合并活动性巨细胞病毒感染的系统性红斑狼疮患者的随访研究

A longitudinal study on patients with systemic lupus erythematosus accompanied by active cytomegalovirus infection

目的观察合并活动性巨细胞病毒（CMV）感染的SLE患者CMV感染状态随时间变化情况，及其与SLE病情变化的关系。方法合并活动性CMV感染的SLE患者，分为治疗组（更昔洛韦）和非治疗组（不抗病毒）。门诊定期随访，复测CMV感染相关检查，同时评价SLE病情活动性。采用χ3检验或者t检验分析数据。结果共纳入102例患者（治疗组66例，非治疗组36例），随访时间（6±8）个月。45．1％（46／102）的患者CMV活动性感染状态转变为既往感染状态。治疗组中42．4％（28／66）的患者CMV状态变化，与非治疗组50．0％（18／36）差异无统计学意义（χ2=0．540，P=-0．462），2组CMV活动性感染持续时间亦差异无统计学意义[（5．0±1．3）个月和（5．4±3．3）个月，P=0．794]。CMV状态变化的患者基线SLEDAI评分（12±6）分显著高于CMV状态变化时（4±3）分（t=7．037，P〈0．01），SLEDAI评分降低（8±5）分，显著大于CMV状态不变的患者（4±4）分（t=3．116，P=0．003）。结论在合并活动性CMV感染的SLE患者中，抗病毒治疗对既往感染状态无影响。SLE病情控制得好有利于CMV感染的控制。

Objective To observe the change of the status of cytomegalovirus （CMV） infection and its relatlonship with the change of disease activity in patients with systemic lupus erythematosus （SLE） complicated by active CMV infection. Methods Patients with SLE complicated with active CMV infection were enrolled and divided into two groups： the therapy group （on ganciclovir） and non-therapy group （not on ganciclovir）. All the patients were followed up regularly and the detection of CMV infection as well as the evaluation of disease activity of SLE [systemiclupus erythematosus disease activity index （SLEDAI） 2000] were made at each visit. Results Altogether 102 patients were enrolled （66 in the therapy group and 36 in the non-therapy group） and the duration of follow up was （6±8） months （0.5-48 months）. The active CMV infection changed to past infection status in 45.1%（46/102） patients. The change occurred in 42.4%（28/66） patients in the therapy group and in 50.0%（18/36） patients in the non-therapy group （χ2=0.540, P=0.462）. The duration of the active CMV infection was not significantly different in the therapy group and non therapy group [（5.0±1.3） months vs （5.4±3.3） months, P=-0.794]. In patients with this change; the SLEDAI at baseline 12±6 was significantly higher than at the time of change 4±3 （t=7.037, P〈0.01）, and the decrease of SLEDAI was 8±5, which was significantly larger than that in those without this change 4±4 （t=3.116, P=0.003）. Conclusion In SLE patients with active CMV infection, nearly half of them changes to past infection after 5 months and anti-virus therapy seems to have little effect on this. The better the disease is controlled, the higher the percentage of active CMV infection is controlled.