Rosselet Anne, Vu Dinh-Hao, Meylan Pascal, Chaubert Audrey S Baur, Schapira Marc, Pascual Manuel, Aubert Vincent, Tissot Jean-Daniel, Duchosal Michel A
Service d'Hématologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Clin Transplant. 2009 Jan-Feb;23(1):74-82. doi: 10.1111/j.1399-0012.2008.00904.x.
Post-transplant lymphoproliferative disease (PTLD) is a life-threatening complication of immunosuppression following transplantation. Epstein-Barr virus (EBV) and gammopathy in serum are associated with PTLD, but these two parameters have not been evaluated in parallel for their association with PTLD.
We evaluated the incidence of EBV load positivity, gammopathy, and protein expression in sera from all PTLD patients diagnosed at our hospital during the past seven yr. Results were compared with those of a control group including matched transplanted patients who did not develop PTLD.
Seven of 10 PTLD patients presented EBV(+) PTLD, for which five patients had detectable serum EBV DNA levels compared with none of 38 controls (RR between two groups =121, p < 0.0001). Five out of 10 patients had gammopathy at PTLD diagnosis compared with 5/38 controls (RR between two groups = 6.6, p = 0.022). Additionally, protein serum analysis by high-resolution two-dimensional gel electrophoresis and image examination failed to evidence specific abnormality in patients with PTLD compared with controls.
Our results confirm an association between EBV in sera and gammopathy with PTLD, and highlight the high specificity of the former analysis. Whether a combination of both analyses will improve the clinical detection of PTLD remains to be evaluated in a larger prospective cohort study.
移植后淋巴组织增生性疾病（PTLD）是移植后免疫抑制的一种危及生命的并发症。血清中的爱泼斯坦-巴尔病毒（EBV）和丙种球蛋白病与PTLD相关，但尚未对这两个参数与PTLD的关联进行平行评估。
我们评估了过去7年在我院诊断的所有PTLD患者血清中EBV载量阳性、丙种球蛋白病和蛋白表达的发生率。将结果与一个对照组进行比较，该对照组包括未发生PTLD的匹配移植患者。
10例PTLD患者中有7例出现EBV（+）PTLD，其中5例患者血清EBV DNA水平可检测到，而38例对照组患者均未检测到（两组间相对危险度=121，p<0.0001）。10例患者中有5例在PTLD诊断时出现丙种球蛋白病，而对照组为5/38（两组间相对危险度=6.6，p=0.022）。此外，与对照组相比，通过高分辨率二维凝胶电泳和图像检查进行的血清蛋白分析未能证明PTLD患者有特异性异常。
我们的结果证实血清中的EBV和丙种球蛋白病与PTLD之间存在关联，并突出了前一种分析的高特异性。两种分析方法联合使用是否能改善PTLD的临床检测，仍有待在更大规模的前瞻性队列研究中进行评估。
