PCR检测肠黏膜HHV6在异基因造血干细胞移植术后重度腹泻患者中的意义  

Significance of PCR detection of HHV6 in gastro biopsy on the course of diarrhea in patients with severe diarrhea after allogeneic hematopoietic stem cell transplantation

作　　者：韩婷婷[1] 赵晓甦[1] 黄晓军[1] 张晓辉[1] 刘开彦[1] 王昱[1] 闫晨华[1] 许兰平[1] 

机构地区：[1]北京大学人民医院、北京大学血液病研究所、造血干细胞移植治疗血液病北京市重点实验室,100044

出　　处：《中华血液学杂志》2017年第8期690-694,共5页Chinese Journal of Hematology

基　　金：国家自然科学基金（81370666）;国家自然科学基金创新研究群体科学基金（81621001）

摘　　要：目的探讨肠黏膜人疱疹病毒6型（HHV6）检测在异基因造血干细胞移植（allo—HSCT）术后重度腹泻患者中的意义。方法回顾性分析2015年2月至2016年8月于北京大学血液病研究所行allo—HSCT后出现重度腹泻并行肠镜检查及肠黏膜活检的患者资料；HHV6、CMV、EBV检测采用RT-PCR方法；肠黏膜病理检查也包括免疫组化方法检测CMV早期抗原、CMV晚期抗原，原位杂交检测EBV。结果共有45例患者纳人研究，其中21例（46．7％）肠黏膜活检HHV6阳性，包括男13例，女8例，中位年龄29（14～54）岁；肠黏膜HHV6阳性与阴性组患者血CMV阳性检出率差异无统计学意义（76．2％对87．5％，P〉0．05），但EBV血症发生率前者（6／21，28．6％）明显高于后者（1／24，4．2％）（P=0．028）；两组患者在腹泻发生的时间、次数及量方面差异无统计学意义（P值均〉0．05）。45例患者中44例接受了膦甲酸钠和（或）更昔洛韦抗病毒治疗，抗病毒治疗并没有影响腹泻的进程。结论肠黏膜HHV6阳性在allo-HSCT术后重症腹泻患者中发生率高，未发现其对于治疗及预后有临床意义。肠黏膜HHV6阳性并不能证明HHV6在肠道的感染。Objective To investigate the clinical significance of PCR detection of human herpesvirus 6 （HHV6） in gastro biopsy on the course of diarrhea in patients with severe diarrhea after allogeneic hematopoietic stem cell transplantation （HSCT）. Methods Data from a cohort of 45 HSCT recipients （including age, sex, transplantation conditions, graft-versus-host disease, treatments, clinical signs, outcome, HHV6, and other infections） performed between 2015 and 2016 were collected. Univariate analysis was used to evaluate influences between the different parameters. Results Of the 45 enrolled recipients, 21 patients （46.7%） presented HHV6 positive in gastro-biopsy during the analyzed period. The incidence of CMV viremia in the positive HHV6 group was comparable with that in the negative HHV6 group. But the incidence of EBV viremia in the positive HHV6 group was significantly higher than in the negative HHV6 group （P=-0,028）. 44 out of 45 patients with severe diarrhea were given antiviral treatment with foscarnet and/or ganciclovir, the latter didn＇ t influence the course of the diarrhea. Conclusions Positive PCR results in GI tract samples didn＇ t necessarily reflect reactivation of HHV6. Further studies are needed to define the significance of HHV6 for GI tract symptoms after allo-HSCT.

关 键 词：疱疹病毒6型 人 腹泻 造血干细胞移植 

分 类 号：R457.7[医药卫生—治疗学]