Sugata K, Taniguchi K, Yui A, Nakai H, Asano Y, Hashimoto S, Ihira M, Yagasaki H, Takahashi Y, Kojima S, Matsumoto K, Kato K, Yoshikawa T
Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
Transpl Infect Dis. 2012 Feb;14(1):49-56. doi: 10.1111/j.1399-3062.2011.00668.x. Epub 2011 Aug 25.
Systemic rotavirus infection, such as rotavirus antigenemia, has been found in immunocompetent rotavirus gastroenteritis patients. However, the pathogenesis of rotavirus infection in immunocompromised transplant recipients remains unclear. Enzyme-linked immunosorbent assay was used to measure rotavirus antigen levels in serially collected serum samples obtained from 62 pediatric patients receiving allogeneic hematopoietic stem cell transplants (HSCT). Rotavirus antigen was detected in 43 (6.8%) of 633 serum samples (8 of 62 patients). The duration of rotavirus antigenemia ranged between 1 and 10 weeks, and diarrhea was concurrent with rotavirus antigenemia in Cases 3, 6, 7, and 8. The level of viral antigen in the transplant recipients (0.19 ± 0.20) was significantly lower than that observed in serum samples collected from immunocompetent patients on either day 1 (0.49 ± 0.18, P = 0.0011) or day 3 (0.63 ± 0.09, P = 0.0005). A patient who received a graft from a human leukocyte antigen (HLA)-mismatched donor was at significant risk for rotavirus antigenemia (P = 0.024; odds ratio = 9.44) in comparison to patients who received grafts from HLA-matched donors. Although the duration of antigenemia was clearly longer in HSCT patients than in immunocompetent rotavirus gastroenteritis patients, the levels of viral antigen were not as high. Therefore, mismatched HLA may be a risk factor for rotavirus antigenemia after HSCT.
在免疫功能正常的轮状病毒胃肠炎患者中已发现系统性轮状病毒感染，如轮状病毒血症。然而，免疫功能低下的移植受者中轮状病毒感染的发病机制仍不清楚。采用酶联免疫吸附测定法检测了62例接受异基因造血干细胞移植（HSCT）的儿科患者连续采集的血清样本中的轮状病毒抗原水平。在633份血清样本中的43份（6.8%）（62例患者中的8例）检测到轮状病毒抗原。轮状病毒血症的持续时间为1至10周，病例3、6、7和8中腹泻与轮状病毒血症同时出现。移植受者的病毒抗原水平（0.19±0.20）显著低于免疫功能正常患者在第1天（0.49±0.18，P = 0.0011）或第3天（0.63±0.09，P = 0.0005）采集的血清样本中的水平。与接受人类白细胞抗原（HLA）匹配供体移植的患者相比，接受HLA不匹配供体移植的患者发生轮状病毒血症的风险显著增加（P = 0.024；比值比 = 9.44）。尽管HSCT患者的抗原血症持续时间明显长于免疫功能正常的轮状病毒胃肠炎患者，但其病毒抗原水平却没有那么高。因此，HLA不匹配可能是HSCT后轮状病毒血症的一个危险因素。
