Львівський клінічний вісник (Dec 2019)
Diagnostic Value of the Laboratory Markers of Acute Cytomegalovirus Infection in Patients With Systemic Lupus Erythematosus
Abstract
Introduction. Systemic lupus erythematosus (SLE) is one of the major medical and social problems, as it is most commonly seen in young people, accompanied by a variety of multiple organ lesions and clinical manifestations that often lead to disability and threaten life. The tactics of treating patients with SLE without and in combination with acute CMV infection are radically different, but appropriate tests are time-consuming, costly, which makes it impossible for all patients who have abnormalities in laboratory blood counts and need treatment changes. Determining the diagnostic value of laboratory blood tests and, therefore, identifying risk groups for acute CMV infection will help optimize work with this category of patients. The aim of the study. To determine the diagnostic value of laboratory markers of acute cytomegalovirus infection in patients with systemic lupus erythematosus. Materials and methods. The study involved 120 patients (15 men (12.50 %) and 105 women (87.50 %) aged 18 to 69 years (mean age 39.38 ± 12.4 years)) who were treated in the rheumatology department of Сommunal Nonprofit Enterprise of LvivRegional Council “Lviv Regional Clinical Hospital” in 2013-2016 In addition to routine examinations, patients were diagnosed with CMV infection by detecting IgM and IgG antibodies to the serum virus. Depending on the detection of increased titer of antibodies to CMV, all patients were divided into two groups: 19 people (15.80%) with acute (increased IgM titer and detection of deoxyribonucleic acid virus in the blood and / or urine) CMV infection (experimental group, EG) of which 18 women and 1 man aged 19 to 53 years (mean age 38.37 ± 2.80 years) and 101 individuals (84.20%) without acute CMV (normal IgM titer) infection (comparison group (CG)). Statistical analysis was performed to calculate the chances of detecting the CMV infection phase of SLE patients using a marker that can be detected during the initial examination. The plausible likelihood of an acute phase of infection was determined by sensitivity, specificity, and accuracy. The odds ratio, the coefficient of association (or contingency), the relative risk, the absolute and relative risk reduction, the pronostic value of the positive result, the pronostic value of the negative result are also determined. The association between acute CMV infection and the trait was considered to be confirmed by an association coefficient of 0.5 (or 0.3 for the contingency factor). Results. Analysis of the results of the evaluation of the total blood test in patients of both groups showed that anemia, leukopenia and lymphopenia are more often found among patients with SLE with acute CMV infection, as well as average values of hemoglobin, the number of erythrocytes, leukocytes, lymphocytes and lymphocytes were significantly smaller than in the group of patients without it, and the ESR values were significantly higher. According to the results of the analysis of some indices of blood biochemical analysis, the increase in the activity of AST and the positive index of RF are more often found in patients with acute CMV infection, and in the group with acute CMV infection, the average activity of AST, AlT and C-RP content were significantly. A direct correlation between the increase in α2-globulin and γ-globulin content and belonging to a group with acute CMV infection was confirmed. LE cells almost thrice detect patients with acute CMV infection. The average titer of antibodies to double-stranded DNA, ANA, antiphospholipid IgM antibodies in EG patients was significantly higher, and the average titer of antiphospholipid IgG antibodies was lower than that of CG. The reduction in the overall complement rate is 5 times more likely to occur in patients with acute CMV infection than in individuals without infection. Leukopenia and lymphopenia were detected in 73.68% of patients with an increase in IgM titer to CMV, and in 66.34% of patients without acute CMV, no combination of these indicators was observed (sensitivity 73.68%, specificity 66.34%, accuracy 67.50 %, the association coefficient is 0.69). The combination of leukopenia and lymphopenia in SLE patients can correctly predict the presence of acute CMV infection at 67.50%. Conclusions. Anemia, leukopenia, lymphopenia, increase in γ-globulin content, increase in antibody titer to two-helical deoxyribonucleic acid, decrease in complement rate are laboratory markers of acute cytomegalovirus infection in patients with systemic lupus erythematosus. A constellation of indicators was found to have the highest sensitivity, specificity, and association coefficient with the presence of acute cytomegalovirus infection, namely: leukopenia and lymphopenia. Considering the presence of these indicators in patients with systemic lupus erythematosus will allow to form groups of risk of acute cytomegalovirus infection, and therefore to examine the patient and to choose the right tactics of treatment.
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