Clement J, Colson P, Saegeman V, Lagrou K, Van Ranst M
National Reference Centre for Hantavirus Infections, Laboratory of Clinical and Epidemiological Virology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium.
Emergency Unit, Clinique Sainte Elisabeth, Namur, Belgium.
Eur J Clin Microbiol Infect Dis. 2016 Jul;35(7):1101-6. doi: 10.1007/s10096-016-2638-4. Epub 2016 Apr 21.
Hantavirus infections, recently renamed 'hantavirus fever' (HTVF), belong to the most common but also most underestimated zoonoses in the world. A small number of reports described the so-called 'lipid paradox' in HTVF, i.e. the striking contrast between a very low serum total cholesterol and/or high-density lipoprotein cholesterol (HDLc), and a paradoxical concomitant hypertriglyceridaemia. In a prospective study, with patients being their own control after illness, we wanted to verify if this quick and easy 'bedside test' was robust enough to warrant a preliminary diagnosis of acute kidney injury (AKI) caused by HTVF. The study cohort consisted of 58 Belgian cases (mean age 44 years), admitted with varying degrees of AKI and of thrombocytopaenia, both characteristic for presumptive HTVF. All cases were sero-confirmed as having acute HTVF. At or shortly after hospital admission, a significant (p < 0.001) decrease of total cholesterol and HDLc was found in comparison with normalised levels in the same cohort, quantified a few days after spontaneous AKI recovery. Conversely, fasting triglyceride levels during HTVF infection were significantly (p < 0.001) higher during illness than after recovery. This 'lipid paradox' was most outspoken in severe HTVF cases, often accompanying, or even predicting, major kidney or lung complications. Thus, this 'bedside assessment' seems to hold even promise for presumptive diagnosis of more severe so-called 'hantavirus cardio-pulmonary syndrome' (HCPS) cases, mostly described hitherto in the New World. In more severe AKI cases, the mean total cholesterol was significantly lower (p = 0.02) than in milder cases, i.e. cases with peak serum creatinine levels of < 1.5 mg/dL. Thrombocytopaenia, generally accepted as the severity index in HTVF, appeared, moreover, significantly correlated with serum levels of total cholesterol (R = 0.52, p < 0.001) and with serum levels of HDLc (R = 0.45, p < 0.01). A link with the novel clinical entity of haemophagocytic syndromes, also characterised by manifest hypertriglyceridaemia, is discussed.
汉坦病毒感染，最近更名为“汉坦病毒热”（HTVF），是世界上最常见但也最被低估的人畜共患病之一。少数报告描述了HTVF中所谓的“脂质悖论”，即血清总胆固醇和/或高密度脂蛋白胆固醇（HDLc）极低与矛盾的伴随高甘油三酯血症之间的显著差异。在一项前瞻性研究中，患者在患病后以自身作为对照，我们想验证这种快速简便的“床边检测”是否足够可靠，以支持对HTVF所致急性肾损伤（AKI）的初步诊断。研究队列包括58例比利时病例（平均年龄44岁），他们因不同程度的AKI和血小板减少症入院，这两者都是疑似HTVF的特征。所有病例血清学确诊为急性HTVF。在入院时或入院后不久，与同一队列在自发性AKI恢复几天后测定的正常水平相比，发现总胆固醇和HDLc显著降低（p<0.001）。相反，HTVF感染期间的空腹甘油三酯水平在患病期间显著高于恢复后（p<0.001）。这种“脂质悖论”在严重的HTVF病例中最为明显，常伴随甚至预示着严重的肾脏或肺部并发症。因此，这种“床边评估”似乎对更严重的所谓“汉坦病毒心肺综合征”（HCPS）病例的初步诊断也有前景，迄今为止，HCPS大多在新大陆被描述。在更严重的AKI病例中，平均总胆固醇显著低于较轻病例（p = 0.02），即血清肌酐峰值水平<1.5mg/dL的病例。此外，血小板减少症通常被认为是HTVF的严重程度指标，它与血清总胆固醇水平（R = 0.52，p<0.001）和HDLc血清水平（R = 0.45，p<0.01）显著相关。文中还讨论了与同样以明显高甘油三酯血症为特征的噬血细胞综合征这一新型临床实体的联系。
