Egorova O N, Balabanova R M, Chuvirov G N
Ter Arkh. 1998;70(5):41-5.
To assay antibodies to cytomegalovirus (CMV), herpes simplex virus type 1 and 2 (HSV-1, HSV-2) and Epstein-Barr virus (EBV) in rheumatic patients and to clarify clinical correlations.
A total of 66 patients were examined: 7, 19, 6, 3, 5, 2 and 24 with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), reactive arthritis (ReA), scleroderma systematica (SS), erythema nodosum (EN), hemorrhagic vasculitis (HV), active or chronic viral infection (A/CVI), respectively. Clinical, laboratory tests, tests for specific IgM- and IgG-antibodies to CMV, HSV-1, HSV-2, EBV, x-ray examinations were performed.
IgG-antibodies to CMV were detected in 79%, VCA-IgG-antibodies to EBV in 70.3%, EA-IgG-antibodies to EBV in 56.6%, IgG-antibodies to HSV-1 in 42.1% of patients. Active CMV infection was diagnosed in 27.8%, active EBV infection in 56.6%, combination of CMV and EBV infection in 46.9% of cases. High titers of antibodies to CMV and EBV correlated with such symptoms as fever, arthritis, myalgia, carditis, hepatomegalia, migrating erythematous eruption. Acute-phase indices were related to high titers of antibodies to CMV and EBV. Elevated titers of antibodies to CMV and EBV were registered both in untreated patients and in patients treated with corticosteroids, nonsteroid antiinflammatory drugs and aminoquinoline drugs.
In differential diagnosis of rheumatic diseases it is necessary to consider possibility of CMV and EBV infections. If these are detected, antiviral measures should be taken.
检测风湿性疾病患者体内抗巨细胞病毒(CMV)、1型和2型单纯疱疹病毒(HSV-1、HSV-2)及EB病毒(EBV)的抗体,并阐明其临床相关性。
共检查66例患者,分别为7例类风湿关节炎(RA)、19例系统性红斑狼疮(SLE)、6例反应性关节炎(ReA)、3例系统性硬皮病(SS)、5例结节性红斑(EN)、2例出血性血管炎(HV)、24例活动性或慢性病毒感染(A/CVI)患者。进行了临床、实验室检查、针对CMV、HSV-1、HSV-2、EBV的特异性IgM和IgG抗体检测以及X线检查。
79%的患者检测到抗CMV的IgG抗体,70.3%的患者检测到抗EBV的VCA-IgG抗体,56.6%的患者检测到抗EBV的EA-IgG抗体,42.1%的患者检测到抗HSV-1的IgG抗体。27.8%的病例诊断为活动性CMV感染,56.6%的病例诊断为活动性EBV感染,46.9%的病例为CMV和EBV混合感染。抗CMV和EBV的高滴度抗体与发热、关节炎、肌痛、心肌炎、肝肿大、游走性红斑疹等症状相关。急性期指标与抗CMV和EBV的高滴度抗体有关。未经治疗的患者以及接受皮质类固醇、非甾体抗炎药和氨基喹啉类药物治疗的患者中均检测到抗CMV和EBV的抗体滴度升高。
在风湿性疾病的鉴别诊断中,有必要考虑CMV和EBV感染的可能性。如果检测到这些感染,应采取抗病毒措施。