Kim Taeeun, Park Se Yoon, Lee Hyun-Jung, Kim Sun-Mi, Sung Heungsup, Chong Yong Pil, Lee Sang-Oh, Choi Sang-Ho, Kim Yang Soo, Woo Jun Hee, Kim Sung-Han
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul Division of Infectious Diseases, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Medicine (Baltimore). 2017 Jul;96(30):e7243. doi: 10.1097/MD.0000000000007243.
The clinical importance of pulmonary cytomegalovirus (CMV) co-infection in patients with Pneumocystis jirovecii pneumonia (PCP) is uncertain. We therefore determined the association of CMV infection with outcomes in non-HIV-infected patients with PCP by assessing CMV viral load and CMV-specific T-cell response.We prospectively enrolled all non-HIV-infected patients with confirmed PCP, over a 2-year period. Real-time polymerase chain reaction from bronchoalveolar lavage was performed to measure CMV viral load, and CMV enzyme-linked immunospot assays of peripheral blood were used to measure CMV-specific T-cell responses. The primary outcome was 30-day mortality.A total of 76 patients were finally analyzed. The mortality in patients with high BAL CMV viral load (>2.52 log copies/mL, 6/32 [18%]) showed a nonsignificant trend to be higher than in those with low CMV viral load (2/44 [5%], P = .13). However, the mortality in patients with low CMV-specific T-cell responses (<5 spots/2.0 × 10 PBMC, 6/29 [21%]) was significantly higher than in patients with high CMV-specific T-cell response (2/47 [4%], P = .048). Moreover, the 2 strata with high CMV viral load and low CMV-specific T-cell responses (4/14 [29%]) and low CMV viral load and low CMV-specific T-cell responses (2/15 [13%]) had poorer outcomes than the 2 strata with high CMV viral load and high CMV-specific T-cell responses (2/18 [11%]) and low CMV viral load and high CMV-specific T-cell responses (0/29 [0%]).These data suggest that the CMV replication and impaired CMV-specific T-cell responses adversely affect the outcomes in non-HIV-infected patients with PCP.
肺巨细胞病毒（CMV）合并感染在耶氏肺孢子菌肺炎（PCP）患者中的临床重要性尚不确定。因此，我们通过评估CMV病毒载量和CMV特异性T细胞反应，确定了CMV感染与非HIV感染的PCP患者预后的相关性。我们在2年期间前瞻性纳入了所有确诊为PCP的非HIV感染患者。通过支气管肺泡灌洗进行实时聚合酶链反应以测量CMV病毒载量，并使用外周血的CMV酶联免疫斑点试验来测量CMV特异性T细胞反应。主要结局为30天死亡率。最终共分析了76例患者。支气管肺泡灌洗CMV病毒载量高的患者（>2.52 log拷贝/mL，6/32 [18%]）的死亡率高于CMV病毒载量低的患者（2/44 [5%]），但差异无统计学意义（P = 0.13）。然而，CMV特异性T细胞反应低的患者（<5个斑点/2.0×10外周血单核细胞，6/29 [21%]）的死亡率显著高于CMV特异性T细胞反应高的患者（2/47 [4%]，P = 0.048）。此外，CMV病毒载量高且CMV特异性T细胞反应低的两个亚组（4/14 [29%]）和CMV病毒载量低且CMV特异性T细胞反应低的亚组（2/15 [13%]）的预后比CMV病毒载量高且CMV特异性T细胞反应高的两个亚组（2/18 [11%]）和CMV病毒载量低且CMV特异性T细胞反应高的亚组（0/29 [0%]）更差。这些数据表明，CMV复制和CMV特异性T细胞反应受损对非HIV感染的PCP患者的预后有不利影响。
