Cytomegalovirus Pneumonia in Patients with Rheumatic Diseases After Immunosuppressive Therapy： A Single Center Study in China

作     者：Yu Xue Li Jiang Wei-Guo Wan Yu-Ming Chen Jiong Zhang Zhen-Chun Zhang Xue Yu;Jiang Li;Wan Wei-Guo;Chen Yu-Ming;Zhang Jiong;Zhang Zhen-Chun

作者机构：Department of Rheumatology Huashan Hospital Fudan University Shanghai 200040 China Institute of Rheumatology Immunology and Allergy Fudan University Shanghai 200040 China Department of Rheumatology Linyi People's Hospital Linyi Shandong 276000 China Department of Laboratory Medicine Huashan Hospital Fudan University Shanghai 200040 China 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2016年第129卷第3期

页      面：267-273页

核心收录：

学科分类：090603[农学-临床兽医学] 1007[医学-药学(可授医学、理学学位)] 100705[医学-微生物与生化药学] 1002[医学-临床医学] 09[农学] 0906[农学-兽医学] 10[医学] 

主　　题：Cytomegalovirus Cytomegalovirus Pneumonia Polymerase Chain Reaction Rheumatic Disease Viral Load 

摘      要：Background： Rheumatic diseases involve multiple organs that are affected by immunological mechanisms.Treatment with corticosteroids and immunosuppressive agents may also increase the frequency of infection.Cytomegalovirus （CMV） is a widespread herpes virus and a well-recognized pathogen, which causes an opportunistic and potentially fatal infection in immunocompromised patients.This retrospective study aimed to investigate the clinical and laboratory characteristics of CMV pneumonia in patients with rheumatic diseases after immunosuppressive therapy in a single center in Shanghai, China.Methods： Eight hundred and thirty-four patients with rheumatic diseases who had undergone CMV-DNA viral load tests were included, and the medical records of 142 patients who were positive for CMV-DNA in plasma samples were evaluated.GraphPad Prism version 5.013 （San Diego, CA, USA） was used to conduct statistical analysis.The correlation between CMV-DNA viral loads and lymphocyte counts was assessed using the Spearman rank correlation coefficient test.Significance between qualitative data was analyzed using Pearson＆#39;s Chi-squared test.The cut-offthresholds for CMV-DNA viral load and lymphocyte count were determined by receiver operating characteristic （ROC） curve analysis.Results： One hundred and forty-two patients had positive CMV viral load tests.Of these 142 patients, 73 patients with CMV pneumonia were regarded as symptomatic, and the other 69 were asymptomatic.The symptomatic group received higher doses ofprednisolone （PSL） and more frequently immunosuppressants than the asymptomatic group （P 〈 0.01）.The symptomatic group had lower lymphocyte counts, especially CD4＋ T-cells, than the asymptomatic group （P 〈 0.01）.By ROC curve analysis, when CD4＋ T-cell count was 〈0.39 ＆#215; 109/L, patients with rheumatic diseases were at high risk for symptomatic CMV infection.The CMV-DNA load was significantly higher in the symptomatic patients than that in asymptomatic patients （P 〈 0.01;threshold viral loads： 1.75 ＆#215; 104 copies/ml）.Seven patients had a fatal outcome, and they had lower peripheral lymphocyte counts （P 〈 0.01）, including CD4＋ and CD8＋ T-cells （P 〈 0.0 l）.Conclusions： When CD4＋ T-cell count is 〈0.39 ＆#215; 109/L, patients are at high risk for pulmonary CMV infection.Patients are prone to be symptomatic with CMV-DNA load 〉1.75 ＆#215; 104 copies/ml.Lymphopenia （especially CD4＋ T-cells）, presence of symptoms, and other infections, especially fungal infection, are significant risk factors for poor outcome, and a higher PSL dosage combined with immunosuppressants may predict CMV pneumonia.