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目的探讨难治性系统性红斑狼疮(refractory systemic lupus erythematosus,RSLE)与巨细胞病毒(CMV)感染的关系。方法收集本院门诊和住院治疗的45例RSLE患者,根据CMV-DNA检测结果,分为CMV阳性RSLE组和CMV阴性RSLE组,另有46位同期来本院查体的健康体检者设为正常对照组。采用实时定量PCR检测RSLE患者和正常对照组外周血单个核细胞或者尿液上皮细胞中的CMV-DNA;四色流式细胞术检测RSLE患者和正常对照组外周血CD3~+,CD4~+,CD8~+T淋巴细胞。结果RSLE患者CMV阳性率(38/45,84.4%)显著高于正常对照组(3/46,6.5%,P<0.01);CMV阳性RSLE患者临床特征与CMV阴性RSLE相比,差异均有统计学意义(均P<0.05);CMV-DNA载量与CMV阳性RSLE患者疾病活动性指标呈正相关(均P<0.05),与补体C_3呈负相关(P<0.05);CMV阳性RSLE组CD3~+,CD4~+,CD8~+T淋巴细胞计数及总淋巴细胞计数显著高于CMV阴性RSLE组和正常对照组(均P<0.05),而CD4~+/CD8~+显著低于CMV阴性RSLE和正常对照组(均P<0.05)。结论RSLE患者应行巨细胞病毒检查,针对性治疗,提高疗效。
Objective To investigate the relationship between refractory systemic lupus erythematosus (RSLE) and cytomegalovirus (CMV) infection. Methods A total of 45 patients with RSLE from outpatient and inpatient hospital were enrolled. According to CMV-DNA test results, they were divided into CMV-positive RSLE group and CMV-negative RSLE group, and 46 healthy subjects were checked as normal during the same period Control group. The real-time quantitative PCR was used to detect the CMV-DNA in peripheral blood mononuclear cells or urine epithelial cells of RSLE patients and normal controls. The levels of CD3 +, CD4 + CD8 ~ + T lymphocytes. Results The positive rate of CMV in RSLE patients was significantly higher than that in normal controls (38/45, 84.4%, 3/46, 6.5%, P <0.01). The clinical features of RSV patients with RSV were statistically different (All P <0.05). CMV-DNA load was positively correlated with disease activity index (P <0.05) in CMV positive RSLE patients and negatively correlated with complement C_3 (P <0.05) +, CD4 ~ +, CD8 ~ + T lymphocyte count and total lymphocyte count were significantly higher than those in CMV negative RSLE group and normal control group (all P <0.05), while CD4 ~ + / CD8 ~ And normal control group (all P <0.05). Conclusion RSLE patients should be cytomegalovirus examination, targeted treatment, to improve efficacy.