Cytomegalovirus infection in patients receiving immunosuppressive therapy for rheumatologic disorders.
Cytomegalovirus infection in patients receiving immunosuppressive therapy for rheumatologic disorders.
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接受免疫抑制治疗风湿病患者的巨细胞病毒感染。
DOI：
10.1093/infdis/133.4.399
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发表时间：
1976
期刊：
影响因子：
--
通讯作者：
M. Ho
中科院分区：
文献类型：
--
作者：
J. Dowling;A. Saslow;J. Armstrong;M. Ho
在131例风湿病门诊就诊患者、211例献血者和14例风湿病患者开始细胞毒免疫抑制治疗前后寻找巨细胞病毒感染的证据。巨细胞病毒补体结合抗体滴度与年龄、性别有显著相关性，而与风湿性疾病无相关性。校正年龄和性别差异后，皮质类固醇治疗患者中具有可测量抗体的比例低于对照组（P <0.025）。硫唑嘌呤或环磷酰胺的免疫抑制治疗并不影响抗体患者的比例，但血清学阳性患者的抗体滴度显着增加（P = 0.04）。巨细胞病毒从20%接受细胞毒性免疫抑制药物治疗的患者的尿液中分离出来，但没有从任何接受皮质类固醇或两种治疗形式的患者中分离出来（P = 0.001）。14例患者中有8例在开始免疫抑制药物治疗后前瞻性随访，发现巨细胞病毒感染，表现为补体结合滴度、病毒尿或两者均升高4倍或更高。八名患者中有七名在治疗前血清反应呈阳性，这一发现表明免疫抑制主要通过重新激活潜伏感染来发挥作用。据推测，单独使用免疫抑制剂可能是同种异体移植后巨细胞病毒感染的主要原因。
Evidence of cytomegalovirus infection was sought in 131 patients attending a rheumatology clinic, 211 blood donors, and 14 patients before and after the initiation of cytotoxic immunosuppressive therapy for a rheumatologic condition. The titer of complement-fixing antibody to cytomegalovirus was significantly related to age and sex, but not to rheumatologic disease. After adjustment for age and sex differences, the proportion of patients treated with corticosteroids who had measurable antibody was lower than that of controls (P less than 0.025). Immunosuppressive therapy with azathioprine or cyclophosphamide did not affect the proportion of patients with antibody, but there was a significantly increased titer of antibody in those who were seropositive (P = 0.04). Cytomegalovirus was isolated from the urine of 20% of patients receiving cytotoxic immunosuppressive drugs, but not from any of the patients receiving corticosteroids or neither form of therapy (P = 0.001). Eight of 14 patients followed prospectively after the initiation of therapy with immunosuppressive drugs became infected with cytomegalovirus as demonstrated by a fourfold or greater rise in complement-fixing titer, viruria, or both. Seven of the eight patients were seropositive before therapy, a finding suggesting that immunosuppression acts largely by reactivating latent infection. It is postulated that immunosuppressive agents alone may account for a large proportion of cytomegalovirus infections seen after allograft transplantation.