Kawashima Nozomu, Muramatsu Hideki, Okuno Yusuke, Torii Yuka, Kawada Jun-ichi, Narita Atsushi, Nakanishi Koji, Hama Asahito, Kitamura Aya, Asai Naoya, Nakamura Shigeo, Takahashi Yoshiyuki, Ito Yoshinori, Kojima Seiji
Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan.
J Infect Chemother. 2015 Dec;21(12):857-63. doi: 10.1016/j.jiac.2015.08.018. Epub 2015 Sep 28.
Viral infection is one of the major causes of mortality in patients undergoing hematopoietic stem cell transplant (HSCT). Systemic infection of adenovirus (AdV) has emerged as a not uncommon viral infection with significant morbidity and mortality as with cytomegalovirus and Epstein-Barr virus infection. Routine surveillance for these viruses has become a clinical practice and subsequent preemptive therapy improves patients' outcomes; however, the effectiveness of preemptive therapy for AdV has not been fully investigated in patients with a lethal form of AdV infection.
Sequential AdV loads were retrospectively analyzed in children with fulminant AdV hepatitis after HSCT.
The AdV DNA became detectable (1 × 10(4) copies/mL) as early as 2 weeks after HSCT. These levels reached >1 × 10(8) copies/mL at the onset of fulminant hepatitis. However, we determined that γ-glutamyltransferase levels were elevated to >100 IU/L at least 2 weeks before the diagnosis of hepatitis.
Our observation raises the possibility that elevated γ-glutamyltransferase could be a sentinel marker for AdV hepatitis, which prompts elaborated monitoring of AdV load and targeted treatment.
病毒感染是接受造血干细胞移植（HSCT）患者死亡的主要原因之一。腺病毒（AdV）全身感染已成为一种并不罕见的病毒感染，其发病率和死亡率与巨细胞病毒和爱泼斯坦-巴尔病毒感染相当。对这些病毒进行常规监测已成为临床实践，后续的抢先治疗可改善患者的预后；然而，对于致死性AdV感染患者，抢先治疗的有效性尚未得到充分研究。
对HSCT后发生暴发性AdV肝炎的儿童患者的连续AdV载量进行回顾性分析。
AdV DNA最早在HSCT后2周即可检测到（1×10⁴拷贝/毫升）。在暴发性肝炎发作时，这些水平达到>1×10⁸拷贝/毫升。然而，我们确定在肝炎诊断前至少2周，γ-谷氨酰转移酶水平升高至>100 IU/L。
我们的观察结果提示，γ-谷氨酰转移酶升高可能是AdV肝炎的一个哨兵标志物，这促使对AdV载量进行详细监测并进行靶向治疗。
