水痘-带状疱疹病毒引起的急性视网膜坏死的病毒载量动态监测和宏基因组测序。

DYNAMIC VIRAL LOAD MONITORING AND METAGENOMIC SEQUENCING IN ACUTE RETINAL NECROSIS CAUSED BY VARICELLA-ZOSTER VIRUS.

机构信息

Department of Ophthalmology, Fudan University Eye and ENT Hospital, Fudan University, Shanghai, China.

Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University Eye and ENT Hospital, Fudan University, Shanghai, China.

出版信息

Retina. 2024 Nov 1;44(11):1966-1975. doi: 10.1097/IAE.0000000000004214.

DOI:10.1097/IAE.0000000000004214

PMID:39141752

Abstract

PURPOSE

To analyze the trend of intraocular viral load after antiviral treatment in patients with varicella-zoster virus-induced acute retinal necrosis and to explore the effect of viral genotypes on clinical manifestations.

METHODS

In this case series, viral load was detected using polymerase chain reaction from aqueous humor during treatment; viral load curves were fitted, and the time required to reach the inflection point between plateau phase and logarithmic reduction phase was estimated. Variations in viral genomes were detected by metagenomic sequencing.

RESULTS

Twenty eyes of 20 patients were included. The median (interquartile range) initial viral load was 5.9 × 10 7 (1.1 × 10 7 -1.1 × 10 8 ) copies/mL. The average duration of retinitis was 5 ± 3 weeks. The average time required to reach the inflection point was 4.2 ± 1.6 days. Time required to reach the inflection point was correlated with the duration of retinitis ( P = 0.025). Patients with varicella-zoster virus carrying the p.S715* variation in ribonucleotide reductase ( RNR ) subunit 1 gene had lower initial viral loads (median 1.3 × 10 7 copies/mL) than those without (median 1.1 × 10 8 copies/mL; adjusted P = 0.030).

CONCLUSIONS

The inflection of viral load curve is helpful to estimate the length of plateau phase and the duration of retinitis during antiviral treatment in patients with acute retinal necrosis. Loss-of-function variation in RNR gene might be correlated with lower virulence of varicella-zoster virus.

摘要

目的

分析抗病毒治疗后水痘带状疱疹病毒引起的急性视网膜坏死患者眼内病毒载量的趋势，并探讨病毒基因型对临床表现的影响。

方法

在本病例系列研究中，使用聚合酶链反应从治疗期间的房水中检测病毒载量；拟合病毒载量曲线，并估计达到平台期和对数减少期之间拐点所需的时间。通过宏基因组测序检测病毒基因组的变异。

结果

纳入 20 例 20 只眼。初始病毒载量中位数（四分位距）为 5.9×10 7（1.1×10 7-1.1×10 8）拷贝/ml。视网膜炎的平均持续时间为 5±3 周。达到拐点所需的平均时间为 4.2±1.6 天。达到拐点所需的时间与视网膜炎的持续时间相关（P=0.025）。携带核糖核苷酸还原酶（RNR）亚单位 1 基因 p.S715*变异的水痘带状疱疹病毒患者的初始病毒载量（中位数 1.3×10 7拷贝/ml）低于无变异者（中位数 1.1×10 8拷贝/ml；调整后 P=0.030）。