鼠巨细胞病毒感染C57BL/6小鼠急性肝炎动物模型的建立与鉴定

目的：建立鼠巨细胞病毒（MCMV）感染C57BL/6小鼠急性肝炎模型并对其感染特点进行分析及鉴定。方法：将24 只C57BL/6小鼠随机分为阴性对照组（n =12）及病毒感染组（n =12），病毒感染组腹腔注射1.0×106 PFU（200 μL）MCMV悬液，阴性对照组注射等体积小鼠胚胎成纤维细胞（MEF）悬液。于感染后第3天和第7天取外周血分离血清检测谷丙转氨酶（ALT）及谷草转氨酶（AST）。同时进行肝组织病毒分离、组织病理学及MCMV IE和M55基因、细胞因子白细胞介素-6（IL-6）、白细胞介素-1β（IL-1β）、肿瘤坏死因子α（TNF-α）的检测。结果：病毒感染组肝组织匀浆病毒分离均为阳性，肝炎发生率为100%。在感染后第3天即发生肝炎病理改变，病毒感染组血清ALT及AST较阴性对照组明显升高（P ＜0.01）；病毒感染组肝脏HE染色第3天可见局灶性炎性细胞浸润及肝脏点灶状坏死，持续至第7天，Ishak评分较阴性对照组明显升高（P ＜0.01）；在感染后第3天病毒感染组肝组织内可检测到MCMV IE及M55基因，且在感染后第7天仍可测得IE基因；感染后第3天及第7天病毒感染组炎性细胞因子IL-6、TNF-α及IL-1β mRNA表达水平明显升高（P ＜0.05）。 结论：成功建立MCMV感染C57BL/6小鼠急性动物肝炎模型，其感染表现主要集中在急性感染前期。     

A new strategy of delayed long-term prophylaxis could prevent cytomegalovirus disease in (D+/R−) solid organ transplant recipients

Abstract:  Long-term prophylaxis against cytomegalovirus (CMV) started immediately after transplantation in (D+/R−) poses a higher risk of late-onset CMV disease. Delayed CMV prophylaxis could allow a transitory exposure of the immune system to CMV, which would let the immune system mount an adequate CMV-specific cytotoxic response in (D+/R−) patients and confer protection against CMV disease. We included all (D+/R−) solid organ transplant recipients (SOT) performed at our institution (January 3/October 6) who received CMV prophylaxis (mainly with oral valganciclovir) during 100 d. In the first period (until December 4), prophylaxis was initiated immediately after transplantation (conventional prophylaxis: CP). Since January 5, it was initiated after 14 d (delayed prophylaxis: DP). Incidence and severity of CMV disease was compared between both groups. A total of 44 SOT recipients were included (CP: 26 and DP: 18). CMV disease was diagnosed in eight patients (18%), seven of 26 (27%) in the CP group, and one of 18 (5.5%) in the DP group (p = 0.07). CMV colitis was reported in five of 26 patients in the CP group (19%), whereas there were no cases of visceral CMV disease in the DP group (p = 0.048). A 14-d delay in the beginning of long-term prophylaxis against CMV in (D+/R−) is safe and could prevent the onset of late-CMV disease.     

Cytomegalovirus infection and disease in the new era of immunosuppression following solid organ transplantation

Abstract: As the most prevalent pathogen among transplant patients, cytomegalovirus (CMV) affects up to three-quarters of all solid organ transplant recipients. While we have made great strides in preventing CMV infection and disease in the early post-transplant period, late CMV infection and indirect effects due to viral immunomodulation remain problematic. Changing immunosuppression practices, including the increasing use of T-cell depleting induction antibodies, have the potential to affect the risk for CMV infection and disease, even in the face of good prophylactic and preemptive therapy. The purpose of this review article is to discuss the impact of CMV infection on long-term allograft outcomes and to re-evaluate the risks and management strategies for prevention of CMV in the framework of evolving modern immunosuppressive strategies.     

聚合酶链反应检测患儿尿标本中的巨细胞病毒DNA

本文建立了聚合酶链反应(PCR)检测人巨细胞病毒(HCMV)方法,探讨了该方法的某些实验条件。用PCR检测24例临床患儿尿标本。证明PCR方法特异、敏感、简便而快速。同科不同属病毒如HSV、EBV等以及人源正常细胞均无假阳性结果:最小检出量可达0.1fg DNA,相当于6个基因拷贝;用水浴箱手控时间即可进行PCR循环,30次循环仅需97min30s;PCR和DNA杂交检测尿标本中HCMV阳性例数分别为20和14例。该结果证明HCMV感染儿童的广泛性和严重性,初步表明儿童肾病综合症与HCMV有关。     

Efficacy and safety of lowering immunosuppression to treat CMV infection in renal transplant recipients on valaciclovir prophylaxis: a pilot study.

BACKGROUND: Routine cytomegalovirus (CMV)-pp65 antigenaemia monitoring shows that some patients will develop pp65 antigenaemia during valaciclovir prophylaxis or after cessation of treatment. The aim of this pilot study was to evaluate the safety and efficacy of lowering immunosuppression in kidney transplant recipients who exhibit mildly symptomatic CMV infections while on valaciclovir prophylaxis. METHODS: We selected 12 patients who experienced mildly symptomatic CMV infections defined as a positive CMV-pp65 antigenaemia test associated with either neutropenia, asthenia or arthralgia, but no fever. All of them received prophylaxis with valaciclovir for at least 3 months. Testing for CMV-pp65 antigenaemia was performed weekly for 6 months. RESULTS: The mildly symptomatic infections occurred at a median interval of 69 days after transplantation-during prophylaxis in eight cases and after valaciclovir discontinuation in the other four cases. All of them were effectively managed by lowering immunosuppressive therapy, leading to the disappearance of symptoms and CMV antigenaemia reduction. No immunological complication or recurrence of CMV infection or disease was noted. I.v. ganciclovir never became necessary. CONCLUSION: The mildly symptomatic CMV infections occurring in valaciclovir-treated patients may be managed efficiently and without immunologic complication by lowering immunosuppressive therapy.     

Sural nerve biopsies in Guillain-Barre syndrome: axonal degeneration and macrophage-associated demyelination and absence of cytomegalovirus genome.

T-cell infiltration was detected by immunohistochemistry in only 2 of 10 sural nerve biopsies from patients with Guillain-Barré syndrome (GBS). The number of endoneurial macrophages, identified by the monoclonal antibody MAC 387, was increased, compared with the number in 10 cases of axonal neuropathy. Macrophage-associated demyelination was identified in 7 and axonal degeneration in 8 cases. Cytomegalovirus (CMV) genome was not detected with the polymerase chain reaction.     

输卵管妊娠与人巨细胞病毒、弓形虫感染的相关性研究

目的　研究人巨细胞病毒、弓形虫感染与输卵管妊娠的相关性。方法　采用酶联免疫吸附测定 (ELISA)方法和聚合酶链反应 (PCR)技术检测输卵管妊娠患者与对照组血清人巨细胞病毒 (HCMV)和弓形虫 (TOXO)抗体以及生殖道HCMV和TOXODNA。结果　病例组血清HCMVIgG抗体阳性检出率为 31 9% ,明显高于对照组15 8% (P <0 0 5 ) ;HCMVIgM抗体、TOXOIgG、IgM抗体检出率均高于对照组 ,在统计学上无明显差异 (P >0 0 5 ) ;病例组宫颈、宫腔及输卵管组织中均分离到HCMVDNA和TOXODNA ,且宫颈HCMVDNA阳性检出率为14 3% ,明显高于对照组 (P <0 0 5 )。结论　输卵管妊娠与HCMV感染有关 ,TOXO感染为输卵管妊娠的可疑因素。     

河北省部分城镇白领人群脑血管病危险因素调查

目的:调查河北省城镇白领人群的脑血管病危险因素。方法:选取石家庄市部分白领人群,由专业医师进行询问病史,查体,检测血脂、血糖,巨细胞病毒晚期抗原PP65与抗体IgG、IgM检测,心电图,胸透,B型超声检查肝、胆及颈动脉、椎动脉。结果:高血压患病率43．38％,城镇白领阶层高血压患病率显著高于普通人群(35．7％);高血脂男性发生率45．79％,女性为17．24％:男性公务员高血脂发生率与其他职业人群比较有统计学意义;糖尿病患病率为8．82％,职业间和性别间无统计学意义;颈、椎动脉超声检查,发现39．71％的人颈动脉或椎动脉有动脉粥样硬化病变,男性发生率40．19％,女性发生率37．93％,男性稍高于女性,职业间、性别间无统计学意义;长期大量饮酒率为82．3％,男性吸烟率56．07％;巨细胞病毒(HCMV)激活感染率3．68％。结论:存在心脑血管疾病高危因素的共有129人,占94．85％,其中86．76％的人存在两个或两个以上危险因素。采取早预防、早治疗的方针,关注城镇白领人群常见的脑血管病的危险因素对我国的可持续发展有重要战略意义。