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[系统性红斑狼疮合并巨细胞病毒感染的临床特征及危险因素]

[Clinical Features and Risk Factors of Systemic Lupus Erythematosus Complicated with Cytomegalovirus Infection].

作者信息

Tan Yu Ting, Shi Xiao Chun, Liu Xiao Qing, Zeng Xiao Feng, Zhou Bao Tong

机构信息

Department of Infectious Diseases, ,PUMC Hospital,CAMS and PUMC,Beijing 100730,China.

Department of Immunology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China.

出版信息

Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2020 Dec 30;42(6):749-754. doi: 10.3881/j.issn.1000-503X.12267.

Abstract

Objective To explore the clinical characteristics and risk factors of systemic lupus erythematosus(SLE)complicated with cytomegalovirus infection(CMV). Methods The medical records of patients diagnosed with SLE at discharge in the Department of Immunology at Peking Union Medical College Hospital between July 1,2017 and April 1,2019 were retrospectively reviewed,and the clinical and laboratory data related to CMV infection were analyzed. Results Of the 231 patients with SLE,115(49.8%)had CMV infection.Among them,78(67.8%)were asymptomatic CMV infection and 37(32.2%)were diagnosed with CMV disease.Univariate analysis showed the number of organs involved(=0.015),presence of other infections(=0.004),methylprednisolone pulse therapy(=0.001),cumulative dose of prednisolone within 30 days(=0.001),average dose of prednisolone within 30 days(<0.001),intravenous cyclophosphamide(=0.003),methylprednisolone pulse therapy plus immunosuppressants(=0.001),Systemic Lupus Erythematosus Disease Activity Index 2000 at admission(=0.018),and serum albumin(ALB)level≤30 g/L(<0.001)were associated with CMV infection.Multivariate analysis showed presence of other infections(=8.003,95%=2.108-30.383,=0.002),methylprednisolone pulse therapy plus immunosuppressants(=10.336,95%=2.107-50.711, =0.004),and serum ALB≤ 30 g/L(=3.367,95%=1.157-9.796,=0.026)were independent risk factors for CMV infection. Conclusion Presence of other infections,recent methylprednisolone pulse therapy plus immunosuppressants,and serum ALB≤30 g/L can increase the risk of CMV infection in patients with SLE.

摘要

目的 探讨系统性红斑狼疮(SLE)合并巨细胞病毒感染(CMV)的临床特征及危险因素。方法 回顾性分析2017年7月1日至2019年4月1日在北京协和医院免疫科出院诊断为SLE患者的病历资料,分析与CMV感染相关的临床及实验室数据。结果 231例SLE患者中,115例(49.8%)发生CMV感染。其中,78例(67.8%)为无症状CMV感染,37例(32.2%)诊断为CMV病。单因素分析显示受累器官数量(P=0.015)、合并其他感染(P=0.004)、甲泼尼龙冲击治疗(P=0.001)、30天内泼尼松累积剂量(P=0.001)、30天内泼尼松平均剂量(P<0.001)、静脉用环磷酰胺(P=0.003)、甲泼尼龙冲击治疗联合免疫抑制剂(P=0.001)、入院时系统性红斑狼疮疾病活动指数2000(SLEDAI-2000)(P=0.018)及血清白蛋白(ALB)水平≤30 g/L(P<0.001)与CMV感染有关。多因素分析显示合并其他感染(P=8.003,95%CI=2.108-30.383,P=0.002)、甲泼尼龙冲击治疗联合免疫抑制剂(P=10.336,95%CI=2.107-50.711,P=0.004)及血清ALB≤30 g/L(P=3.367,95%CI=1.157-9.796,P=0.026)是CMV感染的独立危险因素。结论 合并其他感染、近期甲泼尼龙冲击治疗联合免疫抑制剂及血清ALB≤30 g/L可增加SLE患者CMV感染的风险。

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