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目的研究系统性红斑狼疮(SLE)合并人类巨细胞病毒(HCMV)活动性感染的临床特点。方法 SLE合并HCMV活动性感染的病例105例,按照HCMV感染和SLE之间的关系分为三组,即HCMV触发SLE组42例、HCMV加重SLE组31例、HCMV模拟SLE活动组32例;分析其临床表现、实验室检查及抗病毒治疗方案等资料。结果血细胞减少(81%)、发热(73.3%)、肝功能损害(54.3%)是SLE合并HC-MV活动性感染最常见的临床表现。蝶形红斑、皮肤血管炎、关节炎、浆膜腔炎、中枢神经系统受累和肾脏受累则提示SLE活动。HCMV-pp65阳性率最高(84.9%)。接受更昔洛韦诱导治疗14～21天后,9例(47.6%)HCMV-IgM阳性患者及17例(45.9%)HCMV-pp65阳性患者未转阴,其中7例在3个月内再次出现病情反复,且6例(85.7%)为抗病毒治疗后HCMV-pp65持续阳性的患者。结论 HCMV活动性感染与SLE活动有很多相似的临床表现。HCMV-pp65是指导抗病毒治疗的敏感指标。更昔洛韦14～21天诱导治疗对于部分患者是不够的,如果HCMV-pp65持续阳性,应当延长抗病毒疗程。
Objective To study the clinical features of active infection of systemic lupus erythematosus (SLE) combined with human cytomegalovirus (HCMV). Methods 105 cases of active SLE combined with HCMV infection were divided into three groups according to the relationship between HCMV infection and SLE: 42 cases of HCMV triggering SLE group, 31 cases of HCMV exacerbation SLE group and 32 cases of HCMV simulating SLE activity group. Its clinical manifestations, laboratory tests and antiviral treatment programs and other information. Results Cytopenia (81%), fever (73.3%), and liver dysfunction (54.3%) were the most common clinical manifestations of SLE with active HC-MV infection. Butterfly erythema, cutaneous vasculitis, arthritis, serositis, central nervous system involvement and kidney involvement are indicative of SLE activity. The highest positive rate of HCMV-pp65 (84.9%). After 14 to 21 days of ganciclovir induction therapy, 9 (47.6%) HCMV-IgM-positive patients and 17 (45.9%) HCMV-pp65-positive patients did not go negative and 7 of them again developed disease within 3 months Repeatedly, 6 (85.7%) patients were positive for HCMV-pp65 after antiviral treatment. Conclusion There are many similar clinical manifestations of HCMV active infection and SLE activity. HCMV-pp65 is a sensitive indicator of antiviral therapy. Induction of ganciclovir for 14 to 21 days is inadequate for some patients and antiviral therapy should be prolonged if HCMV-pp65 persists.