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

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Chinese Medical Journal 2016年第3期129卷 267-273页

作者： Yu Xue Li Jiang Wei-Guo Wan Yu-Ming Chen Jiong Zhang Zhen-Chun Zhang 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

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）

关键词： cytomegalovirus Cytomegalovirus Pneumonia Polymerase Chain Reaction Rheumatic Disease Viral Load

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Immunomodulatory therapy of Cytomegalovirus Pneumonia after liver transplantation

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Chinese Medical Journal 2006年第17期119卷 1430-1434页

作者： WANG Gen-shu CHEN Gui-hua LU Min-qiang YANG Yang CAI Chang-jie YI Hui-min LI Hua XU Chi YI Shu-hong Organ Transplantation Institute of Sun Yat-Sen University LiverTransplantation Center Affiliated Third Hospital Sun Yat-SenUniversity Guangzhou 510630 China

Background There has been increasing interest in the research into cytomegalovirus （CMV） pneumonia agter liver transplantation （LT）. This study was undertaken to investigate the immunomodulatory therapy of CMV pneumonia after LT. Methods Six patients with CMV pneumonia after LT from October 2003 to November 2005 were analyzed retrospectively. They were diagnosed according to clinical manifestations, chest X-ray findings and pathogenic changes and given comprehensive therapy including mainly immunomodulation therapy and anti-viral medication. At the early stage of CMV pneumonia, the dose of immunosuppressive agents was decreased or ceased, instead replaced by immunoenhancement therapy. During recovery period from CMV pneumonia, the dose of immunosuppressive agents was given again or enhanced, and immunoenhancement therapy was ceased. The liver function of the patients was monitored closely during the treatment. Results In this series, five patients were survived and one died. The liver function of the six patients remained normal during the treatment, and no episode of acute rejection took place. Conclusions Poor immunity is the pathogenic basis of CMV pneumonia after LT. At early stage of CMV pneumonia, the immunity of the patients should be enhanced, and during the recovery period from CMV pneumonia, immunosuppresants shoud be given again but immunoenhancement therapy ceased. Individualized immunomodulatory therapy is essential to the treatment of CMV pneumonia after LT.

关键词： liver transplantation Cytomegalovirus Pneumonia immunotherapy

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Diferences and similarities of high-resolution computed tomography features between pneumocystis pneumonia and Cytomegalovirus Pneumonia in AIDS patients

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Infectious Diseases of Poverty 2020年第5期9卷 129-130页

作者： Chun‑Jing Du Jing‑Yuan Liu Hui Chen Shuo Yan Lin Pu Hao‑Feng Xiong Pan Xiang Chuan‑Sheng Li Ming Zhang Ru‑Ming Xie Bu‑Dong Chen Ang Li Department of Critical Care Medicine Beijing Ditan HospitalCapital Medical UniversityNo.8 Jingshundong StreetChaoyang DistrictBeijing 100015China Department of Radiology Beijing Ditan HospitalCapital Medical UniversityNo.8 Jingshundong StreetChaoyang DistrictBeijing 100015China

Background:Accurately diferentiating pneumocystis from Cytomegalovirus Pneumonia is crucial for correct therapy selection in AIDS patients.Hence,the goal of this study was to compare the computerized tomography(CT)features of pneumocystis pneumonia and Cytomegalovirus Pneumonia in AIDS patients and identify clinical hallmarks to accurately distinguish these two pathologies.Methods:A total of 112 AIDS patients(78 with pneumocystis pneumonia and 34 Cytomegalovirus Pneumonia)at Beijing Ditan Hospital from January 2017 to May 2019 were included in this study.Two experienced chest radiologists retrospectively reviewed CT images for 17 features including ground-glass opacity,consolidation,nodules,and halo sign.Binary logistic regression analyses were conducted to identify the signifcant parameters that distinguished pneumocystis pneumonia from Cytomegalovirus Pneumonia.Correlations were analyzed by Pearson or Spearman correlation analyses.Result were considered signifcant if PCytomegalovirus Pneumonia than in those with pneumocystis pneumonia.Small nodules(32.5%in Cytomegalovirus Pneumonia,6.41%in pneumocystis pneumonia,PCytomegalovirus Pneumonia.Large nodules were not found in any of patients with Cytomegalovirus Pneumonia.The presence of ground-glass opacity,reticulation,and bronchial wall thickening(all P>0.05)were common in both groups.Conclusions:Analysis of consolidation,nodules,and halo signs may contribute to the diferential diagnosis of pneumocystis pneumonia or Cytomegalovirus Pneumonia.However,some CT features considered typical in one or other diseases appear with similar frequency in both cohorts of AIDS patients.CT features are potentially useful for the diferential diagnosis of pneumocystis pneumonia and Cytomegalovirus Pneumonia in AIDS patients.

关键词： Diagnostic imaging Pneumocystis pneumonia Cytomegalovirus Pneumonia HIV/AIDS

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15例AIDS患者合并HCMV肺部感染的临床分析

15例AIDS患者合并HCMV肺部感染的临床分析

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中华中医药学会防治艾滋病国际学术研讨会

作者：陈谐捷黄湛镰广州市第八人民医院感染一科

冋顾性分析15例艾滋病患者合并HCMV肺部感染的临床特点,提高对艾滋病患者合并HCMV肺部感染的诊断水平。1对象与方法1.1对象搜集广州市第八人民医院2005年?2006年15例艾滋病合并HCMV肺部感染患者。所有病

关键词： AIDS Cytomegalovirus Pneumonia clinical analysis

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