Division of Rheumatology, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Disciplina de Reumatologia, Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Leandro, Dupré, 204, conjunto 74, Vila Clementino, São Paulo, SP, 04025-010, Brazil.
Adv Rheumatol. 2019 May 14;59(1):18. doi: 10.1186/s42358-019-0061-0.
To determine the incidence of positive CMV antigenemia (CMV-Ag) in patients with autoimmune rheumatic diseases (AIRD) and to describe the outcomes of these patients.
From January 2011 to December 2014, a total of 443 patients with AIRD were enrolled in this retrospective analysis. Demographic, clinical and laboratory data, current clinical manifestations, organs affected by CMV infection, therapeutic management and outcomes were evaluated. The CMV-Ag was considered positive when one cell was detected at least.
CMV-Ag was requested in 70 (15.8%) patients with suspicious CMV infection and was positive in 24 (34.3%). The incidence rate of positive CMV-Ag was 4.97% (95% CI 3.1-7.4%). Systemic lupus erythematosus (SLE) (59%), followed by ANCA-related vasculitis (18.2%) and rheumatoid arthritis (9%) were the diseases more associated with positive CMV-Ag. At the time of CMV infection, SLE patients had moderate to severe disease activity, with high frequency of positive anti-dsDNA antibody (69.2%) and complement consumption (61.5%), as well as high doses of corticosteroids and use of immunosuppressants. The main CMV sites involved were lung (45.5%), bone marrow (40.9%) and gut (27.3%). Mortality rate was 45.5%, especially in those with higher doses of daily oral corticosteroids (107 ± 55.4 mg vs. 71.7 ± 46.3 mg; p = 0.07) and lower number of lymphocytes (309 ± 368.2/mm vs. 821 ± 692.9/mm; p = 0.06).
Our data showed high incidence of CMV-Ag in AIRD patients, particularly those with SLE and greater disease severity. In addition, it was observed high mortality in these patients, highlighting the CMV infection should be included in differential diagnosis.
确定自身免疫性风湿病（AIRD）患者巨细胞病毒抗原血症（CMV-Ag）的发生率，并描述这些患者的结局。
回顾性分析 2011 年 1 月至 2014 年 12 月期间共 443 例 AIRD 患者。评估患者的人口统计学、临床和实验室数据、当前临床表现、受 CMV 感染影响的器官、治疗管理和结局。至少检测到一个细胞时，CMV-Ag 被认为是阳性。
70 例（15.8%）疑似 CMV 感染患者要求进行 CMV-Ag 检测，其中 24 例（34.3%）阳性。CMV-Ag 阳性率为 4.97%（95%CI：3.1-7.4%）。CMV-Ag 阳性率较高的疾病依次为系统性红斑狼疮（SLE）（59%）、抗中性粒细胞胞质抗体相关性血管炎（18.2%）和类风湿关节炎（9%）。CMV 感染时，SLE 患者疾病活动度处于中重度，抗 dsDNA 抗体阳性率高（69.2%），补体消耗（61.5%），且大剂量皮质激素和免疫抑制剂的应用。CMV 主要累及部位依次为肺（45.5%）、骨髓（40.9%）和肠道（27.3%）。死亡率为 45.5%，尤其是接受更高剂量的每日口服皮质激素（107±55.4mg 比 71.7±46.3mg；p=0.07）和更低的淋巴细胞计数（309±368.2/mm 比 821±692.9/mm；p=0.06）的患者。
我们的数据显示，AIRD 患者的 CMV-Ag 发生率较高，尤其是 SLE 患者和疾病严重程度较高的患者。此外，这些患者的死亡率较高，表明 CMV 感染应纳入鉴别诊断。
