| Background:DM/PM is a chronic autoimmune disease that mainly affects skeletal muscle,important organs such as the lungs and heart are also often affected.At present,the treatment of DM/PM is mainly glucocorticoids and DMARDs to reduce disease activity.A series of side effects occur during treatment,and the treatment response is often disappointing.Therefore,the need for new treatments has not been met.In China,infection is the leading cause of death in DM/PM patients and can account for half of all deaths.EBV and CMV are common in DM/PM opportunistic infections.Patients with DM/PM combined with EBV and/or CMV viremia urgently need reliable indicators and new treatment options.Objective:To investigate the quantitative status of peripheral blood lymphocyte and CD4+T cell subsets in the patients with DM/PM combined with EBV and/or CMV viremia in order to explore the potential reliable indicators and evaluate the safety and efficacy of short-term low-dose interleukin(IL)-2 therapy in DM/PM combined with EBV and /or CMV viremia patients.Methods:DM/PM patients with EBV and CMV viremia(infection group,n=34)and without infection(non-infection group,n=31)as well as healthy adult controls(HCs,n=20)were enrolled in our study.Absolute numbers of total T,B,NK,CD4+T,CD8+T cells,and CD4+T subsets(Th1,Th2,Th17 and Treg cells)in PB by flow cytometry combined with standard absolute counting beads.Record general clinical data such as age,gender,course of disease,blood routine,liver function and kidney function.And collect disease activity indicators such as ESR and muscle enzymes in DM/PM infected and non-infected groups.In DM/PM patients with infection,13 patients in infection group received subcutaneous injections of human IL-2(aldesleukin)at 0.50 Million IU/day for a 5-day course on the basis of conventional treatment [corticosteroids and disease-modifying anti-rheumatic drugs(DMARDs)] and common antiviral therapy.The peripheral blood lymphocytes and CD4+T subsets were detected by FCM before and after IL-2 treatment,and the changes in ESR,muscle enzymes were compared and analyzed.Record laboratory tests such as blood routines during medication to assess its safety.Results:There were 34 cases in DM/PM infection group,12 cases of EBV infection,20 cases of CMV infection,2 cases of simultaneous infection of two viruses,11 cases of male and 23 cases of female,with an average age of 52.29±16.95 years old;31 cases of non-infected group,there were 10 males and 21 females with an average age of 45.35±16.80 years;20 cases of healthy controls,7 males and 13 females with an average age of 51.75±14.49 years.There was no significant difference in age and gender between the DM/PM patients and the healthy control group(P> 0.05).The infection group had the lowest levels of T,B,NK,CD4+T(Th1,Th2,Th17,Treg)in peripheral blood;compare to the healthy controls,Th17 of infection group(P<0.001)was significantly reduced in the infection group but not in the non-infection(P=0.171).Disease-related indicators(LDH,HBDH)were significantly higher than those in the non-infected group(P<0.01).In DM /PM patients infection group,13 patients received low-dose IL-2 treatment,after IL-2treatment,the absolute number of T,CD4+T and CD8+T cells increased significantly compared to before.Except for Th2 cells,the number of CD4+T subgroups increased significantly.Disease-related indicators(ESR,LDH)decreased to a certain extent(P<0.05).There was no significant difference in safety measures.Conclusion:EBV and/or CMV virus infection further reduced the absolute number of Tregs in patients with DM/PM and reduced Th17 cells.The decrease in Th17 cells may also be the cause and risk indicator of EBV and/or CMV infection in DM/PM.Low-dose IL-2can significantly expand Treg cells and increase Th17 cells moderately in patients with DM/PM combined with EBV and/or CMV viremia.Combined low-dose IL-2 treatment does not cause exacerbation of existing infections.It may be safe and effective for patients with DM/PM combined with EBV and/or CMV viremia. |
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