, MMF；>1000g，p=0.007）会增加患者发生HZ的风险。单因素及多因素分析还显示，诱导治疗期间使用硫唑嘌呤（p=0.008）及甲泼尼龙冲击治疗（p=0.010）具有保护作用。
研究结论：LN病程中可无明显诱因地发生HZ，提示对该类患者进行持续监测具有重要意义。此外，近数十年来HZ的发病率呈上升趋势。诱导治疗采用硫唑嘌呤及甲泼尼龙冲击似乎可起到保护作用，而更高累积剂量的GCs、CYC及MMF则会增加发病易感性。