Toriumi Naohisa, Kobayashi Ryoji, Yoshida Makoto, Iguchi Akihiro, Sarashina Takeo, Okubo Hitoshi, Suzuki Daisuke, Sano Hirozumi, Ogata Masao, Azuma Hiroshi
*Department of Pediatrics, Asahikawa Medical University †Department of Pediatrics, Sapporo Hokuyu Hospital ‡Department of Pediatrics, Hokkaido University Graduate School of Medicine, Hokkaido §Department of Hematology, Oita University Faculty of Medicine, Oita, Japan.
J Pediatr Hematol Oncol. 2014 Jul;36(5):379-83. doi: 10.1097/MPH.0b013e3182a11676.
There have been several reports on the reactivation of human herpesvirus 6 (HHV6) after stem cell transplantation (SCT) in adults, which sometimes induces severe illness. Few reports exist on pediatric patients; therefore, we retrospectively examined HHV6 reactivation after SCT in children. We reviewed 80 patients with a median age of 6 years. We analyzed HHV6 DNA serum samples from the patients before SCT and at 20 and 40 days after SCT using polymerase chain reaction. We also analyzed the relationship between HHV6 reactivation and the syndrome of inappropriate antidiuretic hormone secretion (SIADH). At 20 days after SCT, 35.0% of serum samples were positive for HHV6 DNA. The median viral load was 3.1×10 copies/mL serum. Multivariate analysis showed cord blood transplantation as the only risk factor for HHV6 reactivation. HHV6 reactivation occurs in 59.4% of 32 patients who underwent cord blood transplantation and in 18.8% of 48 patients who underwent SCT from other sources. Among the 14 patients with SIADH, 78.6% experienced HHV6 reactivation. Among the 66 patients without SIADH, only 25.8% had HHV6 reactivation. This result was statistically significant (P<0.001). This analysis revealed that HHV6 reactivation occurs in many children. In addition, HHV6 reactivation plus SIADH should prompt evaluation for central nervous system disease.
已有多篇关于成人干细胞移植（SCT）后人类疱疹病毒6型（HHV6）再激活的报道，这种情况有时会引发严重疾病。关于儿科患者的报道较少；因此，我们对儿童SCT后的HHV6再激活情况进行了回顾性研究。我们回顾了80例中位年龄为6岁的患者。我们使用聚合酶链反应分析了患者在SCT前以及SCT后20天和40天的HHV6 DNA血清样本。我们还分析了HHV6再激活与抗利尿激素分泌不当综合征（SIADH）之间的关系。在SCT后20天，35.0%的血清样本HHV6 DNA呈阳性。病毒载量中位数为每毫升血清3.1×10拷贝。多因素分析显示脐血移植是HHV6再激活的唯一危险因素。在接受脐血移植的32例患者中，59.4%发生了HHV6再激活，而在接受其他来源SCT的48例患者中，这一比例为18.8%。在14例患有SIADH的患者中，78.6%出现了HHV6再激活。在66例没有SIADH的患者中，只有25.8%发生了HHV6再激活。这一结果具有统计学意义（P<0.001）。该分析表明，许多儿童会发生HHV6再激活。此外，HHV6再激活加SIADH应促使对中枢神经系统疾病进行评估。
