Cytomegalovirus: Clinical virological correlations in renal transplant recipients.
Cytomegalovirus: Clinical virological correlations in renal transplant recipients.
复制标题
巨细胞病毒：肾移植受者的临床病毒学相关性。
作者：
R. Simmons;C. López;H. Balfour;J. Kalis;Rattazzi Lc;J. Najarian
对132例肾移植受者进行了系统的病毒感染筛查，结果与临床病程相关。110例患者显示疱疹病毒感染的证据，89例患者显示巨细胞病毒（CMV）感染的实验室证据，未并发细菌感染或技术并发症。无病毒感染的患者通常无症状。在恢复和发展抗病毒抗体后，尽管尿液中的病毒排泄持续存在，但大多数患者无症状。相反，病毒感染的发作几乎总是伴随着以发热、白细胞减少和肾功能不全为特征的显著临床疾病。在89例巨细胞病毒感染患者中，83例存活至少3个月。在这些患者中，发热似乎是自限性的，发热的消退伴随着抗CMV抗体的增加。肾活检显示所有活检患者均出现典型的排斥反应，肾功能障碍通常对抗排斥反应治疗有效。89名CMV感染患者中有6人在病毒分离后一个月内死亡。这些患者可以从那些恢复减少或缺乏抗体反应的病毒，抑制淋巴细胞反应的有丝分裂原在本地的血液，并在肾移植排斥反应的组织学证据。因此，在移植患者中观察到两种对CMV感染的矛盾反应：在相对免疫活性的患者中，感染与肾移植排斥反应，对病毒的迅速抗体反应和恢复有关。严重免疫抑制的患者不能产生抗体应答，不会表现出作为肾功能障碍原因的同种异体移植排斥，他可能因病毒感染而进一步免疫抑制，并且容易发生导致死亡的连续机会性感染。
One-hundred thirty-two renal transplant recipients were systematically screened for viral infections and the findings correlated with the clinical course. One-hundred ten patients showed evidence of infection with herpesviruses and 89 patients showed laboratory evidence of infection with cytomegalovirus (CMV) uncomplicated by bacterial infections or technical complications. Patients without viral infections were usually asymptomatic. After recovery and development of anti-viral antibodies, most patients were asymptomatic despite the persistence of viral excretion in the urine. In contrast, the onset of viral infections were almost always accompanied by a significant clinical illness characterized by fever, leukopenia, and renal malfunction. Of 89 patients with cytomegalovirus infections, 83 survived at least three months. In these patients, the fever appeared to be self-limited and resolution of the fever was accompanied by increases in anti-CMV antibody. Renal biopsies demonstrated typical rejection reactions in all the biopsied patients and renal malfunction usually responded to anti-rejection treatment. Six of the 89 patients with CMV infections died within a month of viral isolation. These patients could be distinguished from those who recovered by a decreased or absent antibody response to the virus, suppressed lymphocyte responses to mitogen in autochthonous blood, and absent histologic evidence of rejection in the renal allografts. Thus, two paradoxical responses to CMV infections are seen in transplant patients: In the relatively immunocompetent patient, the infection is associated with renal allograft rejection, a prompt antibody response to the virus, and recovery. The severely immunosuppressed patient cannot make an antibody response, does not exhibit allograft rejection as a cause of renal malfunction, he may be further immunosuppressed by the viral infection, and is susceptible to sequential opportunistic infections leading to death.