Department of Pathology and Laboratory Medicine, University of North Carolina, 101 Manning Dr., 913 Brinkhous-Bullitt Building, Chapel Hill, NC 27599-7525, USA.
Clin Microbiol Rev. 2010 Apr;23(2):350-66. doi: 10.1128/CMR.00006-09.
Epstein-Barr virus (EBV) DNA measurement is being incorporated into routine medical practice to help diagnose, monitor, and predict posttransplant lymphoproliferative disorder (PTLD) in immunocompromised graft recipients. PTLD is an aggressive neoplasm that almost always harbors EBV DNA within the neoplastic lymphocytes, and it is often fatal if not recognized and treated promptly. Validated protocols, commercial reagents, and automated instruments facilitate implementation of EBV load assays by real-time PCR. When applied to either whole blood or plasma, EBV DNA levels reflect clinical status with respect to EBV-related neoplasia. While many healthy transplant recipients have low viral loads, high EBV loads are strongly associated with current or impending PTLD. Complementary laboratory assays as well as histopathologic examination of lesional tissue help in interpreting modest elevations in viral load. Circulating EBV levels in serial samples reflect changes in tumor burden and represent an effective, noninvasive tool for monitoring the efficacy of therapy. In high-risk patients, serial testing permits early clinical intervention to prevent progression toward frank PTLD. Restoring T cell immunity against EBV is a major strategy for overcoming PTLD, and novel EBV-directed therapies are being explored to thwart virus-driven neoplasia.
Epstein-Barr 病毒（EBV）DNA 测量正被纳入常规医疗实践，以帮助诊断、监测和预测免疫抑制移植受者的移植后淋巴增殖性疾病（PTLD）。PTLD 是一种侵袭性肿瘤，几乎总是在肿瘤性淋巴细胞内存在 EBV DNA，如果不及时识别和治疗，通常是致命的。经过验证的方案、商业试剂和自动化仪器通过实时 PCR 促进 EBV 载量检测的实施。当应用于全血或血浆时，EBV DNA 水平反映了与 EBV 相关肿瘤的临床状态。虽然许多健康的移植受者具有低病毒载量，但高 EBV 载量与当前或即将发生的 PTLD 强烈相关。补充实验室检测以及病变组织的组织病理学检查有助于解释病毒载量的适度升高。连续样本中循环 EBV 水平反映了肿瘤负荷的变化，是监测治疗效果的有效、非侵入性工具。在高危患者中，连续检测可进行早期临床干预，以防止向明显的 PTLD 进展。恢复针对 EBV 的 T 细胞免疫是克服 PTLD 的主要策略，正在探索新型 EBV 靶向治疗来阻止病毒驱动的肿瘤发生。
