Benvenuti Luiz A, Roggério Alessandra, Nishiya Anna S, Campos Silvia V, Fiorelli Alfredo I, Levi José E
Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
J Heart Lung Transplant. 2014 Jul;33(7):698-703. doi: 10.1016/j.healun.2014.01.920. Epub 2014 Feb 4.
Chagas' disease reactivation (CDR) after heart transplantation (HTx) is characterized by relapse of the infectious disease, with direct detection of Trypanosoma cruzi parasites in blood, cerebrospinal fluid, or tissues. We investigated whether a detailed pathologic examination of the explanted heart at HTx with evaluation of myocarditis and parasitic persistence or load in the myocardium could be useful to identify patients at high risk of CDR.
The native hearts of 18 chagasic patients who presented CDR after HTx (CDR+ group) were compared with the native hearts of 16 chagasic patients who never presented CDR in a follow-up of at least 18 months after HTx (CDR- group). The intensity of myocarditis was evaluated semiquantitatively. Parasite persistence/load in the myocardium was investigated through immunohistochemistry for T cruzi antigens and by qualitative and quantitative real-time PCR for T cruzi DNA.
The rate of high-grade myocarditis, parasite persistence, and the median of parasitic load and parasitic load/10(6) cells in the CDR+ group were 83.3%, 77.8%, 8.43 × 10(-3), and 9.890, respectively, whereas in the CDR- group the values were 87.5%, 50%, 7.49×10(-3), and 17.800. There was no statistical difference between the groups. High-grade myocarditis was present in all 22 samples (100%) with parasite persistence and in 7 of 12 samples (58.3%) with no parasite persistence (p = 0.003).
Although associated with high-grade myocarditis, T cruzi parasite persistence in the myocardium of the native heart is not associated with the occurrence of CDR after HTx.
心脏移植（HTx）后恰加斯病再激活（CDR）的特征是传染病复发，可在血液、脑脊液或组织中直接检测到克氏锥虫寄生虫。我们研究了在HTx时对外植心脏进行详细的病理学检查，并评估心肌炎以及心肌中的寄生虫持续存在情况或负荷，是否有助于识别有CDR高风险的患者。
将18例HTx后出现CDR的恰加斯病患者（CDR+组）的心脏与16例在HTx后至少18个月的随访中从未出现CDR的恰加斯病患者（CDR-组）的心脏进行比较。对心肌炎的严重程度进行半定量评估。通过针对克氏锥虫抗原的免疫组织化学以及针对克氏锥虫DNA的定性和定量实时PCR来研究心肌中的寄生虫持续存在情况/负荷。
CDR+组的重度心肌炎发生率、寄生虫持续存在率、寄生虫负荷中位数以及每10⁶个细胞的寄生虫负荷分别为83.3%、77.8%、8.43×10⁻³和9.890，而CDR-组的这些值分别为87.5%、50%、7.49×10⁻³和17.800。两组之间无统计学差异。在所有22个存在寄生虫持续存在的样本（100%）以及12个不存在寄生虫持续存在的样本中的7个（58.3%）中存在重度心肌炎（p = 0.003）。
虽然与重度心肌炎相关，但克氏锥虫在天然心脏心肌中的持续存在与HTx后CDR的发生无关。
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