Laboratory-based risk factors for cytomegalovirus retinitis
Laboratory-based risk factors for cytomegalovirus retinitis
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DOI：
10.1016/s0008-4182(04)80067-x
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发表时间：
2004-12-01
影响因子：
4.2
通讯作者：
Diaz-Mitoma, F
中科院分区：
文献类型：
--
作者：
Hodge, WG;Boivin, JF;Diaz-Mitoma, F
背景：很少有研究调查巨细胞病毒（CMV）视网膜炎的危险因素。确定这些危险因素将有许多好处，包括帮助建立筛查方案、检查频率方案，以及通过口服缬更昔洛韦或其他抗巨细胞病毒药物进行有针对性的预防。本研究的目的是确定艾滋病患者巨细胞病毒性视网膜炎的实验室危险因素。方法：我们进行了一项病例对照研究，包括1990- 1999年诊断为巨细胞病毒性视网膜炎的120例患者和同期未诊断为巨细胞病毒性视网膜炎的159例患者。样本来自安大略省东部和魁北克省西部的一个主要研究基地，这些艾滋病患者在诊断为视网膜炎时CD4细胞计数低于50个/ μ l，或对照组的类似日期。这项研究有两个组成部分。在第一个组成部分（n = 279）中，我们检查了在研究期间完成的标准护理实验室测试（血液学和营养变量）。第二个部分（n = 57）是第一个部分的一个子集，我们检查了安大略省东部地区储存的血液样本的实验室检测（HLA型，定性和定量CMV聚合酶链反应[PCR]和HIV载量）。采用多元逻辑回归对数据进行建模，并控制混杂因素。我们开发了一个系统的模型构建策略，从假设测试到模型构建再到模型检查。结果：低血红蛋白浓度是CMV视网膜炎的有统计学意义的预测因子（优势比[OR] 0.96, 95%可信区间[CI] 0.94-0.98）。定性CMV PCR （OR 21.71, 95% CI 1.80-261.67）和定量CMV PCR （OR 33.03, 95% CI 2.32-469.39）是CMV视网膜炎的强预测因子。在检测的80种HLA类型中，HLA- bw4 （OR 11.68, 95% CI 1.29-105.82）和HLA- drbi15 （OR 9.34, 95% CI 1.014-76.41）是CMV视网膜炎的显著预测因子，而HLA- cw7对CMV视网膜炎具有保护作用（OR 0.09, 95% CI 0.01-0.67）。解释：我们已经确定了升高（或降低）巨细胞病毒性视网膜炎风险的实验室变量。这些发现可能有助于临床医生和卫生政策专家为艾滋病患者制定合理的筛查、检查频率和有针对性的预防指南。
Background: Very few studies have investigated risk factors for cytomegalovirus (CMV) retinitis. Identifying these risk factors will have many benefits, including helping establish screening regimens, examination frequency regimens, and targeted prophylaxis with oral therapy with valganciclovir or other anti-CMV agents. The purpose of this study was to determine the laboratory-based risk factors for CMV retinitis in patients with AIDS.Methods: We conducted a case-control study involving 120 patients in whom CMV retinitis had been diagnosed in 1990-99 and 159 patients without CMV retinitis from the same period. The sampling was from a primary study base in eastern Ontario and western Quebec of patients with AIDS and CD4 counts less than 50 cells/muL at the time of diagnosis of retinitis in the case subjects or an analogous date for the control subjects. There were two components to the study. In the first component (n = 279) we examined standard-of-care laboratory tests (hematologic and nutrition variables) done during the study period. In the second component (n = 57), which was a subset of the first, we examined laboratory tests (HLA type, qualitative and quantitative CMV polymerase chain reaction [PCR] and HIV load) on stored blood samples from the eastern Ontario site. Multivariate logistic regression was used to model the data and control for confounding. We developed a systematic model-building strategy, from assumption testing to model building to model checking.Results: A low hemoglobin concentration was a statistically significant predictor of CMV retinitis (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.94-0.98). Both qualitative CMV PCR (OR 21.71, 95% CI 1.80-261.67) and quantitative CMV PCR (OR 33.03, 95% CI 2.32-469.39) were strong predictors of CMV retinitis. Among the 80 HLA types tested, HLA-Bw4 (OR 11.68, 95% CI 1.29-105.82) and HLA-DRBI15 (OR 9.34, 95% CI 1.014-76.41) were significant predictors of CMV retinitis, whereas HLA-Cw7 was protective against CMV retinitis (OR 0.09, 95% CI 0.01-0.67).Interpretation: We have identified laboratory variables that elevate (or decrease) the risk of CMV retinitis. These findings may be useful to clinicians and health policy experts in developing rational guidelines for screening, examination frequency and targeted prophylaxis for patients with AIDS.