系统性红斑狼疮与HCV、HBV、EBV、CMV感染关系

Relationship between systemic lupus erythematosus and HCV, HBV, EBV, CMV infections

目的分析系统性红斑狼疮(systemic lupus erythematosus,SLE)与丙型肝炎病毒(hepatitis C virus,HCV)、乙型肝炎病毒(hepatitis B virus,HBV)、EB病毒(Epstein-Barr vrius,EBV)、巨细胞病毒(cytomegalovirus,CMV)感染关系。方法选取2017年8月至2020年4月我院90例SLE患者作为观察组,另选取90例健康体检者作为对照组。比较两组、不同病情程度及不同抗中性粒细胞胞浆抗体(anti-neutrophil cytoplasmic antibodies,ANCA)、抗心磷脂抗体(anticardiolipin antibody,ACA)阳性患者HCV、HBV、EBV、CMV阳性率,分析病毒感染与SLE的关系,并随访1个月,比较狼疮肾炎与非狼疮肾炎患者各病毒抗体阳性率。结果(1)观察组HCV、HBV、EBV和CMV阳性率高于对照组(x^2=7.457,P=0.006;x^2=27.321,P<0.01;x^2=35.573,P<0.01;x^2=6.586,P=0.010);(2)HCV、HBV、EBV和CMV阳性为SLE发生危险因素(OR分别为5.076、7.517、10.724、5.925,P均小于0.05);(3)SLE活动期患者HCV、HBV、EBV、CMV阳性率高于稳定期(x^2=8.076,P=0.005;x^2=24.437,P<0.01;x^2=17.058,P<0.01;x^2=3.976,P=0.046);(4)ANCA阳性SLE患者EBV阳性率低于ANCA阴性(x^2=39.429,P<0.01);(5)狼疮肾炎患者HCV、HBV、EBV、CMV阳性率高于非狼疮肾炎患者(x^2=5.517,P=0.019;x^2=11.073,P=0.001;x^2=5.882,P=0.015;x^2=28.940,P<0.01)。结论CMV、HBV及HCV感染对SLE患者自身抗体无影响,EBV感染可能通过SLE患者自身抗体ANCA参与SLE病情进展。

Objective To analyze the relationship between systemic lupus erythematosus(SLE)and hepatitis C virus(HCV),hepatitis B virus(HBV),Epstein-Barr virus(EBV),and cytomegalovirus(CMV)infections.Methods From August 2017 to April 2020,90 patients with SLE in our hospital were selected as the observation group,and 90 healthy persons were selected as the control group.The positive rates of HCV,HBV,EBV and CMV among patients who were positive of antineutrophil cytoplasmic antibody(ANCA)and anticardiolipin antibody(ACA)with different clinical conditions and antibody levels were compared to analyze the relationship between viral infections and SLE.The subjects were followed up for 1 month to compare the positive rates of virus antibodies in patients with and without lupus nephritis.Results(1)The positive rates of HCV,HBV,EBV and CMV in the observation group were higher than those in the control group(x^2=7.457,P=0.006;x^2=27.321,P<0.001;x^2=35.573,P<0.01;x^2=6.586,P=0.010);(2)HCV,HBV,EBV and CMV positive were risk factors for SLE with ORs of 5.076,7.517,10.724 and 5.925(P<0.05),respectively;(3)The positive rates of HCV,HBV,EBV and CMV in patients with SLE activity were higher than that in the stable period(x^2=8.076,P=0.005;x^2=24.437,P<0.01;x^2=17.058,P<0.01;x^2=3.976,P=0.046);(4)The EBV positive rate of ANCA-positive SLE patients was lower than that of ANCA-negative patients(x^2=39.429,P<0.01);(5)The positive rates of HCV,HBV,EBV,and CMV in patients with lupus nephritis were higher than those with non-lupus nephritis(x^2=5.517,P=0.019;x^2=11.073,P=0.001;x^2=5.882,P=0.015;x^2=28.940,P<0.01).Conclusion CMV,HBV and HCV infections had no effect on autoantibodies in SLE patients.EBV infection may participate in the progression of SLE through the autoantibody ANCA in SLE patients.