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Abstract：
The aim of this study was to investigate the clinical traits and consequences of systemic lupus erythematosus (SLE) complicated by active cytomegalovirus (CMV) infection.
This retrospective review involved the examination of medical records for patients diagnosed with SLE who had an active CMV infection at the time of their discharge from Peking Union Medical College Hospital between June 2016 and December 2022. The consistency between plasma CMV deoxyribonucleic acid (DNA) viral load and pp65 antigenemia was analyzed using the chi-square test. Related factors for CMV disease in SLE complicated by active CMV infection patients were analyzed by univariate analysis and multivariable stepwise logistic regression. Cox hazards regression analysis was used to determine predictors for all-cause mortality and CMV recurrence within 3 months.
A total of 206 patients were enrolled in this study. Of the 123 patients who were detected with both plasma CMV DNA viral load and pp65 antigenemia within an interval not exceeding 72 h, the consistency between plasma CMV DNA viral load and pp65 antigenemia was not good (Kappa = -0.304, p < 0.001). Plasma CMV DNA viral load ≥ 1,600 copies/mL [odds ratio (OR) 4.411, 95% CI 1.871-10.402, p = 0.001], current glucocorticoids dose (equivalent to prednisolone) ≥60 mg/d (OR 2.155, 95% CI 1.071-4.334, p = 0.031), and elevated alanine transaminase (OR 3.409, 95% CI 1.563-7.435, p = 0.002) were significant clinical clues indicating CMV disease in SLE. Multivariable Cox hazards regression analysis showed that CMV organ involvement [hazard ratio (HR) 47.222, 95% CI 5.621-396.689, p < 0.001], SLE multi-system involvement (HR 1.794, 95% CI 1.029-3.128, p = 0.039), and elevated hypersensitive C-reactive protein (hsCRP) (HR 5.767, 95% CI 1.190-27.943, p = 0.030) were independent risk factors for 3-month all-cause mortality. CMV organ involvement (HR 3.404, 95% CI 1.074-10.793, p = 0.037) was an independent risk factor for CMV recurrence within 3 months.
In SLE patients, plasma CMV DNA viral load seemed to have a higher value in the diagnosis of CMV disease; patients with CMV organ involvement, SLE multi-system involvement, and elevated hsCRP might have a higher risk of 3-month all-cause mortality; and patients with CMV organ involvement might have a higher risk of CMV recurrence within 3 months.
This retrospective review involved the examination of medical records for patients diagnosed with SLE who had an active CMV infection at the time of their discharge from Peking Union Medical College Hospital between June 2016 and December 2022. The consistency between plasma CMV deoxyribonucleic acid (DNA) viral load and pp65 antigenemia was analyzed using the chi-square test. Related factors for CMV disease in SLE complicated by active CMV infection patients were analyzed by univariate analysis and multivariable stepwise logistic regression. Cox hazards regression analysis was used to determine predictors for all-cause mortality and CMV recurrence within 3 months.
A total of 206 patients were enrolled in this study. Of the 123 patients who were detected with both plasma CMV DNA viral load and pp65 antigenemia within an interval not exceeding 72 h, the consistency between plasma CMV DNA viral load and pp65 antigenemia was not good (Kappa = -0.304, p < 0.001). Plasma CMV DNA viral load ≥ 1,600 copies/mL [odds ratio (OR) 4.411, 95% CI 1.871-10.402, p = 0.001], current glucocorticoids dose (equivalent to prednisolone) ≥60 mg/d (OR 2.155, 95% CI 1.071-4.334, p = 0.031), and elevated alanine transaminase (OR 3.409, 95% CI 1.563-7.435, p = 0.002) were significant clinical clues indicating CMV disease in SLE. Multivariable Cox hazards regression analysis showed that CMV organ involvement [hazard ratio (HR) 47.222, 95% CI 5.621-396.689, p < 0.001], SLE multi-system involvement (HR 1.794, 95% CI 1.029-3.128, p = 0.039), and elevated hypersensitive C-reactive protein (hsCRP) (HR 5.767, 95% CI 1.190-27.943, p = 0.030) were independent risk factors for 3-month all-cause mortality. CMV organ involvement (HR 3.404, 95% CI 1.074-10.793, p = 0.037) was an independent risk factor for CMV recurrence within 3 months.
In SLE patients, plasma CMV DNA viral load seemed to have a higher value in the diagnosis of CMV disease; patients with CMV organ involvement, SLE multi-system involvement, and elevated hsCRP might have a higher risk of 3-month all-cause mortality; and patients with CMV organ involvement might have a higher risk of CMV recurrence within 3 months.
摘要：
■这项研究的目的是调查系统性红斑狼疮（SLE）并发活动性巨细胞病毒（CMV）感染的临床特征和后果。
本回顾性审查涉及2016年6月至2022年12月北京协和医院出院时CMV感染活跃的SLE患者的病历检查。使用卡方检验分析血浆CMV脱氧核糖核酸（DNA）病毒载量与pp65抗原血症之间的一致性。采用单因素分析和多因素逐步logistic回归分析SLE合并活动性CMV感染患者CMV病变的相关因素。Cox风险回归分析用于确定3个月内全因死亡率和CMV复发的预测因子。
■本研究共纳入206例患者。在不超过72小时的间隔内检测到血浆CMVDNA病毒载量和pp65抗原血症的123例患者中，血浆CMVDNA病毒载量与pp65抗原血症的一致性不佳(Kappa=-0.304,p<0.001).血浆CMVDNA病毒载量≥1,600拷贝/mL[比值比（OR）4.411，95％CI1.871-10.402，p=0.001]，当前糖皮质激素剂量（相当于泼尼松龙）≥60mg/d（OR2.155，95％CI1.071-4.334，p=0.031），丙氨酸转氨酶升高（OR3.409，95％CI1.563-7.435，p=0.002）是提示SLECMV疾病的重要临床线索。多变量Cox危险回归分析显示CMV器官受累[危险比(HR)47.222,95%CI5.621-396.689,p<0.001],SLE多系统受累（HR1.794，95%CI1.029-3.128，p=0.039），超敏C反应蛋白（hsCRP）升高（HR5.767，95％CI1.190-27.943，p=0.030）是3个月全因死亡率的独立危险因素。CMV器官受累(HR3.404,95%CI1.074-10.793,p=0.037)是CMV3个月内复发的独立危险因素。
■在SLE患者中，血浆CMVDNA病毒载量在CMV疾病诊断中具有较高的价值,SLE多系统参与，而hsCRP升高可能有较高的3个月全因死亡风险;CMV器官受累患者可能有较高的3个月内CMV复发风险.
本回顾性审查涉及2016年6月至2022年12月北京协和医院出院时CMV感染活跃的SLE患者的病历检查。使用卡方检验分析血浆CMV脱氧核糖核酸（DNA）病毒载量与pp65抗原血症之间的一致性。采用单因素分析和多因素逐步logistic回归分析SLE合并活动性CMV感染患者CMV病变的相关因素。Cox风险回归分析用于确定3个月内全因死亡率和CMV复发的预测因子。
■本研究共纳入206例患者。在不超过72小时的间隔内检测到血浆CMVDNA病毒载量和pp65抗原血症的123例患者中，血浆CMVDNA病毒载量与pp65抗原血症的一致性不佳(Kappa=-0.304,p<0.001).血浆CMVDNA病毒载量≥1,600拷贝/mL[比值比（OR）4.411，95％CI1.871-10.402，p=0.001]，当前糖皮质激素剂量（相当于泼尼松龙）≥60mg/d（OR2.155，95％CI1.071-4.334，p=0.031），丙氨酸转氨酶升高（OR3.409，95％CI1.563-7.435，p=0.002）是提示SLECMV疾病的重要临床线索。多变量Cox危险回归分析显示CMV器官受累[危险比(HR)47.222,95%CI5.621-396.689,p<0.001],SLE多系统受累（HR1.794，95%CI1.029-3.128，p=0.039），超敏C反应蛋白（hsCRP）升高（HR5.767，95％CI1.190-27.943，p=0.030）是3个月全因死亡率的独立危险因素。CMV器官受累(HR3.404,95%CI1.074-10.793,p=0.037)是CMV3个月内复发的独立危险因素。
■在SLE患者中，血浆CMVDNA病毒载量在CMV疾病诊断中具有较高的价值,SLE多系统参与，而hsCRP升高可能有较高的3个月全因死亡风险;CMV器官受累患者可能有较高的3个月内CMV复发风险.
