Miura Hiroki, Kawamura Yoshiki, Hattori Fumihiko, Tanaka Makito, Kudo Kazuko, Ihira Masaru, Yatsuya Hiroshi, Takahashi Yoshiyuki, Kojima Seiji, Yoshikawa Tetsushi
Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan.
Faculty of Clinical Engineering, Fujita Health University School of Health Sciences, Toyoake, Japan.
Transpl Infect Dis. 2018 Aug;20(4):e12916. doi: 10.1111/tid.12916. Epub 2018 Jun 13.
We sought to determine whether late-phase human herpesvirus 6B (HHV-6B) infection in hematopoietic stem cell transplant (HSCT) recipients was associated with serious outcomes and mortality.
The occurrence and course of HHV-6B infection was monitored for at least 60 days after transplant using virus isolation and real-time polymerase chain reaction. Risk factors for late-phase HHV-6B infection were examined, and the propensity score was calculated with significant risk factors. The inverse probability-weighted multivariable logistic regression analysis was performed to estimate odds ratios (ORs) and the 95% confidence intervals (95% CI) for mortality.
Late-phase HHV-6B infection was observed in 12/89 (13.5%) of the HSCT recipients. Older age (OR: 10.3, 95% CI: 2.1/72.9, P = .0027), hematologic malignancy (OR: 10.3, 95% CI: 1.8/97.1, P = .0063), unrelated donor transplantation (OR: 5.3, 95% CI: 1.1/36.0, P = .0345), and sex-mismatched donor transplantation (OR: 6.3, 95% CI: 1.4/39.5, P = .0149) were identified as risk factors for late-phase HHV-6B infection. Fifteen subjects died (17%). Inverse probability-weighted multivariable logistic model analysis revealed that late-phase HHV-6B infection was an independent risk factor for mortality (OR: 4.2, 95% CI: 1.7/11.0, P = .0012). Among 5 of the fatal cases of late-phase HHV-6B infection, viral infection might be associated with severe clinical manifestations.
Late-phase HHV-6B infection in HSCT recipients was associated with worse outcomes. The full spectrum of clinical features of the infection has not been fully elucidated, and therefore, recipients with high-risk factors for late-phase HHV-6B infection should be carefully monitored.
我们试图确定造血干细胞移植（HSCT）受者中晚期人疱疹病毒6B（HHV-6B）感染是否与严重后果及死亡率相关。
移植后至少60天，使用病毒分离和实时聚合酶链反应监测HHV-6B感染的发生及病程。检查晚期HHV-6B感染的危险因素，并用显著危险因素计算倾向评分。进行逆概率加权多变量逻辑回归分析以估计死亡率的比值比（OR）和95%置信区间（95%CI）。
89例HSCT受者中有12例（13.5%）发生晚期HHV-6B感染。年龄较大（OR：10.3，95%CI：2.1/72.9，P = 0.0027）、血液系统恶性肿瘤（OR：10.3，95%CI：1.8/97.1，P = 0.0063）、非血缘供者移植（OR：5.3，95%CI：1.1/36.0，P = 0.0345）以及性别不匹配供者移植（OR：6.3，95%CI：1.4/39.5，P = 0.0149）被确定为晚期HHV-6B感染的危险因素。15例受试者死亡（17%）。逆概率加权多变量逻辑模型分析显示，晚期HHV-6B感染是死亡率的独立危险因素（OR：4.2，95%CI：1.7/11.0，P = 0.0012）。在5例晚期HHV-6B感染致死病例中，病毒感染可能与严重临床表现相关。
HSCT受者中的晚期HHV-6B感染与更差的预后相关。该感染的全部临床特征尚未完全阐明，因此，具有晚期HHV-6B感染高危因素的受者应予以密切监测。
