系统性红斑狼疮合并人类巨细胞病毒活动性感染105例诊治分析  

Human cytomegalovirus active infection in patients with systemic lupus erythematosus:an analysis of 105 cases

作　　者：张瑾[1,2] 吴华香[1,3] 丁健[1] 王健[1,4] 杨婧[1] 张奉春[1] 赵岩[1] 曾晓峰[1] 张煊[1] 唐福林[1] 尤欣[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院风湿免疫科,北京100032 [2]宁波市李惠利医院风湿免疫科 [3]浙江大学医学院附属第二医院免疫风湿科 [4]西安市第五医院风湿二科

出　　处：《中国医刊》2013年第3期23-28,共6页Chinese Journal of Medicine

基　　金：国家自然科学基金(基金编号:30872333和81072404);2010年杨森科学研究基金;北京协和医院青年基金

摘　　要：目的研究系统性红斑狼疮(SLE)合并人类巨细胞病毒(HCMV)活动性感染的临床特点。方法 SLE合并HCMV活动性感染的病例105例,按照HCMV感染和SLE之间的关系分为三组,即HCMV触发SLE组42例、HCMV加重SLE组31例、HCMV模拟SLE活动组32例;分析其临床表现、实验室检查及抗病毒治疗方案等资料。结果血细胞减少(81%)、发热(73.3%)、肝功能损害(54.3%)是SLE合并HC-MV活动性感染最常见的临床表现。蝶形红斑、皮肤血管炎、关节炎、浆膜腔炎、中枢神经系统受累和肾脏受累则提示SLE活动。HCMV-pp65阳性率最高(84.9%)。接受更昔洛韦诱导治疗14～21天后,9例(47.6%)HCMV-IgM阳性患者及17例(45.9%)HCMV-pp65阳性患者未转阴,其中7例在3个月内再次出现病情反复,且6例(85.7%)为抗病毒治疗后HCMV-pp65持续阳性的患者。结论 HCMV活动性感染与SLE活动有很多相似的临床表现。HCMV-pp65是指导抗病毒治疗的敏感指标。更昔洛韦14～21天诱导治疗对于部分患者是不够的,如果HCMV-pp65持续阳性,应当延长抗病毒疗程。Objective To study clinical characteristics of human cytomegalovirus（ HCMV ）active infection in patients with systemic lupus erythematosus（SLE）. Method All 105 cases, who were diagnosed as HCMV active infection in patients with SLE, were in-patients of the department of rheumatology of PUMC hospital from January 2006 to January 2012 and were devided into three groups based on the relationship of HCMV infection and SLE including 42 ca- ses of HCMV triggering SLE, 31 cases of HCMV exacerbating SLE, and 32 cases of HCMV mimicking SLE flare. Their clinical manifestations, laboratory examinations and antiviral therapies were studied. Data were statistically analyzed by SPSS 17.0. Result Hematoeytopenia （81%）, fever （73.3%）, liver dysfunction （54.3%） were the most common clinical manifestations of HCMV active infection in patients with SLE, for which presence of butterfly erythema, cutaneous vasculitis, arthritis, polyserositis, central nervous system lesions and kidney lesions were clues of SLE flare. Positive rate of HCMV-pp65 was highest （84.9%）. Afterl4-21 days of inductive treatment of ganei- elovir, nine （47.6%） HCMV-IgM positive patients and seventeen （45.9%） HCMV-pp65 positive patients still remained positive, among which seven cases relapsed in three months including six （ 85.7% ） with continuous HCMV-pp65 antigenemia after antiviral therapy. Conclusion Clinical manifestations of HCMV active infection are similar to those of lupus flare. HCMV-pp65 is a sensitive indicator to guide antiviral therapy. Induction therapy using ganciclovir with a duration of 14 - 21 days is not enough, and prolonged period of antiviral therapy is necessary to patients whose HCMV-pp65 remains positive.

关 键 词：人类巨细胞病毒感染 系统性红斑狼疮 HCMV—pp65 

分 类 号：R593[医药卫生—内科学]