Clinical Features Of Primary Systemic Lupus Erythematosus Complicated With Human Cytomegalovirus Infection

Objective To investigate the clinical characteristics of new-onset systemic lupus erythematosus(SLE)patients with human cytomegalovirus(HCMV)infection.Methods The medical history data of all SLE patients hospitalized in Peking Union Medical College Hospital from July 2012 to September 2020 were retrospectively collected.The eligible new-onset SLE were selected and then divided into two groups,the HCMV-infected group,and the non-infected group.The differences in clinical and laboratory data were compared between the two groups.Results Fifty-one cases of the infected group and 14 cases of the non-infected group were selected from 319 new-onset SLE among 2387 hospitalized SLE patients.The median age of onset in the infected group was younger than the non-infected group(10 years old vs.18.5 years old,P<0.05).The incidence of arthralgia(52.9%vs.7.1%)and SLEDAI[(19.00±9.63)vs.(11.57±6.19)]were higher in the infected group than those of the non-infected group(P<0.05).The laboratory results showed that the incidence of hypocomplementemia(98.0%vs.71.4%)and the positive rate of anti-dsDNA antibody(94.1%vs.28.6%),anti-nucleosome antibody(80.0%vs.9.1%),anti-histone antibody(77.1%vs.9.1%),and anti-mitochondrial M2 antibody(31.4%vs.0)were significantly different(P<0.05).Multivariate analysis indicated that anti-dsDNA antibody was an independent risk factor for new-onset SLE with HCMV infection(OR=1.009,95%CI 1.002-1.016,P=0.012).The best cut-off value for predicting HCMV infection by ROC curve was 270.5 IU/ml for anti-dsDNA antibody titers,with an area under the curve of 0.943(95%CI 0.889-0.966).The sensitivity and specificity were 86.3%and 100.0%.The positive rate of anti-nucleosome antibody(94.7%vs.62.5%)and anti-histone antibody(94.7%vs.56.3%),and median anti-dsDNA antibody titers[800.0(IU/ml)vs.498.0(IU/ml)]were higher in the CMV IgM-positive subgroup than those in the CMV IgM-negative subgroup(P<0.05),but there was no statistical difference in SLEDAI between the two subgroups(P>0.05).Conclusion Those with early-onset SLE,with arthralgia,severe disease activity,significantly elevated titers of anti-dsDNA antibody,and hypocomplementemia should be on an alert for higher risk of HCMV infection.HCMV infection may affect humoral immunity in new-onset SLE patients,triggering or exacerbating lupus flares.Various autoantibodies production may be relative to HCMV infection.