Gaeta Aurelia, Nazzari Cristina, Verzaro Simona, Latte Maria Cristina, Fabri Giovanni, Scateni Simona, Raggi Claudia, Lubrano Riccardo, Mancini Carlo
Clinical Microbiology, Department of Science and Public Health, School of Medicine, La Sapienza University, P.le A. Moro, 5-00185 Rome, Italy.
New Microbiol. 2006 Oct;29(4):231-41.
Transplant patients are at high risk of post-transplant lymphoproliferative disorder (PTLD). A strong correlation between Epstein-Barr virus (EBV) and PTLD is observed in pediatric patients with primary infection after transplant. Because many patients have responded to reversal of immunosuppressive therapy, an early identification of EBV is essential for the reduction of immunosuppression and/or introduction of antiviral therapy to prevent PTLD. Polymerase chain reaction (PCR) is a specific and sensitive method to identify EBV DNA in blood. The aim of our study was to establish a protocol for monitoring EBV infection in transplanted patients for early identification those at high risk of PTLD. Viral presence in peripheral blood leukocytes (PBL) and serum samples was revealed by Nested PCR; positive specimens were quantified with Real Time PCR (RT-PCR). DNA in PBL was observed in 12 cases and 6 showed EBV in sera. Quantitative analysis showed a wide range of EBV DNA copies in leukocytes that were higher than in sera. Two patients displayed high viral load values in both PBL and sera associated with clinical evidence of PTLD. Our data suggest that the study of the EBV load represents an essential approach in the diagnosis of PTLD and the analysis of serum samples could provide useful information in the post-transplant monitoring of high-risk patients.
移植患者发生移植后淋巴细胞增生性疾病（PTLD）的风险很高。在移植后初次感染的儿科患者中，观察到爱泼斯坦-巴尔病毒（EBV）与PTLD之间存在密切关联。由于许多患者对免疫抑制治疗的逆转有反应，因此早期识别EBV对于减少免疫抑制和/或引入抗病毒治疗以预防PTLD至关重要。聚合酶链反应（PCR）是一种在血液中识别EBV DNA的特异性和灵敏性方法。我们研究的目的是建立一个监测移植患者EBV感染的方案，以便早期识别那些有PTLD高风险的患者。通过巢式PCR检测外周血白细胞（PBL）和血清样本中的病毒存在情况；对阳性标本用实时PCR（RT-PCR）进行定量分析。在12例患者的PBL中检测到DNA，6例血清中检测到EBV。定量分析显示，白细胞中EBV DNA拷贝数范围很广，且高于血清中的拷贝数。两名患者的PBL和血清中病毒载量值都很高，伴有PTLD的临床证据。我们的数据表明，研究EBV载量是诊断PTLD的重要方法，分析血清样本可为高危患者移植后的监测提供有用信息。
