| Objective: To analyze the incidence and clinical features of herpes zoster(HZ)in patients with systemic lupus erythematosus(SLE)hospitalized in the First Affiliated Hospital of Guangxi Medical University,and to investigate systemic lupus erythematosus complicated with herpes zoster.Risk factors for infection.Methods: A retrospective analysis of the general clinical data(sex,age,ethnicity,etc.)of 3234 SLE patients hospitalized in the First Affiliated Hospital of Guangxi Medical University from January 2012 to December 2016,and 110 SLE with HZ Laboratory findings(white blood cell count,hemoglobin,percentage of neutrophils,percentage of lymphocytes,C-reactive protein,erythrocyte sedimentation rate,percentage of CD4+ T cells,percentage of CD8+T cells,rheumatoid factor,C3,C4,Ig G,Ig A,Ig M,serum albumin,24-hour urine protein quantification,anti-ds-DNA antibody quantification,ENA antibody profile,etc.),medication status and type of concurrent nerve injury were analyzed;and 110 patients who were hospitalized in the same period did not combine HZ SLE patients were used as a control analysis;logistic regression analysis was used to statistically analyze the possible risk factors of SLE combined with HZ.Finally,the patients in the observation group were treated according to whether they had complications of HZ(post-herpetic neuralgia,herpes zoster encephalitis/meningitis,keratitis caused by herpes zoster/corneal ulcer,inner ear dysfunction caused by herpes zoster,etc.The patients were divided into the complication group and the non-complication group.The clinical characteristics of the two groups were compared to analyze the possible risk factors of HZ complications in patients with SLE combined with HZ.Statistical software uses SPSS19.0 software.Results: 1.Demographic characteristics:From January 2012 to December2016,there were 3234 patients(7060 cases)who were hospitalized in the First Affiliated Hospital of Guangxi Medical University.Among them,116 patients(118 patients)combined with HZ and 2 patients with HZ There were 2 patients,and 110 patients with complete HZ infection.The annual average incidence rate is about 0.72%.The average age of 3234 patients with SLE was(35.2±15.3)years old,2870 women were women,the average age was(33.8±14.9)years old,and 364 male patients,the average age was(37.4±17.7)years old,male: female It is about 1:9.There were 110 patients in the observation group and the control group,16 males and 94 females,with an average age of(34.2±15.8)years.The observation group: mean disease duration was(24.8±41.2)months,SLE-DAI score was 7.88±6.89;control group: mean disease duration was(26.7±35.9)months,SLE-DAI score was: 6.61±6.46.2.Clinical characteristics:There were 37 cases(33.6%)in the observation group with facial and/or lower extremity edema,and 19 cases(17.3%)in the control group;89 cases(80.9%)in the observation group and 53 cases in the control group(48.2%);the average number of affected systems in the observation group was(1.55±0.92),and the average number of affected systems in the control group was(1.21±0.74).The above difference was P < 0.05.3.The type of nerve injury in the observation group: 15 cases(13.6%)with generalized hair style;18 cases(16.4%)involving the cranial nerve;3 cases(2.7%)involving the cervical plexus;10 cases involving the brachial plexus(9.1%);50 cases(45.5%)involving the intercostal nerve;14 cases(12.7%)involving the phrenic nerve.According to whether the complications of HZ were combined,the observed components were the complication group and the non-complication group.The stratification of the group showed that the average age of the complication group was(42.8±12.4)years old,and that of the non-complication group was(30.7± 15.7)years old;10 cases of cranial nerve involvement in the complication group and 8 cases of non-complication;the cumulative dose of cyclophosphamide in the complication group was(3.91±3.11)g,and the non-complication group was(2.29±1.32)g;The number of cases of leflunomide in the complication group was 7 and in the non-complication group.The above difference was P < 0.05.Multivariate analysis showed that age,cyclophosphamide cumulative dose,and leflunomide were independent risk factors for HZ complications in patients with SLE with HZ,and their OR values??were 1.062,40.583,and 1.765,respectively.4.Laboratory characteristics:The white blood cell count of the observation group was(6.29±3.33)×10~9/l,the percentage of lymphocytes was(0.19±0.09)%,the percentage of CD4+ T lymphocytes was(27.40±6.31)%,and the percentage of CD8+ T lymphocytes was(36.86±10.00)%,Ig G was(10.53±6.98)g/l,Ig A was(1.94±1.33)g/l,Ig M was(1.01±0.72)g/l,serum albumin was(31.05±7.36)g/ l.The white blood cell count of the control group was(7.37±3.49)×10~9/l,the percentage of lymphocytes was(0.23±0.13)%,the percentage of CD4+ T lymphocytes was(34.86±7.64)%,and the percentage of CD8+ T lymphocytes was(30.96± 6.76)%,Ig G was(15.14±6.44)g/l,Ig A was(2.50±1.14)g/l,Ig M was(1.25±0.94)g/l,and serum albumin was(33.17±6.66)g/l.The above difference was P < 0.05.5.Medication characteristics: In the observation group,28 patients received hormone shock in 1 month,and 9 patients in the control group.In the observation group,35 patients received cyclophosphamide shock treatment in 1month,16 patients in the control group,and 32 patients in the observation group used methotrexate.There were 12 cases in the control group;the average number of types of immunosuppressants in the observation group was(1.71±0.91),and that in the control group was(1.25±0.71).The difference was P< 0.05.6.Multivariate analysis The independent risk factors of SLE combined with HZ were: methotrexate,hormonal shock in 1 month,renal involvement,and percentage increase of CD8+ T lymphocytes.The OR values were: 15.321,12.665,4.552.1.20;The protective factors were: the percentage of Ig G and CD4+ T lymphocytes increased,and their OR values were 0.852 and 0.851,respectively.Conclusions: 1.The average annual incidence of HZ in SLE patients hospitalized in the First Affiliated Hospital of Guangxi Medical University from January 2012 to December 2016 was about 0.72%;2.SLE patients with kidney involvement,multiple system involvement,and low immune function are more susceptible to HZ;3.methotrexate,hormone shock,renal involvement,and increased CD8+ T lymphocyte percentage in 1 month are independent risk factors for SLE patients with HZ,while the percentage increase of Ig G and CD4+ T lymphocytes is combined with HZ in SLE patients.Protection factor. |
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