在没有扩张型心肌病或心肌炎证据的患者心脏中，细小病毒 B19 和人博卡病毒 DNA 的流行情况。

Prevalence of parvovirus B19 and human bocavirus DNA in the heart of patients with no evidence of dilated cardiomyopathy or myocarditis.

机构信息

Department of Medicine, University of Dresden, Dresden, Germany.

出版信息

Clin Infect Dis. 2009 Dec 1;49(11):1660-6. doi: 10.1086/648074.

DOI:10.1086/648074

PMID:19863443

Abstract

BACKGROUND

Although the DNA of parvovirus B19 (B19V) is frequently detected in patients with dilated cardiomyopathy or myocarditis, whether the parvovirus causes disease is questionable, since even in healthy individuals the virus persists in various tissues. The same question applies to human bocavirus (HBoV). We have determined the prevalence and quantity of B19V and HBoV DNA in heart tissue of patients who were not experiencing virus-related heart diseases and analyzed whether the seroprevalence corresponded to DNA prevalence in the heart.

METHODS

Samples of left-atrium heart tissue and serum were obtained from 100 patients who underwent open-heart surgery. Serum immunoglobulin (Ig) G and IgM against proteins encoded by B19V and HBoV were detected by enzyme-linked immunoabsorption assay and immunoblotting. B19V and HBoV DNA concentrations were determined by quantitative real-time polymerase chain reaction (PCR) in heart tissue and serum samples. Nested PCRs for VP1, K71, and GT3 identified the B19V genotypes.

RESULTS

The prevalences of serum IgG specific for B19V and HBoV were 85% and 96%, respectively. Of all the patients, 85% had B19V DNA detected in heart tissues, and 4% displayed low-level B19V viremia, whereas only 5% of heart tissue samples and none of the serum samples demonstrated HBoV DNA. The sensitivity of B19V serological testing for B19V DNA in heart samples was 0.96 (95% confidence interval, 0.92-1.0). Specificity was 0.8 (95% confidence interval, 0.6-1.0), and the positive predictive value was 0.96 (95% confidence interval, 0.92-1.0). B19V genotypes 1 and 2 were present in 11% and 89% of heart tissues samples, respectively. B19V genotype 3 was not detected in any of the samples.

CONCLUSIONS

Our data suggest that B19V but not HBoV demonstrates a lifelong persistence in the heart. The detection of B19V DNA in heart tissue showed no correlation with clinical symptoms. We strongly recommend that serological testing become a standardized procedure for future studies, to obtain representative data concerning the prevalence of B19V in the heart.

摘要

背景

尽管细小病毒 B19（B19V）的 DNA 经常在扩张型心肌病或心肌炎患者中检测到，但细小病毒是否引起疾病仍存在疑问，因为即使在健康个体中，病毒也会在各种组织中持续存在。人类博卡病毒（HBoV）也是如此。我们已经确定了在未发生与病毒相关的心脏病的患者的心脏组织中 B19V 和 HBoV DNA 的流行率和数量，并分析了血清阳性率是否与心脏中的 DNA 流行率相对应。

方法

从 100 例行心脏直视手术的患者中获取左心房心脏组织和血清样本。通过酶联免疫吸附试验和免疫印迹法检测针对 B19V 和 HBoV 编码蛋白的血清 IgG 和 IgM。通过定量实时聚合酶链反应（PCR）在心脏组织和血清样本中确定 B19V 和 HBoV DNA 浓度。巢式 PCR 用于 VP1、K71 和 GT3 鉴定 B19V 基因型。

结果

针对 B19V 和 HBoV 的血清 IgG 特异性的流行率分别为 85%和 96%。所有患者中有 85%的心脏组织中检测到 B19V DNA，4%的患者存在低水平的 B19V 血症，而仅 5%的心脏组织样本和无一例血清样本中检测到 HBoV DNA。B19V 血清学检测心脏样本中 B19V DNA 的灵敏度为 0.96（95%置信区间，0.92-1.0）。特异性为 0.8（95%置信区间，0.6-1.0），阳性预测值为 0.96（95%置信区间，0.92-1.0）。B19V 基因型 1 和 2 分别存在于 11%和 89%的心脏组织样本中，未在任何样本中检测到 B19V 基因型 3。