尿毒症免疫缺陷导致EB病毒感染再激活的血清学证据。

Serological evidence for reactivation of EBV infection due to uraemic immunodeficiency.

作者信息

Winkelspecht B, Mueller-Lantzsch N, Köhler H

机构信息

Department of Internal Medicine IV, Nephrology, University of Homburg/Saar, Germany.

出版信息

Nephrol Dial Transplant. 1997 Oct;12(10):2099-104. doi: 10.1093/ndt/12.10.2099.

DOI:10.1093/ndt/12.10.2099

PMID:9351072

Abstract

BACKGROUND

Reactivation of EBV infection is a common finding in immunocompromised individuals. The influence of 'uraemic immunodeficiency' on EBV infection is so far not well defined.

METHODS

We determined specific antibodies to EBV nuclear antigens (EBNA) 1 and 2 in sera of 286 patients with immunodeficiency due to progressive chronic renal failure and of 51 healthy controls. We used the baculovirus vector expression system for recombinant production of EBNA1 and EBNA2.

RESULTS

Serological evidence of reactivated or chronic persistent EBV infection, i.e. an anti-EBNA1/anti-EBNA2 ratio (E1/E2) < 1, was found in 18% of patients with chronic renal failure not yet receiving renal replacement therapy (CRF), 11% of peritoneal dialysis patients (CAPD), 25% of haemodialysis patients (HD), 24% of renal transplant recipients (TX), and in 6% of healthy controls. Rate of EBV reactivation was significantly increased in HD (P = 0.004) and TX (P = 0.006) patients compared to healthy controls. Moreover, the difference between HD and CAPD patients was statistically significant (P < 0.05). This finding may reflect additional effects modulating the function of the immunosystem, probably through activation of immunologically competent cells by contact with the artificial surfaces of dialysis membranes. Although the rate of EBV reactivations is expected to increase further under conditions of therapeutic immunosuppression, our serological approach did not detect an additional effect of immunosuppressive therapy following renal transplantation. However, this finding may reflect an impaired endogenous synthesis of antibodies caused by immunosuppressive agents.

CONCLUSIONS

We conclude that determination of E1/E2 is useful for assessment of EBV infection in patients with chronic renal failure and 'uraemic immunodeficiency'. In patients with immunosuppressive therapy following renal transplantation additional testing including direct estimation of viral load, is necessary to correctly assess the state of EBV infection.

摘要

背景

EB病毒感染的再激活在免疫功能低下的个体中很常见。迄今为止，“尿毒症免疫缺陷”对EB病毒感染的影响尚未明确界定。

方法

我们检测了286例因进行性慢性肾衰竭导致免疫缺陷的患者以及51名健康对照者血清中针对EB病毒核抗原（EBNA）1和2的特异性抗体。我们使用杆状病毒载体表达系统重组生产EBNA1和EBNA2。

结果

在尚未接受肾脏替代治疗的慢性肾衰竭患者（CRF）中，18%出现了EB病毒再激活或慢性持续感染的血清学证据，即抗EBNA1/抗EBNA2比值（E1/E2）<1；腹膜透析患者（CAPD）中为11%；血液透析患者（HD）中为25%；肾移植受者（TX）中为24%；健康对照者中为6%。与健康对照相比，HD患者（P = 0.004）和TX患者（P = 0.006）的EB病毒再激活率显著升高。此外，HD患者和CAPD患者之间的差异具有统计学意义（P < 0.05）。这一发现可能反映了调节免疫系统功能的额外效应，可能是通过与透析膜的人工表面接触激活免疫活性细胞。尽管在治疗性免疫抑制条件下EB病毒再激活率预计会进一步升高，但我们的血清学方法未检测到肾移植后免疫抑制治疗的额外效应。然而，这一发现可能反映了免疫抑制剂导致的内源性抗体合成受损。