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[潜在系统性风湿性疾病患者巨细胞病毒感染的临床特征及相关危险因素]

[Clinical characteristics and associated risk factors of cytomegalovirus infection in patients with underlying systemic Rheumatic diseases].

作者信息

Ren L M, Li Y, Zhang C F, Zhao X T, Liu X, Li Z G

机构信息

*Department of Rheumatology and Immunology, Peking University People's Hospital & Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis, Beijing 100044, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2016 Sep 20;96(35):2772-2776. doi: 10.3760/cma.j.issn.0376-2491.2016.35.002.

Abstract

To retrospectively investigate the clinical characteristics, risk factors of Cytomegalovirus (CMV) infection in patients with underlying rheumatic diseases. Clinical records of 263 rheumatic patients with or without CMV infection, hospitalized from March 2011 to June 2014 in Peking University People's Hospital, were analyzed.Clinical characteristics were summarized and compared in CMV positive and negative groups, to investigate the risk factors for CMV infection.Statistical analyses were conducted with SPSS 20.0 software. A total of 62 rheumatic patients were found to have CMV infection, with 48 regarded as CMV viremia, 7 diagnosed as CMV pneumonia, while the remaining 7 suffered both CMV viremia and pneumonia.Eleven of 62 patients (17.7%) had a fatal outcome.Systemic lupus erythematosus (SLE) was the most commonly underlying disease (41.9%), followed by Sjögren syndrome (16.1%) and systemic vasculitis (12.9%). Lymphopenia and the reduction of CD4 T lymphocytes, corticosteroids, cyclophosphamide (CTX) or mycophenolate mofetil (MMF), combined use of more than 2 immunosuppressants and other severe underlying infections as risk factors for CMV infection in rheumatic patients.Meanwhile, the total dose of CTX wasn't different significantly between CMV positive and negative groups.Multivariate analysis revealed that large or pulsed dose of corticosteroids, combined use of immunosuppressants, and severe underlying infections remained independent risk factors for CMV infection. Lymphocytes, particularly the CD4 T subsets, might play a vital role in the regulation and control of CMV infection.Other underlying infections, undergoing large dose corticosteroids therapy or combined use of immunosuppressants could be the risk factors for CMV infection in rheumatic patients.

摘要

回顾性研究合并基础风湿性疾病患者巨细胞病毒(CMV)感染的临床特征及危险因素。分析2011年3月至2014年6月期间于北京大学人民医院住院的263例有或无CMV感染的风湿性疾病患者的临床记录。总结并比较CMV阳性和阴性组的临床特征,以研究CMV感染的危险因素。使用SPSS 20.0软件进行统计分析。共发现62例风湿性疾病患者存在CMV感染,其中48例为CMV病毒血症,7例诊断为CMV肺炎,其余7例同时患有CMV病毒血症和肺炎。62例患者中有11例(17.7%)死亡。系统性红斑狼疮(SLE)是最常见的基础疾病(41.9%),其次是干燥综合征(16.1%)和系统性血管炎(12.9%)。淋巴细胞减少、CD4 T淋巴细胞减少、使用糖皮质激素、环磷酰胺(CTX)或霉酚酸酯(MMF)、联合使用2种以上免疫抑制剂以及其他严重基础感染是风湿性疾病患者CMV感染的危险因素。同时,CMV阳性和阴性组之间CTX的总剂量无显著差异。多因素分析显示,大剂量或冲击剂量的糖皮质激素、联合使用免疫抑制剂以及严重基础感染仍是CMV感染的独立危险因素。淋巴细胞,尤其是CD4 T亚群,可能在CMV感染的调控中起重要作用。其他基础感染、接受大剂量糖皮质激素治疗或联合使用免疫抑制剂可能是风湿性疾病患者CMV感染的危险因素。

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