Loebe M, Schüler S, Zais O, Warnecke H, Fleck E, Hetzer R
Department of Surgery, German Heart Institute Berlin, F.R.G.
J Heart Transplant. 1990 Nov-Dec;9(6):707-11.
In heart transplantation, accelerated graft arteriosclerosis leading to late postoperative graft failure is still an unsolved problem, and its pathogenesis is poorly understood. The existence of multiple underlying mechanisms has been discussed without conclusive results. In kidney transplantation, a negative influence of cytomegalovirus infection on long-term graft function and patient survival could be demonstrated. To evaluate the role of this infection on the incidence of coronary artery disease in the transplanted heart, we have analyzed the cytomegalovirus serostatus in 38 long-term survivors of orthotopic heart transplantation. In 14 patients (group A) graft arteriosclerosis was diagnosed by means of coronary angiography. In 24 patients (group B) the coronary vessels showed no pathologic findings. In 10 patients (71%) of group A serologic study showed evidence of cytomegalovirus infection, whereas only five patients (24%) of group B revealed cytomegalovirus infection. In two further patients of this group herpes zoster infection occurred (p less than 0.0001). Cytomegalovirus infection seems to be an important factor in the development of accelerated graft arteriosclerosis in the transplanted heart.
在心脏移植中，导致术后晚期移植物衰竭的加速性移植物动脉硬化仍是一个未解决的问题，其发病机制也知之甚少。虽然已经讨论了多种潜在机制的存在，但尚无定论。在肾移植中，已证实巨细胞病毒感染对长期移植物功能和患者存活有负面影响。为了评估这种感染对移植心脏中冠状动脉疾病发生率的作用，我们分析了38例原位心脏移植长期存活者的巨细胞病毒血清学状态。14例患者（A组）通过冠状动脉造影诊断为移植物动脉硬化。24例患者（B组）冠状动脉血管未发现病理改变。A组10例患者（71%）血清学研究显示有巨细胞病毒感染证据，而B组只有5例患者（24%）有巨细胞病毒感染。该组另外2例患者发生带状疱疹感染（p<0.0001）。巨细胞病毒感染似乎是移植心脏中加速性移植物动脉硬化发展的一个重要因素。
