肺移植后 1 年联合预防中细胞和体液巨细胞病毒免疫的变化：来自和针对临床实践的建议。

Cellular and humoral cytomegalovirus immunity changes in one-year combined prophylaxis after lung transplantation: suggestions from and for clinical practice.

机构信息

Division of Respiratory Medicine, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, Torino, Italy.

Medical Sciences Department, University of Turin, Torino, Italy.

出版信息

Ther Adv Respir Dis. 2020 Jan-Dec;14:1753466620981851. doi: 10.1177/1753466620981851.

DOI:10.1177/1753466620981851

PMID:33356914

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7780175/

Abstract

BACKGROUND

Immune responses, both cellular and humoral, against cytomegalovirus (CMV) are used to predict CMV manifestations in solid organ recipients. The aim of this study is to evaluate CMV enzyme-linked immunospot (ELISPOT) assay and serology during CMV infections, their concordance and variations after lung transplantation (LTx).

METHODS

We retrospectively analysed in one year the follow-up data of 43 patients receiving combined CMV prophylaxis with antiviral agents and CMV-specific immunoglobulin G (IgG). CMV infections were investigated by using molecular analyses on both 167 bronchoalveolar lavage and biopsy specimens and 1134 blood samples. Cellular CMV immunity was assessed with specific ELISPOT whereas the humoral one was assessed by quantifying specific immunoglobulins.

RESULTS

At the first month after LTx the majority of patients were ELISPOT responders (52.3%) and 30.9% were non-responders. ELISPOT responders had a lower incidence of CMV viremia ( = 0.047), whereas neither effects on CMV pulmonary asymptomatic infection nor on acute rejection were observed. Responders had a higher CMV IgG titre ( < 0.0001) in particular at the first month after LTx ( = 0.0001). Concordance among CMV ELISPOT assay and IgG levels was moderate (Cohen's K 0.524), with an agreement of 89.8%. All ELISPOT responders maintained their status and almost all non-responders became responders during follow-up (92.3%); the percentage of IgG seropositive subjects increased from 74.4% at the first month of follow-up to 97.4% after 1 year.

CONCLUSIONS

Despite a moderate concordance with serology, ELISPOT response predicted a lower incidence of CMV viremia in LTx patients; no effects were reported on pulmonary clinical manifestations nor on acute rejection. The ELISPOT response as well as serology changed during the follow-up, not only after first CMV contact.

摘要

背景

针对巨细胞病毒（CMV）的细胞和体液免疫反应被用于预测实体器官受者的 CMV 表现。本研究旨在评估 CMV 酶联免疫斑点（ELISPOT）检测和血清学在 CMV 感染期间、肺移植（LTx）后的一致性和变化。

方法

我们对接受抗病毒药物联合 CMV 特异性免疫球蛋白 G（IgG）联合预防的 43 例患者进行了为期一年的回顾性随访数据分析。通过对 167 例支气管肺泡灌洗液和活检标本和 1134 份血样进行分子分析，对 CMV 感染进行了研究。细胞 CMV 免疫通过特异性 ELISPOT 进行评估，而体液免疫通过定量特异性免疫球蛋白进行评估。

结果

LTx 后第一个月，大多数患者为 ELISPOT 反应者（52.3%），30.9%为非反应者。ELISPOT 反应者的 CMV 病毒血症发生率较低（ = 0.047），而对 CMV 肺部无症状感染或急性排斥反应均无影响。反应者在 LTx 后第一个月具有更高的 CMV IgG 滴度（ < 0.0001）（ = 0.0001）。CMV ELISPOT 检测和 IgG 水平之间的一致性为中度（Cohen's K 0.524），一致性为 89.8%。所有 ELISPOT 反应者均保持其状态，几乎所有非反应者在随访期间均成为反应者（92.3%）；IgG 血清阳性者的百分比从随访第一个月的 74.4%增加到 1 年后的 97.4%。