HHV-6 reactivation and its effect on delirium and cognitive functioning in hematopoietic cell transplantation recipients
HHV-6 reactivation and its effect on delirium and cognitive functioning in hematopoietic cell transplantation recipients
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DOI：
10.1182/blood-2010-10-316083
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发表时间：
2011-05-12
期刊：
影响因子：
20.3
通讯作者：
Leisenring, Wendy M.
中科院分区：
文献类型：
--
作者：
Zerr, Danielle M.;Fann, Jesse R.;Leisenring, Wendy M.
人类疱疹病毒6型（HHV-6）在约40%接受造血细胞移植（HCT）的患者血浆中检测到，并在该人群中偶尔引起脑炎。HHV-6再激活对中枢神经系统功能的影响尚未完全表征。这项前瞻性研究旨在评估同种异体HCT后HHV-6再激活与中枢神经系统功能障碍之间的相关性。患者在HCT前入组。在基线和移植后每周两次检测血浆样品的HHV-6，直至第84天。使用经验证的仪器，在基线、每周3次直至第56天和第56天至第84天每周评估谵妄。在基线和大约第84天进行神经认知测试。在纳入的315例患者中，111例（35%）检测到HHV-6。在HCT后的前84天内，HHV-6患者更可能发生谵妄（校正比值比= 2.5; 95%置信区间，1.2-5.3）并表现出神经认知功能下降（校正比值比= 2.6; 95%置信区间，1.1-6.2）。脐带血和无关移植增加了HHV-6再激活的风险。这些数据提供了进行随机临床试验的基础，以确定预防HHV-6再激活是否会降低HCT接受者的神经认知发病率。（血。2011; 117（19）：5243-5249）
Human herpesvirus 6 (HHV-6) is detected in the plasma of approximately 40% of patients undergoing hematopoietic cell transplantation (HCT) and sporadically causes encephalitis in this population. The effect of HHV-6 reactivation on central nervous system function has not been fully characterized. This prospective study aimed to evaluate associations between HHV-6 reactivation and central nervous system dysfunction after allogeneic HCT. Patients were enrolled before HCT. Plasma samples were tested for HHV-6 at baseline and twice weekly after transplantation until day 84. Delirium was assessed at baseline, 3 times weekly until day 56, and weekly on days 56 to 84 using a validated instrument. Neurocognitive testing was performed at baseline and at approximately day 84. HHV-6 was detected in 111 (35%) of the 315 included patients. Patients with HHV-6 were more likely to develop delirium (adjusted odds ratio = 2.5; 95% confidence interval, 1.2-5.3) and demonstrate neurocognitive decline (adjusted odds ratio = 2.6; 95% confidence interval, 1.1-6.2) in the first 84 days after HCT. Cord blood and unrelated transplantation increased risk of HHV-6 reactivation. These data provide the basis to conduct a randomized clinical trial to determine whether prevention of HHV-6 reactivation will reduce neurocognitive morbidity in HCT recipients. (Blood. 2011; 117(19):5243-5249)