EB病毒感染淋巴细胞类型在儿童肝移植术后淋巴增殖性疾病中的意义

Significance of Epstein-Barr virus-infected lymphocyte cell types in peripheral blood mononuclear cells in post-transplant lymphoproliferative disorder after pediatric liver transplantation

目的总结儿童肝移植术后淋巴增殖性疾病(PTLD)受者EB病毒(EBV)感染后淋巴细胞类型的特点,探讨EBV感染淋巴细胞类型在儿童肝移植术后PTLD中的意义。方法收集首都医科大学附属北京友谊医院肝移植中心2013年6月至2021年3月收治的14例儿童肝移植术后PTLD受者的临床资料。对14例儿童受者治疗前后的外周血单核细胞(PBMC)、血浆和TBNK细胞分选后EBV-DNA进行回顾性分析。结果14例PTLD儿童受者PBMC EBV-DNA呈高复制水平(>104拷贝数/ml),其中8例血浆EBV-DNA>103拷贝数/ml。12例儿童受者EBV感染淋巴细胞类型以B淋巴细胞为主,2例伴有T淋巴细胞和/或NK细胞EBV-DNA高载量感染。治疗后7例PBMC和血浆EBV-DNA转为阴性,6例较前下降,1例较前升高。10例儿童受者治疗后B淋巴细胞EBV-DNA转阴,3例较前下降,1例治疗后T、B淋巴细胞和NK细胞中EBV-DNA较前升高。13例受者治疗后好转,1例治疗后效果不佳,出现噬血综合征,最终因PTLD进展而死亡。结论大多数EBV相关PTLD以B淋巴细胞感染类型为主,少数伴有T淋巴细胞和/或NK细胞EBV-DNA高复制。伴有T淋巴细胞和/或NK细胞EBV-DNA高载量感染的PTLD儿童受者相比B细胞感染为主的儿童受者对治疗反应性较差,预后不佳。EBV感染淋巴细胞类型的检测在EBV相关PTLD受者中具有一定的研究价值,对临床治疗和预后有指导作用。

Objective To explore the characteristics and significance of Epstein-Barr virus-infected lymphocyte cell types in peripheral blood mononuclear cells(PBMC)in post-transplant lymphoproliferative disorder(PTLD)after pediatric liver transplantation.Methods From June 2013 to March 2021,retrospective data analysis was performed for 14 pediatric liver transplant recipients with PTLD.The determination of EBV-DNA in PBMC,plasma and TBNK lymphocyte cells was analyzed.Results EBV-DNA in PBMC showed a high viral load(>104 copies/ml)and plasma EBV-DNA was>103 copies/ml(n=8).There were dominant B-cell-type infection(n=12)and T/NK-cell-type infection(n=2).After treatment,EBV-DNA in PBMC and plasma turned negative in 7 patients with a decline(n=6)and an increase(n=1).EBV-DNA in B lymphocyte became negative(n=10)with a decline(n=3).In one case,EBV-DNA increased in T,B and NK cells with a high viral load.The remainders recovered after treatment.One case of hemophagocytic syndrome died from a progression of PTLD.Conclusions A large majority of EBV-related PTLD are dominated by B-cell-type infection and a few belong to T or NK-cell-type infection.Patients with T/NK-cell-type infection have a worse response to therapy and poorer prognosis than those with B-cell-type infection.Determination of EBV-infected lymphocyte cell types is of vital research value for treatment and prognosis.