Cytomegalovirus viremia: risk factor for allograft cirrhosis after liver transplantation for hepatitis C.
Cytomegalovirus viremia: risk factor for allograft cirrhosis after liver transplantation for hepatitis C.
复制标题
巨细胞病毒血症：丙型肝炎肝移植后同种异体肝硬化的危险因素。
DOI：
10.1097/00007890-199709150-00010
复制
发表时间：
1997
期刊：
影响因子：
6.2
通讯作者：
K. Benner
中科院分区：
文献类型：
--
作者：
H. Rosen;S. Chou;C. Corless;D. Gretch;K. Flora;A. Boudousquie;S. Orloff;J. Rabkin;K. Benner
背景
尽管最近在诊断和治疗方面取得了进展，但巨细胞病毒(CMV)感染仍然是肝移植(LT)受者发病率的常见原因。由于巨细胞病毒感染抑制了细胞免疫，而细胞免疫似乎在中和丙型肝炎病毒感染中起着重要作用，我们评估了巨细胞病毒感染对肝移植后丙型肝炎复发的影响。
方法
研究组包括43名连续接受肝移植的患者，并进行了至少6个月的组织学随访。第1组为肝移植术后出现CMV病毒血症的患者8例，第2组为无CMV病毒血症的35例患者。在年龄、初始免疫抑制、排斥反应发生率、丙型肝炎病毒基因分布或平均随访方面，两组之间没有显著差异。同种异体肝炎的组织病理学半定量评估采用Knodell评分。
结果
第1组患者最后一次同种异体肝组织活检的平均总Knodell评分显著高于对照组(P=0.016)，大部分差异是由于门脉周围/桥接性坏死(P=0.009)和小叶活动性亚项(P=0.009)。与巨细胞病毒阴性患者中11%的患者相比，一半的巨细胞病毒感染患者最终发展为同种异体移植肝硬变(P=0.027)。因此，根据Kaplan-Meier估计，CMV病毒症患者的无肝硬变精算生存率显著降低。巨细胞病毒分离株的糖蛋白B基因分型分析显示，发生这种情况的患者和没有发展为同种异体肝硬变的患者之间没有显著差异。
结论
慢性丙型肝炎肝移植后，出现CMV病毒血症的患者发生严重丙型肝炎复发的风险显著增加。
BACKGROUND
Despite recent advances in diagnosis and treatment, cytomegalovirus (CMV) infection continues to be a common cause of morbidity in liver transplant (LT) recipients. Because CMV infection suppresses cell-mediated immunity, which seems to be important in neutralizing hepatitis C virus (HCV) infection, we assessed the impact of CMV infection on histopathological HCV recurrence after LT.
METHODS
The study group was comprised of 43 consecutive LT recipients with at least 6 months of histologic follow-up. Group 1 consisted of the 8 patients who developed CMV viremia after LT; group 2 comprised the 35 patients without CMV viremia. There was no significant difference with regard to age, initial immunosuppression, incidence of rejection, distribution of HCV genotypes, or mean follow-up between the groups. Semiquantitative histopathologic assessment of allograft hepatitis was performed using the Knodell's score.
RESULTS
The mean total Knodell score of the final allograft biopsy was significantly greater in group 1 patients (P=0.016), with most of the difference due to periportal/bridging necrosis (P=0.009) and lobular activity subitem (P=0.01) scores. Half of the CMV viremic patients eventually developed allograft cirrhosis as compared with 11% of the CMV-negative patients (P=0.027). Accordingly, the cirrhosis-free actuarial survival by Kaplan-Meier estimates was significantly diminished in the CMV viremic patients. Glycoprotein B genotype analysis of CMV isolates revealed no significant differences between patients who did and those who did not develop allograft cirrhosis.
CONCLUSIONS
After LT for chronic HCV, patients who develop CMV viremia incur a significantly greater risk of severe HCV recurrence.
免疫反应与巨细胞病毒相关疾病发病机制的相关性。
影响因子：
0.9
作者：
Gehrz,RC;Liu,YN;Eckhardt,J;Klaus,A
通讯作者：
Klaus,A
影响因子：
6.4
作者：
FRIES, BC;CHOU, SW;TOROKSTORB, B
通讯作者：
TOROKSTORB, B