Ito Haruka, Yoshimoto Takahiko, Kokaze Akatsuki, Wakabayashi Kuninobu, Noguchi Kazuteru, Matsui Kiyoshi, Natsumoto Bunki, Fujio Keishi, Hayashi Yutaro, Kaneko Yuko, Gono Takahisa, Okamoto Koh, Okugawa Shu, Moriya Kyoji, Sueki Hirohiko
Department of Dermatology, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
Department of Hygiene, Public Health and Preventive Medicine, Showa University Graduate School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
BMC Infect Dis. 2025 Jan 28;25(1):137. doi: 10.1186/s12879-025-10543-z.
Cytomegalovirus (CMV) can cause life-threatening diseases in immunosuppressed patients. Some of the patients with connective tissue disease develop CMV infection, and approximately half of this group has been reported to have received pulsed-methylprednisolone (p-MPSL) therapy. This study aimed to identify predictors of the onset of CMV infection in patients receiving p-MPSL therapy for connective tissue disease.
This was a retrospective, multicenter cohort study. We included patients who received p-MPSL therapy for connective tissue disease and had CMV antigenemia measured between April 2011 and December 2020. Peripheral blood cell data before the start of p-MPSL therapy and at the start of steroid tapering were collected in addition to baseline characteristics, including age, sex, and body mass index. CMV infection was defined as detection of one or more CMV antigen-positive cells (CMV-positive). The study examined and compared the CMV-positive group with the CMV-negative group. Logistic regression analysis was used to explore the factors associated with CMV antigen positivity. Receiver operating characteristic curve analysis was used to identify the cut-off values for the factors associated with CMV antigen sensitivity.
Of the 200 patients included, 87 had antigen positivity. Logistic regression analysis showed that age ≥ 65 years [adjusted odds ratio (aOR): 2.75, 95% confidence interval (CI): 1.54-4.92] and platelet count less than 30.20 × 10 /µL [aOR: 4.38, 95%CI: 2.21-8.68] at baseline were significantly associated with CMV antigen positivity. Lymphocyte count < 1440 /µL [aOR: 5.36, 95% CI: 1.96-14.65], neutrophil-to-lymphocyte ratio (NLR) ≥ 3.42 [aOR: 7.31, 95% CI: 2.52-21.22], and platelet-to-lymphocyte ratio (PLR) ≥ 145.28 [aOR:6.10, 95% CI: 2.24-16.64] at the start of steroid tapering also increased the OR for CMV infection. The areas under the receiver operating characteristic curves for lymphocytes, NLR, and PLR were 0.742, 0.693, and 0.673 respectively.
Platelet count, lymphocyte count, NLR, and PLR may be crucial predictors of the onset of CMV infection in patients with connective tissue disease. These easily obtainable factors may be clinically useful as predictors of CMV infection. A potential research area would be to validate the parameters in a prospective patient population.
巨细胞病毒（CMV）可在免疫抑制患者中引发危及生命的疾病。一些结缔组织病患者会发生CMV感染，据报道，这组患者中约有一半接受过脉冲式甲泼尼龙（p-MPSL）治疗。本研究旨在确定接受p-MPSL治疗的结缔组织病患者发生CMV感染的预测因素。
这是一项回顾性多中心队列研究。我们纳入了因结缔组织病接受p-MPSL治疗且在2011年4月至2020年12月期间检测过CMV抗原血症的患者。除了年龄、性别和体重指数等基线特征外，还收集了p-MPSL治疗开始前和激素减量开始时的外周血细胞数据。CMV感染定义为检测到一个或多个CMV抗原阳性细胞（CMV阳性）。该研究对CMV阳性组和CMV阴性组进行了检查和比较。采用逻辑回归分析来探索与CMV抗原阳性相关的因素。采用受试者工作特征曲线分析来确定与CMV抗原敏感性相关因素的截断值。
纳入的200例患者中，87例抗原呈阳性。逻辑回归分析显示，基线时年龄≥65岁[调整后的优势比（aOR）：2.75，95%置信区间（CI）：1.54 - 4.92]和血小板计数低于30.20×10⁹/µL[aOR：4.38, 95%CI：2.21 - 8.68]与CMV抗原阳性显著相关。在激素减量开始时，淋巴细胞计数<1440/µL[aOR：5.36, 95%CI：1.96 - 14.65]、中性粒细胞与淋巴细胞比值（NLR）≥3.42[aOR：7.31, 95%CI：2.5二 - 21.22]以及血小板与淋巴细胞比值（PLR）≥145.28[aOR：6.10, 95%CI：2.24 - 16.64]也增加了CMV感染的优势比。淋巴细胞、NLR和PLR的受试者工作特征曲线下面积分别为0.742、0.693和0.673。
血小板计数、淋巴细胞计数、NLR和PLR可能是结缔组织病患者发生CMV感染的关键预测因素。这些易于获得的因素可能在临床上作为CMV感染的预测指标有用。一个潜在的研究领域将是在前瞻性患者群体中验证这些参数。
