| 69 | 0 | 43 |
| 下载次数 | 被引频次 | 阅读次数 |
目的探讨巨细胞病毒（Cytomegalovirus,CMV）再激活与急性加重特发性肺纤维化（Acute exacerbation idiopathic pulmonary fibrosis,AE-IPF）之间的关联性及分析其对IPF患者预后的影响。方法 本研究选取我院2020年5月～2023年5月收治的IPF患者256例，根据入组时及随访期间CMV再激活情况分为CMV再激活组（77例）和非CMV再激活组（179例）。患者每3个月门诊随访，随访时间截止至2025年5月。收集记录患者临床资料。随访期间检测患者CMV-DNA，记录AE-IPF的发生情况。结果 CMV再激活组接受糖皮质激素治疗的比例为45.45%，高于非CMV再激活组（28.49%）(P<0.05)。CMV再激活组中有30例（38.96%）发生AE-IPF，非CMV再激活组中有21例（11.73%）发生AE-IPF。与持续未激活者相比，患者在发生CMV再激活后，其发生AE-IPF的风险更高（P<0.05）。CMV再激活、使用糖皮质激素均是AE-IPF的独立危险因素（P<0.05）。CMV再激活组死亡38例（49.4%），非CMV再激活组死亡51例（28.5%）。CMV再激活组死亡率高于非CMV再激活组（P<0.05）。CMV再激活、AE-IPF发生均是患者预后不良的独立危险因素（P<0.05）。结论 CMV再激活是IPF患者发生AE-IPF及其预后不良的独立危险因素。临床实践中，对IPF患者，尤其是接受糖皮质激素治疗者，应警惕CMV再激活的风险，加强监测与管理。
Abstract：Objective To investigate the association between cytomegalovirus(CMV) reactivation and acute exacerbation of idiopathic pulmonary fibrosis(AE-IPF), and to evaluate the impact of CMV reactivation on the prognosis of patients with IPF.Methods A total of 256 patients with idiopathic pulmonary fibrosis admitted to our hospital between May 2020 and May 2023 were enrolled in this study. According to CMV reactivation status at baseline and during follow-up, patients were divided into a CMV reactivation group(n = 77) and a non-CMV reactivation group(n = 179). Patients were followed up in the outpatient clinic every 3 months, with follow-up continuing until May 2025. Clinical data were collected, CMV DNA levels were monitored during follow-up, and the occurrence of AE-IPF was recorded. Results The proportion of patients receiving glucocorticoid therapy was significantly higher in the CMV reactivation group than in the non-CMV reactivation group(45.45% vs. 28.49%, P < 0.05). During follow-up, AE-IPF occurred in 30 patients(38.96%) in the CMV reactivation group and in 21 patients(11.73%) in the non-CMV reactivation group. Compared with patients without CMV reactivation, those with CMV reactivation had a significantly increased risk of developing AE-IPF(P<0.05). Multivariate analysis identified CMV reactivation and glucocorticoid use as independent risk factors for AE-IPF(P<0.05). A total of 38(49.4%) in the CMV reactivation group and 51 patients(28.5%) in the non-CMV reactivation group died during follow-up. Mortality was significantly higher in the CMV reactivation group(P<0.05). CMV reactivation and the occurrence of AE-IPF were both independent risk factors for poor prognosis in patients with IPF(P<0.05). Conclusion CMV reactivation is an independent risk factor for the development of AE-IPF and for poor prognosis in patients with idiopathic pulmonary fibrosis. In clinical practice, increased vigilance for CMV reactivation is warranted in IPF patients, particularly those receiving glucocorticoid therapy, and enhanced monitoring and management should be implemented.
[1]蒋英彩，韩毓，韦佩佳，等.人巨细胞病毒感染通过Wnt/β-catenin通路抑制滋养细胞的增殖及侵袭[J].病毒学报，2021, 37(4):803-808. DOI:10. 13242/j.cnki. bingduxuebao. 003919.
[2]李硕，何浩，鹿腾飞，等.人巨细胞病毒编码的趋化因子及其受体同源物参与病毒免疫逃逸新进展[J].病毒学报，2023, 39(6):1768-1777. DOI:10. 13242/j.cnki. bingduxuebao. 004429.
[3]Sheng G, Chen P, Wei Y, et al. Viral infection increases the risk of idiopathic pulmonary fibrosis:a meta-analysis[J]. Chest, 2020, 157(5):1175-1187.DOI:10. 1016/j. chest. 2019. 10. 032.
[4]Yin Q, Strong MJ, Zhuang Y, et al. Assessment of viral RNA in idiopathic pulmonary fibrosis using RNAseq[J]. BMC Pulm Med, 2020, 20(1):81. DOI:10. 1186/s12890-020-1114-1.
[5]Yan H, Zhu C, Jin X, et al. Mendelian randomization reveals no correlations between herpesvirus infection and idiopathic pulmonary fibrosis[J]. PLoS One, 2023, 18(11):e0295082. DOI:10. 1371/journal.pone. 0295082.
[6]Raghu G, Remy-Jardin M, Myers JL, et al. Diagnosis of idiopathic pulmonary fibrosis. an official ATS/ERS/JRS/ALAT clinical practice guideline[J]. Am J Respir Crit Care Med, 2018, 198(5):e44-e68. DOI:10. 1164/rccm. 201807-1255st.
[7]Finnerty JP, Ponnuswamy A, Dutta P, et al. Efficacy of antifibrotic drugs, nintedanib and pirfenidone, in treatment of progressive pulmonary fibrosis in both idiopathic pulmonary fibrosis(IPF)and non-IPF:a systematic review and meta-analysis[J]. BMC Pulm Med, 2021, 21(1):411. DOI:10. 1186/s12890-021-01783-1.
[8]Duckworth A, Longhurst HJ, Paxton JK, et al. The role of herpes viruses in pulmonary fibrosis[J]. Front Med, 2021, 8:704222. DOI:10. 3389/fmed. 2021. 704222.
[9]Tan W, Wang Y, Chen Y, et al. Cell tracing reveals the transdifferentiation fate of mouse lung epithelial cells during pulmonary fibrosis in vivo[J]. Exp Ther Med,2021, 22(4):1188. DOI:10. 3892/etm. 2021. 10622.
[10]Li M, Wu L, Chen M, et al. Co-activation of Caspase-1 and Caspase-8 in CMV-induced SGN death by inflammasome-associated pyroptosis and apoptosis[J].Int Immunopharmacol, 2022, 113(Pt A):109305.DOI:10. 1016/j. intimp. 2022. 109305.
[11]Chen F, Chen Z, Wu HT, et al. Mesenchymal stem cell-derived exosomes attenuate murine cytomegalovirusinfected pneumonia via NF-κB/NLRP3 signaling pathway[J]. Viruses, 2024, 16(4):619. DOI:10. 3390/v16040619.
[12]Huang X, Sun P, Qin Y, et al. Disulfiram attenuates MCMV-Induced pneumonia by inhibition of NF-κB/NLRP3 signaling pathway in immunocompromised mice[J]. Int Immunopharmacol, 2022, 103:108453. DOI:10. 1016/j. intimp. 2021. 108453.
[13]Baasch S, Giansanti P, Kolter J, et al.Cytomegalovirus subverts macrophage identity[J].Cell, 2021, 184(14):3774-3793. e25. DOI:10. 1016/j. cell. 2021. 05. 009.
[14]Bansal A, Kooi C, Kalyanaraman K, et al. Synergy between interleukin-1β, interferon-γ, and glucocorticoids to induce TLR2 expression involves NF-κB, STAT1, and the glucocorticoid receptor[J].Molecular Pharmacol, 2024, 105(1):23-38. DOI:10. 1124/molpharm. 123. 000740.
[15]Pickering H, Sen S, Arakawa-Hoyt J, et al. NK and CD8+T cell phenotypes predict onset and control of CMV viremia after kidney transplant[J]. JCI Insight,2021, 6(21):e153175. DOI:10. 1172/jci.insight. 153175.
[16]Iwatani Y, Amemiya N, Nokiba H, et al. Risk factors for cytomegalovirus reactivation in patients with kidney disease under immunosuppressive therapy[J]. Clin Exp Nephrol, 2022, 26(1):22-28. DOI:10. 1007/s10157-021-02117-5.
[17]Kampouri E, Ibrahimi SS, Xie H, et al.Cytomegalovirus(CMV)reactivation and CMV-specific cell-mediated immunity after chimeric antigen receptor T-cell therapy[J]. Clin Infect Dis, 2024, 78(4):1022-1032. DOI:10. 1093/cid/ciad708.
[18]Li L, Wang C, Sun L, et al. Clinical characteristics and prognostic risk factors of mortality in patients with interstitial lung diseases and viral infection:a retrospective cohort study[J]. J Med Microbiol, 2021,70(11):001449. DOI:10. 1099/jmm. 0. 001449.
基本信息:
中图分类号:R563
引用信息:
[1]张瑞,陈亚飞,李小丽,等.巨细胞病毒再激活与特发性肺纤维化急性加重的关联性及对预后的影响[J].病毒学报().
2026-02-25
2026-02-25
2026-02-25