Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China.
Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
Pediatr Rheumatol Online J. 2023 Mar 16;21(1):25. doi: 10.1186/s12969-023-00807-w.
Cytomegalovirus (CMV) plays an important role in the pathogenesis of systemic lupus erythematosus (SLE). However, it is not clear whether the anti-CMV treatment has an impact on the prognosis of SLE patients with CMV infection. We aimed to analyze the clinical characteristics and prognosis of CMV infection in pediatric SLE (pSLE) and to evaluate the effect of anti-CMV treatment on pSLE outcome.
A retrospective study including 146 pSLE from 2012 to 2021 was conducted. CMV-positive and CMV-negative groups were compared by univariate analysis and stepwise logistic multiple regression to analyze the clinical characteristics of CMV infection in pSLE. Generalized estimating equations (GEE) were used to model the longitudinal dynamics of pSLE disease activity with or without CMV infection and anti-CMV treatment.
The CMV infection rate was 74.7% (109/146) in this pSLE cohort. CMV-positive pSLE patients were more likely to present positive anti-dsDNA antibody, hypocomplementemia, high SLEDAI-2K score and musculoskeletal involvement (P < 0.05). Survival analysis showed that CMV-positive pSLE patients were more prone to disease flare and poorer outcomes. GEE modeling indicated that CMV phosphoprotein 65 (pp65) titers were positively correlated with SLEDAI-2K, and anti-CMV treatment could better reduce pSLE activity than non-treatment (P < 0.05).
CMV infection is highly prevalent among pSLE patients. Positive anti-dsDNA antibody, hypocomplementemia, high SLEDAI-2K score and musculoskeletal involvement were significant clinical clues indicating CMV infections in pSLE. CMV infection is correlated with higher disease activity and poorer outcome. Anti-CMV treatment can reduce disease activity and flares.
巨细胞病毒（CMV）在系统性红斑狼疮（SLE）的发病机制中起着重要作用。然而，目前尚不清楚抗 CMV 治疗是否会影响 CMV 感染的 SLE 患者的预后。我们旨在分析儿童系统性红斑狼疮（pSLE）中 CMV 感染的临床特征和预后，并评估抗 CMV 治疗对 pSLE 结局的影响。
进行了一项回顾性研究，纳入了 2012 年至 2021 年期间的 146 例 pSLE 患者。通过单因素分析和逐步逻辑多元回归比较 CMV 阳性和 CMV 阴性组，以分析 pSLE 中 CMV 感染的临床特征。广义估计方程（GEE）用于建立有或无 CMV 感染和抗 CMV 治疗的 pSLE 疾病活动的纵向动力学模型。
在该 pSLE 队列中，CMV 感染率为 74.7%（109/146）。CMV 阳性 pSLE 患者更可能出现抗 dsDNA 抗体阳性、低补体血症、高 SLEDAI-2K 评分和肌肉骨骼受累（P<0.05）。生存分析表明，CMV 阳性 pSLE 患者更易出现疾病复发且预后较差。GEE 模型表明，CMV 磷蛋白 65（pp65）滴度与 SLEDAI-2K 呈正相关，抗 CMV 治疗可较非治疗更好地降低 pSLE 活性（P<0.05）。
CMV 感染在 pSLE 患者中高度流行。抗 dsDNA 抗体阳性、低补体血症、高 SLEDAI-2K 评分和肌肉骨骼受累是 pSLE 中 CMV 感染的重要临床线索。CMV 感染与更高的疾病活动度和更差的预后相关。抗 CMV 治疗可降低疾病活动度和复发率。
