Epstein-Barr and other herpesvirus infections in patients with early onset type 1 diabetes treated with daclizumab and mycophenolate mofetil.
Epstein-Barr and other herpesvirus infections in patients with early onset type 1 diabetes treated with daclizumab and mycophenolate mofetil.
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使用达克珠单抗和吗替麦考酚酯治疗的早发 1 型糖尿病患者的 Epstein-Barr 和其他疱疹病毒感染。
DOI：
10.1093/cid/cis848
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发表时间：
2013
期刊：
影响因子：
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通讯作者：
Type1DiabetesTrialNetDaclizumab/MycophenolicAcidStudyGroup
中科院分区：
文献类型：
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作者：
Loechelt,BrettJ;Boulware,David;Green,Michael;Baden,LindseyR;Gottlieb,Peter;Krause-Steinrauf,Heidi;Weinberg,Adriana;Type1DiabetesTrialNetDaclizumab/MycophenolicAcidStudyGroup
背景：我们评估了参加免疫抑制治疗研究的1型糖尿病(T1D)患者中疱疹病毒的发病率。方法：对126名参与者进行了EB病毒、巨细胞病毒、单纯疱疹病毒和水痘带状疱疹病毒感染的随机、双盲、安慰剂对照研究，包括DZB+MMF+、DZB−MMF+、DZB+MMF−和DZB−MMF−。在2年的随访中，通过血清学和血液DNA聚合酶链式反应对疱疹病毒感染进行临床监测。结果：在57名基线EBV血清阴性的参与者中，9人发展为EBV原发感染，其中2人患有传染性单核细胞增多症综合征。在不同的治疗组中，原发性EBV感染的病程没有明显的差异。在69名基线EB病毒血清阳性的参与者中，22名病毒学重新激活，包括1名有症状的DZB−MMF+受试者。与7种DZB-MMF-EBV复活剂相比，9种DZB+MMF+复活剂的病毒血症持续时间更长(11.4个月比4.4个月；P=0.06)，累积病毒载量更高(14.2比12.5个对数EBV拷贝/毫升；P=0.06)。85例基线CMV血清阴性的受试者中有4例发展为无症状的原发CMV感染。没有CMV重新激活。在30名基线单纯疱疹病毒血清阳性的受试者中，8名患者出现了≥-1起唇疱疹；1名受试者有原发单纯疱疹病毒感染；1名没有基线血清学信息的受试者被新诊断为生殖器单纯疱疹病毒。不同治疗组之间HSV复发的发生率没有显著差异。在100例VZV血清阳性受试者中，1例DZB-−阳性受试者发生带状疱疹，1例DZB-MMF阳性受试者发生贝尔麻痹，可能与VZV有关。结论：单独使用或与霉酚酸酯联合使用与疱疹病毒引起的发病率增加无关。
Background.We assessed the morbidity of herpesviruses in patients with type 1 diabetes mellitus (T1D) enrolled in immunosuppressive treatment studies.Methods.Epstein-Barr virus (EBV), cytomegalovirus (CMV), herpes simplex virus (HSV), and varicella zoster virus (VZV) infections were monitored in 126 participants of a randomized, double-blind, placebo-controlled study of daclizumab (DZB) and mycophenolate mofetil (MMF) including DZB+MMF+, DZB−MMF+, DZB+MMF−, and DZB−MMF−. During the 2-year follow-up, herpesviral infections were monitored clinically, by serology and blood DNA polymerase chain reaction.Results.Among 57 baseline EBV-seronegative participants, 9 developed EBV primary infections, including 2 with infectious mononucleosis syndrome. There were no appreciable differences in the course of the primary EBV infections across treatment groups. Among 69 baseline EBV-seropositive participants, 22 had virologic reactivations, including 1 symptomatic DZB−MMF+subject. Compared with 7 DZB–MMF–EBV reactivators, the 9 DZB+MMF+reactivators tended to have more prolonged viremia (11.4 vs 4.4 months;P= .06) and higher cumulative viral burden (14.2 vs 12.5 log EBV copies/mL;P= .06). Four of 85 baseline CMV-seronegative subjects developed asymptomatic primary CMV infections. There were no CMV reactivations. Of 30 baseline HSV-seropositive subjects, 8 developed ≥1 episode of herpes labialis; 1 subject had a primary HSV infection; and 1 subject without baseline serology information had a new diagnosis of genital HSV. There were no significant differences in the incidence of HSV recurrences across treatment groups. Of 100 baseline VZV-seropositive subjects, 1 DZB–MMF–subject developed herpes zoster and 1 DZB−MMF+subject had Bell's palsy possibly related to VZV.Conclusions.The use of DZB alone or in combination with MMF was not associated with increased morbidity due to herpesviruses.Clinical Trials Registration.NCT00100178.