Respiratory syncytial virus in hematopoietic cell transplant recipients: factors determining progression to lower respiratory tract disease.
Respiratory syncytial virus in hematopoietic cell transplant recipients: factors determining progression to lower respiratory tract disease.
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DOI：
10.1093/infdis/jit832
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发表时间：
2014-04-15
期刊：
影响因子：
--
通讯作者：
Boeckh M
中科院分区：
文献类型：
--
作者：
Kim YJ;Guthrie KA;Waghmare A;Walsh EE;Falsey AR;Kuypers J;Cent A;Englund JA;Boeckh M
背景：呼吸道合胞病毒（RSV）引起的下呼吸道疾病（LRD）是造血细胞移植（HCT）受者的一种危及生命的并发症。 淋巴细胞减少症与上呼吸道感染（URI）进展为LRD的风险增加相关。 方法：本研究回顾性分析了淋巴细胞植入动力学、肺功能、吸烟史、皮质类固醇、抗病毒治疗、病毒亚型和RSV特异性中和抗体对181例RSV URI HCT受者进展为LRD的意义。 结果：在多变量模型中，吸烟史、大剂量全身照射和上呼吸道感染发作时绝对淋巴细胞计数（ALC）≤100/mm 3与疾病进展显著相关。 在URI发作时ALC>1000/mm 3的患者中没有发生进展。淋巴细胞植入动力学在进展者和非进展者中相似。移植前和移植后供体和移植后受体RSV亚型特异性中和抗体水平、RSV病毒亚型和皮质类固醇也与LRD进展无显著相关性。 结论：宿主和移植相关因素似乎比病毒因素更能决定进展为LRD的风险。 细胞介导的免疫功能障碍似乎在HCT后进行性RSV疾病的发病机制中很重要。RSV特异性T细胞免疫的表征是必要的。
Background. Respiratory syncytial virus (RSV) lower respiratory tract disease (LRD) is a life-threatening complication in hematopoietic cell transplant (HCT) recipients. Lymphopenia has been associated with an increased risk of progression from upper respiratory tract infection (URI) to LRD. Methods. This study retrospectively analyzed the significance of lymphocyte engraftment dynamics, lung function, smoking history, corticosteroids, antiviral treatment, viral subtypes, and RSV-specific neutralizing antibodies for the progression to LRD in 181 HCT recipients with RSV URI. Results. In multivariable models, smoking history, conditioning with high-dose total body irradiation, and an absolute lymphocyte count (ALC) ≤100/mm3 at the time of URI onset were significantly associated with disease progression. No progression occurred in patients with ALCs of >1000/mm3 at URI onset. Lymphocyte engraftment dynamics were similar in progressors and nonprogressors. Pre- and posttransplant donor and posttransplant recipient RSV subtype-specific neutralizing antibody levels, RSV viral subtypes, and corticosteroids also were not significantly associated with LRD progression. Conclusions. Host and transplant related factors appear to determine the risk of progression to LRD more than viral factors. Dysfunctional cell-mediated immunity appears to be important in the pathogenesis of progressive RSV disease after HCT. A characterization of RSV-specific T-cell immunity is warranted.
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DOI：
10.1016/j.jcv.2004.03.018
发表时间：
2004-10
期刊：
Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology
影响因子：
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作者：
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DOI：
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发表时间：
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期刊：
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影响因子：
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作者：
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