探讨巨细胞病毒(Cytomegalovirus, CMV)、EB病毒(Epstein-Barr virus, EBV)及人疱疹病毒8(Human herpesvirus 8, HHV-8)感染状态与特发性肺纤维化(idiopathic pulmonary fibrosis, IPF)患者病情严重程度及预后的相关性。

选取2020年1月至2024年12月我院收治的79例IPF患者为对象。根据肺功能指标用力肺活量(forced vital capacity, FVC)和一氧化碳弥散量(diffusing capacity for carbon monoxide, DLCO)占预计值百分比及临床表现分为轻度组41例、中度组24例和重度组14例。采用实时荧光定量PCR法检测血清中CMV、EBV及HHV-8核酸载量。门诊随访，比较不同病情严重程度及预后者的病毒阳性率和核酸载量差异，采用Pearson相关性分析病毒载量与病情及预后关联，通过受试者工作特征(receiver operating characteristic, ROC)曲线判断病毒载量对预后的预测。

轻度、中度和重度组用力肺活量(FVC%预计值)分别为(78.86±8.15)、(60.25±6.71)和(42.25±4.89)；一氧化碳弥散量(DLCO%预计值)分别为(61.15±6.37)、(45.52±4.78)和(31.15±4.18)(P<0.001)。轻度、中度和重度组CMV阳性率分别为9.76%、37.50%和71.43%。CMV、EBV及HHV-8病毒核酸载量与IPF病情严重程度呈正相关(r＝0.562，0.625，0.482，P<0.001)。生存者62例(78.48%)，死亡者17例(21.52%)。死亡者病毒载量CMV(4 112.25±705.51)copies/ml、EBV(36 412.15±3 348.84)copies/ml和HHV-8(389.95±35.56)copies/ml高于生存者CMV(845.51±145.56)copies/ml、EBV(8 847.15±1 521.15)copies/ml、HHV-8(122.25±25.56) copies/ml，病毒载量与不良预后呈正相关(r＝0.612, 0.665, 0.567，P<0.001)。ROC曲线分析显示，联合检测三种病毒感染状态预测IPF预后曲线下面积(area under the curve, AUC)为0.823，灵敏度94.12%，特异度87.30%。

CMV、EBV及HHV-8感染状态对IPF患者病情严重程度和预后判断具有意义。

To investigate the correlation between the infection status of cytomegalovirus (CMV), Epstein-Barr virus (EBV), and human herpesvirus 8 (HHV-8) and the disease severity and prognosis of patients with idiopathic pulmonary fibrosis (IPF).

Seventy-nine IPF patients admitted to our hospital from January 2020 to December 2024 were selected as subjects. Based on the percentage of predicted forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLCO), as well as clinical manifestations, they were divided into a mild group 41 cases, a moderate group 24 cases, and a severe group (14 cases). Real-time fluorescent quantitative PCR was used to detect the serum nucleic acid load of CMV, EBV, and HHV-8. Follow-up was conducted via outpatient visits to compare the differences in virus positivity rates and nucleic acid loads among patients with different disease severities and prognoses. Pearson correlation analysis was used to analyze the association between viral load and disease condition/prognosis. The predictive value of viral load for prognosis was assessed using receiver operating characteristic (ROC) curve analysis.

The FVC (% predicted) values for the mild, moderate, and severe groups were (78.86±8.15), (60.25±6.71), and (42.25±4.89), respectively; the DLCO(% predicted) values were (61.15±6.37), (45.52±4.78), and (31.15±4.18), respectively (P<0.001). The CMV positivity rates in the mild, moderate, and severe groups were 9.76%, 37.50%, and 71.43%, respectively. The nucleic acid loads of CMV, EBV, and HHV-8 were positively correlated with the severity of IPF (r=0.562, 0.625, 0.482, P<0.001). Sixty-two survivors(78.48%), while 17 deaths (21.52%). The viral loads in deceased patients [CMV (4 112.25±705.51) copies/ml, EBV (36 412.15±3 348.84) copies/ml, HHV-8(389.95±35.56) copies/ml] were higher than those in surviving patients [CMV (845.51±145.56) copies/ml, EBV (8 847.15±1 521.15) copies/ml, HHV-8 (122.25±25.56) copies/ml]. Viral load was positively correlated with poor prognosis (r=0.612, 0.665, 0.567, P<0.001). ROC curve analysis showed that the combined detection of the three viral infection statuses for predicting IPF prognosis had an area under the curve (AUC) of 0.823, with a sensitivity of 94.12% and a specificity of 87.30%.

The infection status of CMV, EBV, and HHV-8 is significant for evaluting the disease severity and prognosis of IPF patients.