Human herpesvirus 6 reactivation in trichloroethylene-exposed workers suffering from generalized skin disorders accompanied by hepatic dysfunction
Human herpesvirus 6 reactivation in trichloroethylene-exposed workers suffering from generalized skin disorders accompanied by hepatic dysfunction
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DOI：
10.1539/joh.48.417
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发表时间：
2006-11-01
影响因子：
3
通讯作者：
Li, Laiyu
中科院分区：
文献类型：
--
作者：
Huang, Hanlin;Kamijima, Michihiro;Li, Laiyu
据报道，职业接触三氯乙烯后发生了类似严重药物过敏的特异质全身性皮肤病。然而，与疾病相关的因素仍然未知，除了三氯乙烯暴露。本研究旨在阐明三氯乙烯相关的全身性皮肤病患者中感染性疾病是否会导致皮疹或肝炎的发生。在2002年3月至2003年12月期间连续住院的59名患者和在患者工厂中根据年龄匹配选择的59名健康暴露工人参加了研究。通过结构化检查表收集有关皮疹和肝炎可能风险因素的信息。测量甲型、B和丙型肝炎病毒、肺炎支原体、单纯疱疹病毒1型和2型、EB病毒、巨细胞病毒、人疱疹病毒6型、麻疹和风疹病毒的抗体滴度。剥脱性皮炎36例（59%），多形性红斑17例（28%），Stevens-Johnson综合征4例（7%），中毒性表皮坏死松解症4例（7%）。在皮疹发作之前，16例（27%）患者曾接受过针对发热（疾病的主要首发症状）的处方药物治疗。在14例（25%）患者中观察到抗人疱疹病毒6型IgG滴度显著增加（>= 256），表明病毒再活化，而在对照组中未检测到异常增加（p < 0.001）。抗麻疹IgM滴度为阳性2例（7%），但在对照组（p=0.49）。排除了其他已知的皮疹或肝炎风险因素的参与。这些结果表明，部分三氯乙烯相关的全身性皮肤病发生在中国和药物诱导的过敏综合征重叠的人类疱疹病毒6的再激活。
Idiosyncratic generalized skin disorders resembling serious drug hypersensitivities have reportedly occurred after occupational exposure to trichloroethylene. However, factors associated with the disorders remain unknown except for trichloroethylene exposure. This study aimed at clarifying whether infectious diseases contributed to the development of rash or hepatitis in patients with trichloroethylene-related generalized skin disorders. Fifty-nine patients consecutively hospitalized between March 2002 and December 2003 and 59 healthy exposed workers selected on an age-matched basis in the patients' factories were enrolled in the study. Information on possible risk factors for rash and hepatitis was collected with structured checklists. Antibody titers were measured for hepatitis A, B and C viruses; Mycoplasma pneumoniae, herpes simplex viruses 1 and 2, Epstein-Barr virus, cytomegalovirus, human herpesvirus 6, measles and rubella virus. Thirty-six cases (59%) showed exfoliative dermatitis, 17 (28%) erythema multiforme, 4 (7%) Stevens-Johnson syndrome, and 4 (7%) toxic epidermal necrolysis. Before the onset of rash, 16 (27%) cases had received medication prescribed for the preceding fever, a main first symptom of the disorders. Marked increases in anti-human herpesvirus 6 IgG titer (>= 256), which indicated viral reactivation, were noted in 14 (25%) patients, while no abnormal increase was detected in the controls (p < 0.001). Anti-measles IgM titer was positive in 2 (7%) cases but not in the controls (p=0.49). The involvement of other known risk factors of rash or hepatitis was ruled out. These results suggest that part of trichloroethylene-related generalized cutaneous disorders occurring in China and drug-induced hypersensitivity syndrome overlap in terms of human herpesvirus 6 reactivation.