Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States.
Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States; Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, United States.
J Clin Virol. 2024 Oct;174:105705. doi: 10.1016/j.jcv.2024.105705. Epub 2024 Jul 13.
Epstein-Barr Virus (EBV) is associated with lung disease in immunocompromised patients, particularly transplant recipients. EBV DNA testing of lower respiratory tract specimens may have diagnostic utility.
This was a retrospective, observational study of all patients with bronchoalveolar lavage (BAL) fluids submitted for EBV qPCR testing from February 2016 to June 2022 at the Stanford Clinical Virology Laboratory.
There were 140 patients that underwent 251 EBV qPCR BAL tests (median 1; range 1 - 10). These patients had a mean age of 15.9 years (standard deviation, 15.1 years) and 50 % were female. Transplant recipients accounted for 67.1 % (94/140) of patients, including 67.0 % (63/94) solid organ transplant (SOT) and 33.0 % (31/94) hematopoietic cell transplant. Diagnostic testing was performed more commonly than surveillance testing [57.0 % (143/251) v. 43.0 % (108/251)]; 96.2 % (104/108) of surveillance samples were from lung transplant recipients. Excluding internal control failures, 34.7 % (83/239) of BAL had detectable EBV DNA, encompassing a wide range of viral loads (median=3.03 log IU/mL, range 1.44 to 6.06). Overall agreement of EBV DNA in BAL compared to plasma was 74.1 % [117/158; 95 % confidence interval (CI): 66.5 % to 80.7 %], with a kappa coefficient of 0.44 (95 % CI: 0.30 to 0.57). Only 20.1 % (48/239) of results were discussed in a subsequent clinical note, and one result (0.4 %; 1/239) changed clinical management.
EBV qPCR testing on BAL offers limited clinical impact. Additional biomarkers are required to improve the diagnosis of EBV-associated lung diseases.
爱泼斯坦-巴尔病毒（EBV）与免疫功能低下患者的肺部疾病有关，尤其是移植受者。下呼吸道标本 EBV DNA 检测可能具有诊断价值。
这是一项回顾性观察性研究，纳入了 2016 年 2 月至 2022 年 6 月斯坦福临床病毒学实验室进行 EBV qPCR 支气管肺泡灌洗液检测的所有患者。
共 140 例患者进行了 251 次 EBV qPCR 支气管肺泡灌洗检测（中位数为 1 次；范围 1-10 次）。这些患者的平均年龄为 15.9 岁（标准差 15.1 岁），50%为女性。移植受者占 67.1%（94/140），包括 67.0%（63/94）实体器官移植（SOT）和 33.0%（31/94）造血细胞移植。诊断性检测比监测性检测更常见[57.0%（143/251）比 43.0%（108/251）]；96.2%（104/108）的监测样本来自肺移植受者。排除内部对照失败后，34.7%（83/239）的支气管肺泡灌洗液中可检测到 EBV DNA，病毒载量范围广泛（中位数=3.03 log IU/mL，范围 1.44-6.06）。支气管肺泡灌洗液与血浆中 EBV DNA 的总一致性为 74.1%[117/158；95%置信区间（CI）：66.5%-80.7%]，kappa 系数为 0.44（95%CI：0.30-0.57）。仅 20.1%（48/239）的结果在后续临床记录中进行了讨论，仅有 1 例（0.4%；1/239）结果改变了临床管理。
支气管肺泡灌洗液 EBV qPCR 检测的临床影响有限。需要额外的生物标志物来改善 EBV 相关肺部疾病的诊断。
