A relationship between varicella-zoster virus-specific delayed hypersensitivity and varicella-zoster virus-induced anterior uveitis.
A relationship between varicella-zoster virus-specific delayed hypersensitivity and varicella-zoster virus-induced anterior uveitis.
复制标题
水痘带状疱疹病毒特异性迟发型超敏反应与水痘带状疱疹病毒诱发的前葡萄膜炎之间的关系。
DOI：
10.1001/archopht.120.9.1183
复制
发表时间：
2002
影响因子：
--
通讯作者：
M. Usui
中科院分区：
文献类型：
--
作者：
T. Kezuka;J. Sakai;H. Minoda;M. Takeuchi;H. Keino;J. Streilein;M. Usui
背景
我们最近报道了人类急性视网膜坏死发生在对水痘带状疱疹病毒（VZV）抗原不存在迟发型超敏反应（DH）的环境中，这意味着病毒特异性DH减轻了急性视网膜坏死。
目的
确定VZV引起的前葡萄膜炎患者是否存在类似的相关性。
设计
使用VZV和纯化的蛋白衍生物（PPD）抗原来评估DH，我们对急性VZV诱导的前葡萄膜炎患者进行皮肤测试（眼带状疱疹[ZO-AU]）（n = 12），在无皮炎的情况下由VZV引起的葡萄膜炎患者（带状疱疹无症状性[ZSH-AU]）（n = 3），年龄匹配的眼部带状疱疹与葡萄膜炎无关的患者作为对照（n = 7）。水痘带状疱疹病毒引起的前葡萄膜炎的诊断聚合酶链反应方法和血清抗体滴定。收集血清样品并分析抗VZV抗体滴度。临床评估前葡萄膜炎活动性。迟发型超敏反应皮肤试验重复带状疱疹患者发病后3个月，当眼睛已经恢复。
结果
当用VZV和PPD抗原检测时，所有仅VZV诱导的皮肤病患者（对照组）均显示出强烈的DH。相比之下，12例ZO-AU患者中只有4例（33%）对VZV呈阳性DH，而这些患者中有11例（91.6%）显示PPD皮肤反应阳性。前葡萄膜炎的临床强度与VZV DH反应呈负相关（P<0.05）。血清抗VZV和抗单纯疱疹病毒抗体滴度在DH阳性VZV病例和DH阴性葡萄膜炎患者中相当。患有葡萄膜炎和ZSH-AU的患者也显示缺乏VZV特异性DH，尽管他们的PPD反应正常。
主要观察指标
ZO-AU患者的水痘-带状疱疹病毒特异性DH、PPD特异性DH、VZV特异性抗体滴定和眼内压。
结论
DH对VZV抗原的反应性缺失（或丧失）似乎是高强度VZV葡萄膜炎的伴随特征，这意味着病毒特异性DH可能干扰VZV诱导的前葡萄膜炎的出现，就像它对急性视网膜坏死一样。
临床相关性
在临床环境中，VZV引起的前葡萄膜炎的病毒特异性DH的缺乏不仅可能揭示了可能的致病机制，而且阴性DH反应可能有助于诊断急性期的ZSH-AU。
BACKGROUND
We recently reported that acute retinal necrosis in humans develops in a setting where delayed hypersensitivity (DH) to the varicella-zoster virus (VZV) antigen was absent, implying that virus-specific DH mitigates against acute retinal necrosis.
OBJECTIVE
To determine whether a similar correlation exists for patients with anterior uveitis caused by VZV.
DESIGN
Using VZV and purified protein derivative (PPD) antigens to evaluate DH, we skin tested patients with acute, VZV-induced anterior uveitis (herpes zoster ophthalmicus [ZO-AU]) (n = 12), those with uveitis caused by VZV in the absence of dermatitis (zoster sine herpete [ZSH-AU]) (n = 3), and age-matched patients whose ophthalmic herpes zoster was unassociated with uveitis as controls (n = 7). Varicella-zoster virus-induced anterior uveitis was diagnosed by polymerase chain reaction methods and serum antibody titration. Serum samples were collected and analyzed for anti-VZV antibody titers. Anterior uveitis activity was assessed clinically. Delayed hypersensitivity skin tests were repeated in patients with zoster sine herpete 3 months after onset, when ocular recovery had taken place.
RESULTS
All patients with VZV-induced skin disease alone (control group) displayed intense DH when tested with VZV and PPD antigens. By contrast, only 4 (33%) of 12 patients with ZO-AU had a positive DH to VZV, whereas 11 (91.6%) of these patients displayed positive PPD skin reactions. The clinical intensity of anterior uveitis correlated negatively with VZV DH responses (P<.05). Serum anti-VZV and anti-herpes simplex virus antibody titers were comparable in DH-positive VZV cases and in DH-negative patients with uveitis. Patients with uveitis and ZSH-AU also displayed absent VZV-specific DH, although their PPD responses were normal.
MAIN OUTCOME MEASURES
Varicella-zoster virus-specific DH, PPD-specific DH, VZV-specific antibody titration, and intraocular pressure in patients with ZO-AU.
CONCLUSIONS
Absence (or loss) of DH reactivity to VZV antigens seems to be a concomitant feature of VZV uveitis of high intensity, implying that virus-specific DH may interfere with the emergence of VZV-induced anterior uveitis, as it does for acute retinal necrosis.
CLINICAL RELEVANCE
In a clinical setting, absence of virus-specific DH to anterior uveitis caused by VZV may not only reveal a possible pathogenic mechanism, but a negative DH response may prove useful in diagnosing ZSH-AU in the acute stage.