Wang Li-Ru, Dong Lu-Jia, Zhang Mei-Jie, Lu Dao-Pei
Peking University Institute of Hematology, Peking University People's Hospital, Beijing, PR China.
Biol Blood Marrow Transplant. 2006 Oct;12(10):1031-7. doi: 10.1016/j.bbmt.2006.06.001.
Although human herpesvirus 6 (HHV-6) has been considered an important opportunistic and potentially fatal pathogen for allogeneic hematopoietic stem cell transplantation (HSCT), the clinical significance of HHV-6 reactivation remains controversial. In this study, we monitored HHV-6 DNAemia in 72 consecutive allogeneic HSCT recipients by real-time quantitative polymerase chain reaction. A total of 680 peripheral blood specimens were collected from the recipients before HSCT or at weekly intervals after HSCT. As the predominant variant, HHV-6B was detectable at least once in 47.2% (34/72) of HSCT recipients on the median day 21 (range, 7-84 days); HHV-6A reactivation occurred in only 1 recipient (1.4%). Detectable HHV-6B reactivation was associated with increased probability of skin rash by day 30 after HSCT (hazard ratio [HR], 3.68; 95% confidence interval [CI], 1.24-10.92; P = .019), cytomegalovirus (CMV) antigenemia (HR, 2.35; 95%CI, 1.32-4.19; P = .004), and hemorrhagic cystitis (HC) (HR, 2.59; 95%CI, 0.96-6.98; P = .061) by day 100 after HSCT. Neutrophil and platelet engraftment, mortality for 100 days after HSCT were not affected by HHV-6B reactivation. In conclusion, HHV-6 reactivation is a common event, and this study demonstrates a correlation between HHV-6B infection and CMV reactivation, early rash, and possibly increased incidence of HC after transplantation.
尽管人类疱疹病毒6型（HHV-6）被认为是异基因造血干细胞移植（HSCT）中一种重要的机会性且可能致命的病原体，但HHV-6再激活的临床意义仍存在争议。在本研究中，我们通过实时定量聚合酶链反应监测了72例连续的异基因HSCT受者的HHV-6病毒血症。在HSCT前或HSCT后每周从受者采集总共680份外周血标本。作为主要变体，在中位数第21天（范围为7 - 84天），47.2%（34/72）的HSCT受者中至少有一次检测到HHV-6B；HHV-6A再激活仅发生在1例受者（1.4%）中。可检测到的HHV-6B再激活与HSCT后第30天出现皮疹的概率增加相关（风险比[HR]，3.68；95%置信区间[CI]，1.24 - 10.92；P = 0.019），与巨细胞病毒（CMV）抗原血症相关（HR，2.35；95%CI，1.32 - 4.19；P = 0.004），以及与HSCT后第100天出血性膀胱炎（HC）相关（HR，2.59；95%CI，0.96 - 6.98；P = 0.061）。中性粒细胞和血小板植入、HSCT后100天的死亡率不受HHV-6B再激活的影响。总之，HHV-6再激活是一个常见事件，本研究证明了HHV-6B感染与CMV再激活、早期皮疹以及移植后可能增加的HC发生率之间存在相关性。
