Gastroenterology/Hepatology and Pathology Sections, Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington School of Medicine, Seattle, Washington.
Pathometrix, Moorpark, California.
J Viral Hepat. 2019 Nov;26(11):1344-1350. doi: 10.1111/jvh.13176. Epub 2019 Aug 4.
Mortality from cytomegalovirus disease after marrow transplantation can be reduced by treatment with antiviral drugs based on the detection of viremia and organ involvement. We examined autopsy liver specimens to determine the frequency, extent and outcome of cytomegalovirus hepatitis and whether cytomegalovirus hepatitis occurred in the absence of cytomegalovirus disease elsewhere. Autopsy specimens from 50 transplant patients were evaluated for cytomegalovirus-infected cells, in five groups of 10, according to extent of CMV during life and at autopsy. Liver sections were examined by routine light microscopy, immunohistochemistry and in situ DNA hybridization. Clinical and laboratory data collected during the last 30 days of life were analysed as markers of liver cytomegalovirus infection. Cytomegalovirus-infected cells were detected in the livers of 10/10 patients with cytomegalovirus infection during life and widespread cytomegalovirus at autopsy; in 3/20 livers from patients with cytomegalovirus infection during life but negative liver cultures at autopsy; and in 1/10 livers from cytomegalovirus-seropositive patients who had been without other evidence of cytomegalovirus infection. Histology detected a lower density of cytomegalovirus-bearing cells per unit area of liver, compared to immunohistochemistry and in situ hybridization. No cytomegalovirus-infected cells were detected in livers from cytomegalovirus-seronegative controls. No distinctive clinical or laboratory findings correlated with liver cytomegalovirus detection. CMV liver disease is common in allografted patients with disseminated CMV but may rarely be isolated to the liver, best demonstrated with IHC and ISH. Massive hepatic necrosis from CMV was not seen in any autopsy liver in this study.
骨髓移植后巨细胞病毒病的死亡率可以通过抗病毒药物治疗降低，这些药物基于病毒血症和器官受累的检测结果。我们检查了尸检肝脏标本，以确定巨细胞病毒肝炎的频率、程度和结果，以及巨细胞病毒肝炎是否在其他部位没有巨细胞病毒病的情况下发生。根据生前和尸检时巨细胞病毒的程度，将 50 例移植患者的尸检标本分为 5 组每组 10 例，评估巨细胞病毒感染细胞。通过常规光镜、免疫组织化学和原位 DNA 杂交检查肝切片。分析生命最后 30 天收集的临床和实验室数据，作为肝巨细胞病毒感染的标志物。在生前有巨细胞病毒感染且尸检时广泛存在巨细胞病毒的 10/10 例患者的肝脏中检测到巨细胞病毒感染的细胞；在生前有巨细胞病毒感染但尸检时肝脏培养物阴性的 20/20 例患者的肝脏中检测到 3/20；在生前无其他巨细胞病毒感染证据但巨细胞病毒血清阳性的 10/10 例患者的肝脏中检测到 1/10。与免疫组织化学和原位杂交相比，组织学检测到每单位肝面积的巨细胞病毒携带细胞密度较低。在巨细胞病毒血清阴性对照的肝脏中未检测到巨细胞病毒感染的细胞。没有独特的临床或实验室发现与肝巨细胞病毒检测相关。播散性巨细胞病毒感染的同种异体移植患者中巨细胞病毒肝疾病很常见，但肝脏可能很少孤立存在，免疫组织化学和原位杂交可最好地显示。在本研究中，任何尸检肝脏均未见到巨细胞病毒引起的大量肝坏死。
