Clinical significance of cytomegalovirus (CMV) pp65 antigenemia in the prediction of CMV infection during immunosuppressive therapy for rheumatic disease
Clinical significance of cytomegalovirus (CMV) pp65 antigenemia in the prediction of CMV infection during immunosuppressive therapy for rheumatic disease
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DOI：
10.1007/s00296-022-05196-z
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发表时间：
2022-08-30
影响因子：
4
通讯作者：
Kagami, Shin-Ichiro
中科院分区：
文献类型：
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作者：
Suga, Kensuke;Nishiwaki, Aya;Kagami, Shin-Ichiro
探讨风湿病患者巨细胞病毒感染的危险因素，明确巨细胞病毒pp65抗原血症的临界值，以预测风湿病患者巨细胞病毒感染相关的临床症状。我们对261例接受免疫抑制治疗的风湿病患者进行了回顾性分析。CMV感染定义为每两张玻片中有1个CMV阳性细胞(CMV pp65抗原血症C10/C11)。根据巨细胞病毒病的抗病毒治疗情况，将巨细胞病毒感染患者分为两组。我们确定了巨细胞病毒阳性细胞诊断巨细胞病毒病的临界值。巨细胞病毒感染141例(54%)。在多因素分析中，巨细胞病毒感染与3个因素有关：年龄60岁(OR1.87[95%CI1.04~3.36])；淋巴细胞计数1000个/亩L(OR3.34[95%CI1.88~6.05])；激素冲击治疗(OR2.60[95%CI1.27~5.55])。经受试者工作特征曲线分析，CMV pp65抗原血症诊断CMV病的临界值为5个阳性细胞，平均2个玻片(AUC 0.95，敏感性0.94，特异性0.80)。年龄60岁、淋巴细胞减少(L 1000人/亩)、激素冲击治疗是巨细胞病毒感染的危险因素。我们建议CMV pp65抗原血症>；5细胞平均两片(C10/C11)的风湿病患者应给予抗病毒药物治疗。
To investigate the risk factors for CMV infection and to clarify the cut-off count of CMV pp65 antigenemia predicting clinical symptoms related to CMV infection in patients with rheumatic disease. We retrospectively analyzed 261 patients with rheumatic disease who were treated with immunosuppressive therapy. CMV infection was defined as positive > 1 CMV-positive cell per two slides (CMV pp65 antigenemia C10/C11). Patients with CMV infection were divided into two groups based on the presence of antiviral treatment for CMV disease. We determined a cut-off value of CMV-positive cells for the diagnosis of CMV disease. CMV infection was observed in 141 cases (54%). In a multivariate analysis, CMV infection was associated with three following factors: Age > 60 years (OR 1.87 [95% CI 1.04-3.36]); lymphocyte counts < 1000/mu L (OR 3.34 [95% CI 1.88-6.05]); steroid pulse therapy (OR 2.60 [95% CI 1.27-5.55]). The cut-off level of CMV pp65 antigenemia indicating CMV disease was five positive cells average two slides by using receiver operating characteristic curve analysis (AUC 0.95, sensitivity 0.94, specificity 0.80). Age > 60 years, lymphocytopenia (< 1000/mu L) and steroid pulse therapy are risk factors of CMV infection. We recommend that CMV pp65 antigenemia of > 5 cells average two slides (C10/C11) in patients with rheumatic disease should be the treated with antiviral drugs.