Fries B C, Khaira D, Pepe M S, Torok-Storb B
Fred Hutchinson Cancer Research Center, Seattle, WA 98104-2092.
Exp Hematol. 1993 Sep;21(10):1387-92.
A previous pilot study conducted on 12 bone marrow transplant recipients suggested that detection of cytomegalovirus (CMV) in lymphocytes was associated with a drop in lymphocyte counts and death due to CMV disease. To test the association between decreasing lymphocytes and CMV-related death, we undertook a retrospective study of 332 CMV-infected patients transplanted between 1987 and 1990. The patients were divided into three groups: I = 170 patients who survived their infection and were alive at the time of the study; II = 103 patients who died of causes other than CMV infection; and III = 59 patients who died of CMV disease. Lymphocyte counts were analyzed during a 24-day period, starting 10 days before the day of first positive CMV culture (day 0). Lymphocyte counts were significantly lower in Group III from day 0 through day +14 (p < .001 vs. group I; and p = .002 vs. group II). Multivariate statistical analysis was used to adjust for other differences between the groups that might influence lymphocyte numbers. Average lymphocyte counts in patients who died of CMV disease decreased by an average of 35% after day 0. The differences in lymphocyte counts remained independent of the effects of acute graft-vs.-host disease (GVHD), time since transplant, transplant type, and high-dose steroid treatment. In summary, these data suggest that in some patients a drop in lymphocyte counts is a consequence of CMV infection associated with fatal CMV disease. Whether this can be attributed to direct infection of lymphocytes, a defective immune response, or some other mechanism remains to be determined.
此前对12名骨髓移植受者进行的一项初步研究表明，淋巴细胞中检测到巨细胞病毒（CMV）与淋巴细胞计数下降及因CMV疾病导致的死亡有关。为了检验淋巴细胞减少与CMV相关死亡之间的关联，我们对1987年至1990年间接受移植的332例CMV感染患者进行了一项回顾性研究。患者被分为三组：I组 = 170例感染后存活且在研究时仍存活的患者；II组 = 103例死于CMV感染以外原因的患者；III组 = 59例死于CMV疾病的患者。从首次CMV培养阳性当天（第0天）前10天开始，在24天内分析淋巴细胞计数。从第0天到第 +14天，III组的淋巴细胞计数显著低于其他两组（与I组相比，p <.001；与II组相比，p =.002）。采用多变量统计分析来调整可能影响淋巴细胞数量的其他组间差异。死于CMV疾病的患者在第0天后平均淋巴细胞计数下降了35%。淋巴细胞计数的差异不受急性移植物抗宿主病（GVHD）、移植后时间、移植类型和大剂量类固醇治疗的影响。总之，这些数据表明，在一些患者中，淋巴细胞计数下降是与致命性CMV疾病相关的CMV感染的结果。这是否可归因于淋巴细胞的直接感染、免疫反应缺陷或其他机制仍有待确定。
