中国医学科学院学报

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中国医学科学院学报

中国医学科学院学报 ›› 2020, Vol. 42 ›› Issue (6): 749-754.doi: 10.3881/j.issn.1000-503X.12267

• 论著 • 上一篇    下一篇

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

谭雨亭1,侍效春1,刘晓清1,曾小峰2,周宝桐1()   

  1. 1中国医学科学院 北京协和医学院 北京协和医院 感染内科, 北京 100730
    2中国医学科学院 北京协和医学院 北京协和医院 免疫内科, 北京 100730
  • 收稿日期:2019-11-18 出版日期:2020-12-30 发布日期:2021-01-11
  • 通讯作者: 周宝桐 E-mail:zhoubt@pumch.cn
  • 基金资助:
    国家科技重大专项课题(2017ZX100201302-003)(2017ZX10201302-003);中国医学科学院医学与健康科技创新工程(2016-I2M-1-013)

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

TAN Yuting1,SHI Xiaochun1,LIU Xiaoqing1,ZENG Xiaofeng2,ZHOU Baotong1()   

  1. 1Department of Infectious Diseases, ,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
    2Department of Immunology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
  • Received:2019-11-18 Online:2020-12-30 Published:2021-01-11
  • Contact: ZHOU Baotong E-mail:zhoubt@pumch.cn
  • Supported by:
    National Major Science and Technology Research Projects of China(2017ZX10201302-003);Medical and Health Science and Technology Innovation Project of Chinese Academy of Medical Sciences(2016-I2M-1-013)

摘要:

目的 探讨系统性红斑狼疮(SLE)合并巨细胞病毒(CMV)感染的临床特征及危险因素。方法 回顾性收集2017年7月1日至2019年4月1日在北京协和医院免疫内科出院诊断为SLE患者的病史资料,分析CMV感染相关的临床和实验室数据。结果 231例SLE患者中,115例(49.8%)合并CMV感染,其中78例(67.8%)为亚临床CMV感染,37例(32.2%)诊断为CMV病。单因素分析显示SLE受累脏器数目(P=0.015)、合并其他感染(P=0.004)、糖皮质激素冲击治疗(P=0.001)、30 d内糖皮质激素累积剂量(P=0.001)、30 d内糖皮质激素平均剂量(P<0.001)、静脉环磷酰胺(P=0.003)、糖皮质激素冲击联合免疫抑制剂治疗(P=0.001)、入院时系统性红斑狼疮疾病活动指数-2000(P=0.018)、血清白蛋白(ALB)≤30 g/L(P<0.001)与发生CMV感染有关。多因素分析显示合并其他感染(OR=8.003,95%CI=2.108~30.383,P=0.002)、糖皮质激素冲击联合免疫抑制剂治疗(OR=10.336,95%CI=2.107~50.711,P=0.004)、ALB≤30 g/L(OR=3.367,95%CI=1.157~9.796,P=0.026)为发生CMV感染的独立危险因素。结论 合并其他感染、近期激素冲击联合免疫抑制剂治疗、血清ALB≤30 g/L可增加SLE患者发生CMV感染风险。

关键词: 系统性红斑狼疮, 巨细胞病毒感染, 危险因素

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(P=0.015),presence of other infections(P=0.004),methylprednisolone pulse therapy(P=0.001),cumulative dose of prednisolone within 30 days(P=0.001),average dose of prednisolone within 30 days(P<0.001),intravenous cyclophosphamide(P=0.003),methylprednisolone pulse therapy plus immunosuppressants(P=0.001),Systemic Lupus Erythematosus Disease Activity Index 2000 at admission(P=0.018),and serum albumin(ALB)level≤30 g/L(P<0.001)were associated with CMV infection.Multivariate analysis showed presence of other infections(OR=8.003,95%CI=2.108-30.383,P=0.002),methylprednisolone pulse therapy plus immunosuppressants(OR=10.336,95%CI=2.107-50.711, P=0.004),and serum ALB≤ 30 g/L(OR=3.367,95%CI=1.157-9.796,P=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.

Key words: systemic lupus erythematosus, cytomegalovirus infection, risk factors

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