294例心脏移植受者人巨细胞病毒感染的临床和病毒学监测

Clinical and virological monitoring of human cytomegalovirus infection in 294 heart transplant recipients.

作者信息

Grossi P, Minoli L, Percivalle E, Irish W, Vigano M, Gerna G

机构信息

Istituto di Clinica delle Malattie Infettive, University of Pavia, Italy.

出版信息

Transplantation. 1995 Mar 27;59(6):847-51.

PMID:7701579

Abstract

Two hundred and ninety-four heart transplant recipients (HTR) were followed prospectively for a mean of 44.9 +/- 28.4 (range 1.0-100.8 months) after transplantation (tx). Immunosuppression was based on cyclosporine, azathioprine, and steroids, supplemented by a 7-day course of antithymocyte globulins. All patients were virologically monitored by inoculating aliquots of 2 x 10(5) peripheral blood polymorphonuclear leukocytes (PMNs) onto human embryonic lung fibroblasts monolayers grown in shell vials for early cytomegalovirus (CMV) identification and quantification (viremia). The same number of PMNs was cytocentrifuged onto glass slides for direct CMV pp65 antigen detection and quantification (antigenemia). Heparinized blood samples were collected weekly during the first 3 months following tx and at least twice a week if antigenemia and viremia levels were increasing. After 3 months, samples were collected if antigenemia and viremia persisted or when clinically indicated. The overall incidence of CMV infection was 53.4% (157/294). Only 32.4% (51/157) of the viremic patients required antiviral treatment because of symptomatic infection. Of the remaining 106 untreated CMV viremic HTR, 104 were asymptomatic while 2 had only mild clinical symptoms. The overall incidence of CMV infection in pre-tx CMV seropositive (CMV+) HTR was 50.9% (136/267); 75.7% (103/136) were asymptomatic and 24.3% (33/267); 75.7% (103/136) were asymptomatic and 24.3% (33/136) were symptomatic. The overall incidence of CMV infection in pre-tx CMV-seronegative (CMV-) HTR was 77.8% (21/27; P = 0.007 vs. seropositive HTR). Among 22 CMV- HTR with CMV+ donor, 20 (90.9%) had a CMV infection and all of them were symptomatic (versus 1 of 5 (20%) CMV- HTR with CMV- donor; P = 0.002, Fisher's exact test). The median numbers of circulating CMV-infected PMNs detected at the onset of clinical symptoms by the antigenemia and viremia assays were 385/2 x 10(5) and 100/2 x 10(5), respectively.

摘要

294例心脏移植受者（HTR）在移植后进行了前瞻性随访，平均随访时间为44.9±28.4个月（范围1.0 - 100.8个月）。免疫抑制方案基于环孢素、硫唑嘌呤和类固醇，并辅以7天疗程的抗胸腺细胞球蛋白。所有患者通过将2×10⁵外周血多形核白细胞（PMN）接种到生长在壳瓶中的人胚肺成纤维细胞单层上进行病毒学监测，以早期鉴定和定量巨细胞病毒（CMV）（病毒血症）。相同数量的PMN经细胞离心涂片用于直接检测和定量CMV pp65抗原（抗原血症）。在移植后的前3个月每周采集肝素化血样，如果抗原血症和病毒血症水平升高，则每周至少采集两次。3个月后，如果抗原血症和病毒血症持续存在或有临床指征则采集样本。CMV感染的总体发生率为53.4%（157/294）。仅32.4%（51/157）的病毒血症患者因有症状感染需要抗病毒治疗。其余106例未治疗的CMV病毒血症HTR中，104例无症状，2例仅有轻微临床症状。移植前CMV血清学阳性（CMV+）的HTR中CMV感染的总体发生率为50.9%（136/267）；75.7%（103/136）无症状，24.3%（33/136）有症状。移植前CMV血清学阴性（CMV-）的HTR中CMV感染的总体发生率为77.8%（21/27；与血清学阳性HTR相比，P = 0.007）。在22例供体为CMV+的CMV- HTR中，20例（90.9%）发生了CMV感染，且所有患者均有症状（而5例供体为CMV-的CMV- HTR中有1例（20%）发生感染；Fisher精确检验，P = 0.002）。通过抗原血症和病毒血症检测在临床症状出现时检测到的循环中被CMV感染的PMN的中位数分别为385/2×10⁵和100/2×10⁵。