多发性骨髓瘤患者带状疱疹危险因素分析及预防性抗病毒治疗的作用  

Risk Factors and the Effect of Antiviral Prophylaxis for Herpes Zoster in Multiple Myeloma Patients

作　　者：王丽霞[1] 季艳萍 雷芳[1] 余先球[1] 费小明[1] WANG Li-Xia;JI Yan-Ping;LEI Fang;YU Xian-Qiu;FEI Xiao-Ming(Department of Hematology,The Affliated Hospital of Jiangsu University,Zhenjiang 212001,Jiangsu Province,China)

机构地区：[1]江苏大学附属医院血液科,江苏镇江212001

出　　处：《中国实验血液学杂志》2024年第1期171-175,共5页Journal of Experimental Hematology

基　　金：江苏省社会发展重点项目(临床前沿技术)课题(BE2020681);江苏省卫生健康委科研课题(H2018084);江苏大学附属医院科技项目(jdfyRC2019006);镇江市重点研发计划(社会发展)项目(SH2018067)。

摘　　要：目的:研究多发性骨髓瘤患者带状疱疹的发病情况及其危险因素,并评价预防性抗病毒治疗的效果。方法:回顾性分析合并带状疱疹的多发性骨髓瘤患者的临床特征,分析带状疱疹的危险因素以及抗病毒预防的作用。结果:180例多发性骨髓瘤患者中,23例发生带状疱疹(12.8%),其中合并肾功能不全的患者的带状疱疹发生率为19.1%。自体造血干细胞移植(AHSCT)患者在术后带状疱疹的发生率为23.5%(4/17)。23例患者中21例接受含有硼替佐米的方案治疗,2例接受不含硼替佐米的方案治疗,接受含硼替佐米方案的患者带状疱疹发生率(21/137,15.3%)高于不含硼替佐米方案的患者的发生率(2/43,4.7%),但未显示统计学差异(P=0.067)。在未采取抗病毒预防的患者中,带状疱疹发生率为21.7%(15/69),而在接受抗病毒预防的患者中,带状疱疹发生率为7.2%(8/111),两者具有显著统计学差异(P=0.005)。65.2%的带状疱疹患者没有接受抗病毒预防。多因素分析结果显示,接受硼替佐米治疗、AHSCT、肾功能不全均为多发性骨髓患者带状疱疹发生的独立危险因素,而抗病毒预防与降低带状疱疹发生风险独立相关。带状疱疹对多发性骨髓瘤患者的OS无影响。结论:多发性骨髓瘤患者发生带状疱疹的风险增加,预防性使用抗病毒药物可降低基于硼替佐米治疗的多发性骨髓瘤患者带状疱疹的发生风险。Objective:To study the incidence and risk factors of herpes zoster in patients with multiple myeloma and to evaluate the preventive effect of antiviral therapy.Methods:The clinical features of multiple myeloma patients with herpes zoster were retrospectively analyzed,the risk factors of herpes zoster and the effect of antiviral prophylaxis were analyzed.Results:Among 180 patients with multiple myeloma,23 cases developed herpes zoster(12.8%).The incidence of herpes zoster was 19.1%in patients with renal dysfunction and 23.5%after autologous hematopoietic stem cell transplantation(ASCT).The incidence of herpes zoster was higher in patients receiving bortezomib-containing regimens(21/137,15.3%)than that in those without bortezomib(2/43,4.7%),but there was no statistical difference(P=0.067).Antiviral prophylaxis was associated with fewer zoster infections,8/111(7.2%)developed herpes zoster in patients who received antiviral prophylaxis,and 15/69(21.7%)in those receiving no prophylaxis(P=0.005).65.2%of patients with herpes zoster did not receive antiviral prophylaxis.Multivariate analysis showed that bortezomib treatment,AHSCT and renal dysfunction were independent risk factors for multiple myeloma with herpes zoster,while antiviral prophylaxis was independently associated with reducing the risk of herpes zoster.Herpes zoster had no effect on OS in patients with multiple myeloma.Conclusion:The risk of herpes zoster in multiple myeloma patients was increased.Antiviral prophylaxis can reduce the risk of herpes zoster in patients on bortezomib-based therapy.

关 键 词：多发性骨髓瘤 带状疱疹 抗病毒预防 

分 类 号：R733.3[医药卫生—肿瘤]