Koskinen P K, Krogerus L A, Nieminen M S, Mattila S P, Häyry P J, Lautenschlager I T
Transplantation Laboratory, University of Helsinki, Finland.
Transpl Int. 1994 May;7(3):163-71. doi: 10.1007/BF00327082.
An association between cytomegalovirus (CMV) infection, heart allograft rejection, and arteriosclerosis has been reported. To investigate the mechanisms of this association, the cellular immune response in peripheral blood and the inflammation in heart allografts during antigenemia were studied. CMV antigenemia occurred in 13 recipients. In recipients with severe CMV infection, a significantly weaker immune response was recorded in peripheral blood: fewer lymphoid blast cells (max. 2.4% +/- 0.4%) and large granular lymphocytes (LGL; max. 9.3% +/- 1.4%) were seen than in patients with mild or asymptomatic CMV infection (lymphoid blast cells max. 6.5% +/- 0.8% P < 0.01 and LGLs max. 20% +/- 2.3%, P < 0.05). Thus, a strong immune response with lymphoid activation was associated with clinically good outcome of CMV infection. In heart allograft histology, subendothelial inflammation of small intramyocardial vessels was a characteristic finding during CMV antigenemia compared to CMV-free recipients (at the peak P < 0.01). However, no difference in this mild and short-lived inflammatory response was observed between clinically mild or severe CMV infection. The CMV-linked generalized immune activation and inflammation of the vascular structures might contribute to the initiation of allograft vasculopathy and to the pathogenesis of chronic heart allograft rejection.
据报道，巨细胞病毒（CMV）感染、心脏同种异体移植排斥反应和动脉硬化之间存在关联。为了研究这种关联的机制，我们研究了抗原血症期间外周血中的细胞免疫反应以及心脏同种异体移植物中的炎症反应。13名受者出现了CMV抗原血症。在严重CMV感染的受者中，外周血中的免疫反应明显较弱：与轻度或无症状CMV感染的患者相比，可见的淋巴母细胞（最多2.4%±0.4%）和大颗粒淋巴细胞（LGL；最多9.3%±1.4%）更少（淋巴母细胞最多6.5%±0.8%，P<0.01；LGL最多20%±2.3%，P<0.05）。因此，伴有淋巴细胞活化的强烈免疫反应与CMV感染的良好临床结果相关。在心脏同种异体移植组织学中，与无CMV的受者相比，CMV抗原血症期间心肌内小血管的内皮下炎症是一个特征性发现（在峰值时P<0.01）。然而，在临床轻度或重度CMV感染之间，未观察到这种轻度和短暂炎症反应的差异。CMV相关的全身性免疫激活和血管结构炎症可能有助于同种异体移植血管病的发生以及慢性心脏同种异体移植排斥反应的发病机制。
