系统性红斑狼疮合并巨细胞病毒感染121例临床分析

Cytomegalovirus infection in systemic lupus erythematosus： an analysis of 121 cases

目的探讨系统性红斑狼疮（SLE）合并巨细胞病毒（CMV）感染的临床表现。方法分析SLE合并CMV感染患者的相关临床资料，进行统计分析。结果2221例SLE住院患者中，合并CMV活动性感染121例，发生率为5．4％。发热98例占81％，其中80例（66．1％）以发热为唯一表现，肝功能损害8例、呼吸道症状5例、血液系统异常4例、心肌炎和脑病各1例，分别占6．6％、4．1％、3．3％、0．8％、0．8％；另22例（18．2％）不明原因原发病活动而经检查发现CMV感染。75．2％患者SLE疾病活动指数达10分以上。121例中，4例死亡，6例放弃治疗。其余患者CMV感染均于治疗2．4周[（15±6）d]得到控制。结论CMV感染是SLE的常见合并症，临床表现无特征性，对不明原因发热者应及时做CMV的相关检查以利诊断。

Objective To investigate the clinical manifestations of cytomegalovirus （CMV） infection in patients with systemic lupus erythematosus （SLE）. Methods Data of the consecutive cases of SLE complicated with active CMV infection including clinical manifestations, SLEDAI score, dosage of corticosteroid and immunosuppressants used for treatment, radiological and laboratory examinations were collected and analyzed. Results Among 2221 consecutive patients of SLE, 5.4%（121 cases） were diagnosed to be complicated with active CMV infection. Fever was the most common symptom, followed by serious liver function damage, respiratory symptoms, hematological abnormalities, myocarditis, and encephalopathy, accounted for 8 t % （98 cases）, 6.6%（8 cases）, 4.1%（5 cases）, 3.3%（4 cases）, 0.8%（1 case）, and 0.8%（1 case）respectively; in addition, 22 （18.2%） cases had no symptom. SLEDAI was higher than 15 in 47.1% cases, and 10-14 in 28.1% cases. 81% of patients were treated with corticosteroid, and 55.4% were treated with immunosuppressants. Ganciclovir was given once the diagnosis of active CMV infection was established. In most of the patients, active CMV infection had been controlled within 14-28 days, except 4 died and 6 gave up the therapy. Conclusion SLE with active CMV infection is common, especially in patients who are treated with corticosteroid and/or immunosuppressants. Clinical manifestations of SLE complicated with active CMV infection are generally nonspecific. In patients with unexplained fever, or liver damage, or lung disease, or active SLE patients who have no symptom but are refractory to the treatment, CMV infection should be suspected and the relevant laboratory, tests should be ordered for early diagnosis and treatment.