关键词: 带状疱疹, 免疫低下人群, 临床特征, 病例对照研究

Abstract: 【Abstract】 Objective To investigate clinical characteristics of immunocompromised individuals with herpes zoster. Methods A retrospective study was conducted on 78 immunocompromised patients with herpes zoster hospitalized at Zhongda Hospital affiliated to Southeast University from January 2016 to December 2023, and these patients were assigned to the observation group. During the same period, 78 immunocompetent inpatients with herpes zoster matched （1∶1 ratio） by age and admission time served as a control group. General data, clinical manifestations, and laboratory findings （including blood routine test, liver and kidney function, and inflammatory markers） were compared between the two groups. Results In the observation group, there were 27 males and 51 females, with the age being 65.76 ± 14.47 years; the main causes of immunocompromise in this group were solid tumors （47 cases, 60.26%） and hematologic tumors （7 cases, 8.97%）; 26 （33.33%） patients with autoimmune diseases were treated with prednisone at a dose of ≥ 10 mg/d for more than 2 weeks. In the control group, there were 35 males and 43 females, with the age being 67.73 ± 13.89 years. No significant differences were found between the two groups in terms of gender, age, time from the onset of rashes or pain to hospitalization, time to lesion healing, the order of appearance of pain and rashes, the affected side of the body, or the proportion of patients with disseminated herpes zoster （all P > 0.05）. However, there was a significant difference in the distribution of affected nerve segments between the two groups （P = 0.013）; the main affected nerves were the thoracic and brachial nerves （34 cases, 43.59%） and the lumbosacral nerves （29 cases, 37.18%） in the observation group, while the lumbosacral nerves （31 cases, 39.74%） and cranial-cervical nerves （25 cases, 32.05%） were more commonly affected in the control group. The skin lesions in both groups mainly manifested as blisters, pustules and/or hemorrhagic blisters, and the proportion of patients with pustules and/or hemorrhagic blisters was significantly higher in the observation group （25 cases, 32.05%） than in the control group （11 cases, 14.10%; χ2 = 7.08, P = 0.008）. The observation group showed a significantly higher proportion of patients with fever （24 cases, 30.77%）, frequency of oral analgesic use during hospital stay ［2.00 （1.26, 2.33） times/day］, and recurrence rate （6 cases, 7.69%） compared with those in the control group （13 cases, 16.67%; 1.43 ［1.00, 2.00］ times/day; 0, respectively）. Additionally, the observation group exhibited significant increases in several parameters compared with the control group, including the proportions of patients with anemia （27 cases ［34.62%］ vs. 6 cases ［7.69%］）, kidney function abnormalities （9 cases ［11.54%］ vs. 2 cases ［2.56%］）, elevated alanine aminotransferase/aspartate aminotransferase ratios, increased erythrocyte sedimentation rates, and with elevated C-reactive protein levels, as well as those with decreased white blood cell counts, albumin levels, prealbumin levels, and with CD8+ T cell counts （all P < 0.05）. In terms of novel inflammatory markers, the observation group showed significantly increased neutrophil/lymphocyte ratios, red blood cell distribution width/hemoglobin ratios, and C-reactive protein/albumin ratios, but significantly decreased albumin/fibrinogen ratios and platelet/neutrophil ratios compared with the control group （all P < 0.05）. Conclusion Compared with the immunocompetent patients with herpes zoster, the immunocompromised patients with herpes zoster showed poorer cell-mediated immunity, more complex clinical manifestations, more severe systemic inflammatory responses, more pronounced pain, and higher likelihood of recurrent herpes zoster.

Key words: Herpes zoster, Immunocompromised population, Clinical characteristics, Case-control studies