Allen M D, Denny C F, Kruse A P, Revkin J H, Fishbein D P, Ashley R L
Department of Laboratory Medicine, University of Washington, Seattle.
J Heart Lung Transplant. 1991 Sep-Oct;10(5 Pt 1):664-73.
Twenty heart transplant recipients were assayed serially with cytomegalovirus cultures and with Western blot techniques for development of anticytomegalovirus immunoglobulin M (IgM) and immunoglobulin G (IgG). Patients were followed up 3 to 29 months (mean, 15 months) after transplantation. All but three patients received a 5-week perioperative course of passive immunization with immune globulin. Of nine seronegative patients with seropositive grafts, positive cytomegalovirous cultures developed in all, secondary organ involvement (gastrointestinal or pneumonia) developed in four of nine. Four of nine patients produced limited IgM profiles, consisting of only one to three bands; six of the nine patients had atypical, restricted IgG profiles. Three of four patients in whom secondary organ invasion developed had limited IgM profiles, and all four had atypical IgG profiles. Four of five patients with primary infection without symptoms produced full IgM profiles. Delay of IgM production until a time coincident with or after evidence of viral shedding was documented in all patients with primary infection and secondary organ involvement. Among 11 seropositive patients, five received seropositive grafts and six seronegative grafts. Of the five patients with seropositive grafts, positive cultures (reinfection) developed in three; all three responded with full IgM profiles. However, secondary organ involvement developed in two of these three in spite of full IgM profiles. Symptomatic illness did not develop in any patient with a seronegative donor, even in the presence of positive cultures (reactivation). Persistence of IgM for up to 26 months was found in all patients with primary infection or reinfection. In heart transplant recipients, limited IgM and IgG profiles in primary infection may confer increased risk of secondary organ invasion whereas the early development of full IgM profiles may correlate with disease without symptoms. In seropositive patients, production of full IgM profiles may not protect from reinfection with secondary organ involvement if the organ donor is seropositive, a potential source of a new viral strain.
对20名心脏移植受者进行了连续的巨细胞病毒培养检测，并采用蛋白质印迹技术检测抗巨细胞病毒免疫球蛋白M（IgM）和免疫球蛋白G（IgG）的产生情况。患者在移植后随访3至29个月（平均15个月）。除3名患者外，所有患者均接受了为期5周的免疫球蛋白被动免疫围手术期疗程。9名血清学阴性患者接受了血清学阳性移植物，所有患者均出现了阳性巨细胞病毒培养结果，9名患者中有4名出现了继发性器官受累（胃肠道或肺炎）。9名患者中有4名产生了有限的IgM图谱，仅由1至3条带组成；9名患者中有6名具有非典型的、受限的IgG图谱。发生继发性器官侵袭的4名患者中有3名具有有限的IgM图谱，且所有4名患者均具有非典型的IgG图谱。5名无症状原发性感染患者中有4名产生了完整的IgM图谱。在所有原发性感染和继发性器官受累患者中，均记录到IgM产生延迟至与病毒脱落证据同时或之后的时间。在11名血清学阳性患者中，5名接受了血清学阳性移植物，6名接受了血清学阴性移植物。在5名接受血清学阳性移植物的患者中，3名出现了阳性培养结果（再感染）；所有3名患者均产生了完整的IgM图谱。然而，尽管有完整的IgM图谱，这3名患者中有2名出现了继发性器官受累。即使存在阳性培养结果（再激活），任何接受血清学阴性供体的患者均未出现症状性疾病。在所有原发性感染或再感染患者中均发现IgM持续存在长达26个月。在心脏移植受者中，原发性感染时有限的IgM和IgG图谱可能会增加继发性器官侵袭的风险，而完整IgM图谱的早期出现可能与无症状疾病相关。在血清学阳性患者中，如果器官供体为血清学阳性（一种新病毒株的潜在来源），产生完整的IgM图谱可能无法预防再感染及继发性器官受累。
