人类疱疹病毒-6感染与药疹发病关系的研究

Study on the role of human herpesvirus-6 infection in cutaneous drug eruptions

目的:观察人类疱疹病毒-6(HHV-6)感染在药疹发病中的作用。方法:收集127例住院的药疹患者和67名正常对照者。用实时荧光定量PCR测定药疹患者和67名正常对照者的血清HHV-6DNA载量,并用ELISA测定患者和正常对照者的血清HHV-6IgM和HHV-6IgG。结果:127例药疹患者中15例(11.8%)患者有HHV-6活动性感染,其中以药物超敏综合征(DIHS)最多见,占46.7%,还可见于发疹型(EE)、多形红斑型(EM)、Stevens-Johnson综合征(SJS)和剥脱性皮炎型(ED)。HHV-6感染组男性的药疹发生率高于无HHV-6感染组(P<0.05);HHV-6感染组DIHS的发生率显著高于无HHV-6感染组(P<0.01);HHV-6感染组较无HHV-6感染组更易发生发热(P<0.05)、淋巴结肿大、肝功能损害、肾功能损害、嗜酸粒细胞增多(P均<0.01);HHV-6感染患者药疹发病潜伏期和病情控制时间均显著长于无HHV-6感染组(P<0.01);药疹患者入院时和恢复期的HHV-6IgG阳性率均显著高于正常对照组(P<0.01)。结论:HHV-6感染在药疹发病中起一定作用;HHV-6活动性感染最常见于DIHS,也可见于EE、EM、SJS和ED;HHV-6感染与DIHS的发生密切相关;有HHV-6活动性感染的患者病情重、系统损害多、潜伏期长、治疗所需时间长;药疹患者有较高的HHV-6潜伏感染率。

Objective To investigate the role of human herpesvirus-6 （HHV-6） in cutaneous drug eruptions. Methods One hundred and twenty-seven patients with cutaneous drug eruptions and 67 healthy controls were enrolled in the study. Real-time polymerase chain reaction （PCR） was performed for the assessment of HHV-6 DNA in serum of the patients and the healthy controls. HHV-6 IgG and IgM antibody levels were measured by ELISA. Results Fifteen patients （11.8%）had active HHV-6 infection, of whom drug-induced hypersensitivity syndrome （DIHS） was the most frequent （46.7%）. Besides, HHV-6 infection had also been demonstrated in exanthematous eruptions （EE）, erythema muhiforme （EM）, Stevens- Johnson syndrome （SJS） and exfoliative dermatitis （ED）. The males were more likely to have active HHV-6 infection （P〈0.05）. The incidence of DIHS was higher in the patients with HHV-6 infection than those without HHV-6 infection （P〈0.01）. The patients who had HHV-6 infection were more susceptible to fever （P〈0.05）, lymphadenopathy, liver and renal function insufficiency and eosinophilia （P〈0.01）. The latency or course for diseasecontrolling of patients with HHV-6 infection was significantly longer than that of those without HHV-6 infection （P〈0.01）. The positive rate of HHV-6 IgG was higher in patients with cutaneous drug eruptions than that in healthy controls （P〈 0.01）. Conclusions HHV-6 infection played a role in cutaneous drug eruptions. HHV-6 infection is most frequent in DIHS, and then in EE, EM, SJS and ED. The development of DIHS is correlated with HHV-6 infection. HHV-6 infection might contribute to the severity, latency, prolonged course, and occurrence of complication of cutaneous drug eruptions. Cutaneous drug eruptions are prone to occur in patients with latent HHV-6 infection.