巨细胞病毒感染与炎症性肠病患者糖皮质激素剂量、CD_(4)^(+)T淋巴细胞数量的相关性

Association between cytomegalovirus infection and dose of glucocorticoids,CD_(4)^(+) T lymphocyte counts of patients with inflammatory bowel disease

目的 探讨巨细胞病毒(CMV)感染与炎症性肠病(IBD)患者糖皮质激素剂量、CD_(4)^(+)T淋巴细胞数量的相关性。方法 选取2017年6月-2020年6月南通市中医院门诊诊治的IBD患者240例,依据IBD患者是否合并CMV感染分为CMV感染组、非CMV感染组。收集患者临床资料,采用流式细胞仪检测外周血中CD_(4)^(+)T淋巴细胞数量。结果 240例IBD患者检出CMV感染50例,CMV感染率为20.83%。CMV感染组患者病程≥24个月、发热症状、并发症、既往用药史为糖皮质激素类药物及免疫抑制剂、结肠镜表现为深大溃疡的占比均高于非CMV感染组,ALB、Hb水平均低于非CMV感染组(P<0.05)。CMV感染组应用糖皮质激素剂量高于非CMV感染组,CD_(4)^(+)T淋巴细胞数量低于非CMV感染组(P<0.05)。病程、Hb、ALB水平、糖皮质激素剂量、CD_(4)^(+)T淋巴细胞数量为IBD患者合并CMV感染的影响因素(P<0.05)。受试者工作特征曲线(ROC)分析显示糖皮质激素剂量、CD_(4)^(+)T淋巴细胞数量联合检测预测IBD患者CMV感染的曲线下面积为0.887。结论 病程长、血清Hb和ALB水平降低、糖皮质激素剂量高和CD_(4)^(+)T淋巴细胞数量降低,是IBD患者CMV感染风险升高的影响因素,糖皮质激素剂量、CD_(4)^(+)T淋巴细胞数量检测对IBD患者CMV感染有较高预测价值。

OBJECTIVE To explore the association between cytomegalovirus(CMV)infection and dose of glucocorticoids,CD_(4)^(+)T lymphocyte counts of the patients with inflammatory bowel disease(IBD).METHODS A total of 240 patients with IBD who were treated in outpatient department of Nantong Hospital of Traditional Chinese Medicine from Jun 2017 to Jun 2020 were enrolled in the study and divided into the CMV infection group and the non-CMV infection group according to the status of CMV infection.The clinical data were collected from the patients,and the peripheral blood CD_(4)^(+)T lymphocytes counts were detected by flow cytometry.RESULTS Among the 240 patients with IBD,50 were detected with CMV infection,with the incidence of CMV infection 20.83%.The proportions of the patients with course of disease no significantly less than 24 months,fever,complications,previous medication history of glucocorticoids and immunosuppressants,and deep ulcer under colonoscope were significantly significantly higher in the CMV infection group than in the non-CMV infection group,the levels of ALB and Hb of the CMV infection group were significantly lower thanthose of the non-CMV infection group(P<0.05).The dose of glucocorticoids of the CMV infection group was significantly higher than that of the non-CMV infection group,and the CD_(4)^(+)T lymphocytes counts of the CMV infection group were significantly less than those of the non-CMV infection group(P<0.05).The course of disease,Hb,ALB,dose of glucocorticoids and CD_(4)^(+)T lymphocytes counts were the influencing factors for the CMV infection in the IBD patients(P<0.05).Receiver operating characteristic(ROC)curve analysis showed that the area under curve of the joint detection of glucocorticoids and CD_(4)^(+)T lymphocytes counts was 0.887 in prediction of CMV infection in the IBD patients.CONCLUSION The long course of disease,low levels of serum Hb and ALB,high dose of glucocorticoids and decrease of CD_(4)^(+)T lymphocytes counts are the influencing factors for the increase of risk for CMV infection in the IBD patients.The dose of glucocorticoids and CD_(4)^(+)T lymphocytes counts have high value in prediction of CMV infection in the IBD patients.