Ito Kiminari, Shimizu Norio, Watanabe Ken, Saito Toshiharu, Yoshioka Yuriko, Sakane Emiko, Tsunemine Hiroko, Akasaka Hiroshi, Kodaka Taiichi, Takahashi Takayuki
Department of Hematology, Shinko Hospital, Japan.
Intern Med. 2013;52(2):201-11. doi: 10.2169/internalmedicine.52.8206. Epub 2013 Jan 15.
While unexplained liver dysfunction is common, it is sometimes difficult to identify its exact cause. One cause is viral infections. The identification of viruses other than hepatitis B and C that cause liver dysfunction is difficult because no methods to simultaneously identify these viruses have been established. The aim of this study was to quickly and simultaneously identify multiple virus species.
A total of 49 patients with unexplained liver dysfunction and undetermined inflammation were examined. The majority of patients had hematologic malignancies, and some had undergone bone marrow transplantation. Qualitative polymerase chain reactions (PCR) were performed to detect 12 species of DNA virus in whole blood. Quantitative real-time PCR was performed when a specific virus was amplified. In addition, 6 RNA hepatitis viruses were directly assayed by real-time PCR. These 2 PCR steps were completed within 1 hour.
The most frequently detected virus in 37 patients with liver dysfunction, was transfusion transmitted virus (38%), which was followed by human herpes virus (HHV) type 6 (35%), Epstein-Barr virus (14%), cytomegalovirus (8%), and rarely hepatitis G virus and HHV-7 (3%). Similar viremia was observed in 12 patients with mild liver dysfunction. The results of the PCR assay were mostly consistent with those of routine virus serological tests.
A multiplex viral PCR assay was a useful tool for quickly identifying viruses that possibly cause liver dysfunction. It was also important that liver dysfunction acted as a proband that led to the discovery of serious viremia.
虽然不明原因的肝功能障碍很常见，但有时很难确定其确切病因。其中一个病因是病毒感染。由于尚未建立同时鉴定这些病毒的方法，因此很难鉴定出除乙型和丙型肝炎病毒以外的其他导致肝功能障碍的病毒。本研究的目的是快速同时鉴定多种病毒种类。
共检查了49例不明原因肝功能障碍且炎症未明的患者。大多数患者患有血液系统恶性肿瘤，部分患者接受过骨髓移植。采用定性聚合酶链反应（PCR）检测全血中的12种DNA病毒。当扩增出特定病毒时，进行定量实时PCR。此外，通过实时PCR直接检测6种RNA肝炎病毒。这两个PCR步骤在1小时内完成。
在37例肝功能障碍患者中，最常检测到的病毒是输血传播病毒（38%），其次是6型人类疱疹病毒（HHV）（35%）、爱泼斯坦-巴尔病毒（14%）、巨细胞病毒（8%），很少检测到庚型肝炎病毒和HHV-7（3%）。在12例轻度肝功能障碍患者中也观察到类似的病毒血症。PCR检测结果大多与常规病毒血清学检测结果一致。
多重病毒PCR检测是快速鉴定可能导致肝功能障碍的病毒的有用工具。肝功能障碍作为先证者导致发现严重病毒血症也很重要。
