The clinical significance of EBV DNA in the plasma and peripheral blood mononuclear cells of patients with or without EBV diseases
The clinical significance of EBV DNA in the plasma and peripheral blood mononuclear cells of patients with or without EBV diseases
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DOI：
10.1182/blood-2015-09-672030
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发表时间：
2016-04-21
期刊：
影响因子：
20.3
通讯作者：
Valsamakis, Alexandra
中科院分区：
文献类型：
--
作者：
Kanakry, Jennifer A.;Hegde, Aparna M.;Valsamakis, Alexandra
EB病毒（EBV）是一种普遍存在的病毒，其在宿主内建立潜伏感染，并且在某些情况下可导致EBV相关淋巴瘤、淋巴组织增生性病症、噬血细胞性淋巴组织细胞增多症、实体瘤和其他疾病的发展。我们研究了2146例患者血浆和外周血单个核细胞（PBMC）中EBV DNA检测的临床意义，这些患者的血液标本被送往约翰霍普金斯医院临床实验室进行病毒定量实时聚合酶链反应检测，为期5年。在这个免疫功能低下和住院的队列中，535例患者（25%）在血浆或PBMC中检测到EBV。当在没有EBV+疾病的情况下检测到EBV时（n = 402），69%的病例仅存在于PBMC中。免疫功能低下的患者血浆中EBV的可能性低于没有EBV+疾病的PBMC。在活动性全身性EBV+疾病患者中（n = 105），99%的病例在血浆中检测到EBV，但仅54%在PBMC中检测到EBV。在一系列拷贝数截止值范围内，与PBMC中的EBV相比，血浆中的EBV对EBV+疾病具有更高的特异性和敏感性。血浆中的EBV拷贝数将未治疗的EBV+淋巴瘤与缓解期的EBV+淋巴瘤和EBV-淋巴瘤区分开，并且还将未治疗的EBV+移植后淋巴增生性疾病（PTLD）与缓解期的EBV+ PTLD和EBV-PTLD区分开。EBV拷贝数定量是EBV+疾病谱中有用的诊断标志物，甚至在免疫功能低下的患者中，血浆标本比PBMC更能指示EBV+疾病。
Epstein-Barr virus (EBV) is a ubiquitous virus that establishes a latent infection within the host and in some cases can lead to the development of EBV-associated lymphomas, lymphoproliferative disorders, hemophagocytic lymphohistiocytosis, solid tumors, and other diseases. We studied the clinical significance of detecting EBV DNA in the plasma and peripheral blood mononuclear cells (PBMCs) of 2146 patients who had blood specimens sent to the Johns Hopkins Hospital clinical laboratory for viral quantitative real-time polymerase chain reaction assay over a 5-year period. Within this largely immunocompromised and hospitalized cohort, 535 patients (25%) had EBV detected in plasma or PBMCs. When EBV was detected in the absence of an EBV+ disease (n = 402), it was present only in PBMCs in 69% of cases. Immunocompromised patients were less likely to have EBV in plasma than in PBMCs in the absence of EBV+ disease. In patients with active, systemic EBV+ diseases (n = 105), EBV was detected in plasma in 99% of cases but detected in PBMCs in only 54%. Across a range of copy number cutoffs, EBV in plasma had higher specificity and sensitivity for EBV+ disease as compared with EBV in PBMCs. EBV copy number in plasma distinguished untreated, EBV+ lymphoma from EBV+ lymphoma in remission and EBV- lymphoma, and also distinguished untreated, EBV+ posttransplantation lymphoproliferative disorder (PTLD) from EBV+ PTLD in remission and EBV- PTLD. EBV copy number quantification is a useful diagnostic marker across the spectrum of EBV+ diseases, even among immunocompromised patients, with plasma specimens more indicative of EBV+ disease than PBMCs.