期刊目次

加入编委

期刊订阅

添加您的邮件地址以接收即将发行期刊数据:

Open Access Article

International Journal of Clinical Research. 2022; 6: (7) ; 4-9 ; DOI: 10.12208/j.ijcr.20220294.

Advances in diagnosis and treatment of adult-onset chronic active EBV infection
成人慢性活动性EB病毒感染诊疗进展

作者: 王龙飞, 邢昊, 张传辉, 张倩, 金珍婧 *

吉林大学第二医院肝胆胰内科 吉林长春

*通讯作者: 金珍婧,单位:吉林大学第二医院肝胆胰内科 吉林长春;

发布时间: 2022-09-07 总浏览量: 491

摘要

慢性活动性EB病毒感染(chronic active Epstein–Barr virus infection,CAEBV)是EB病毒阳性T/NK细胞淋巴增值性疾病之一,其特征为EBV感染的T/NK细胞克隆性增殖并浸润全身器官,导致其衰竭。本病发病机制尚不明确,该病往往持续进展,病程中可出现噬血细胞综合征、多脏器功能衰竭、淋巴瘤、机会性感染等危及生命并发症。该病预后差,病死率高,尚无明确治疗方案,异基因造血干细胞移植被证明为唯一有效治疗方法。CAEBV临床少见,好发于儿童及青少年,成人罕见,国内有关成人CAEBV研究较少,本文就成人CAEBV临床特点及诊治进行综述,以提高临床对该病的诊治水平。

关键词: 成人;慢性活动性EB病毒感染;治疗

Abstract

Chronic active EB virus infection is one of EB virus positive T/NK cell lymphoproliferative diseases, characterized by clonal proliferation of EBV-infected T/NK cells and their infiltration into systemic organs, leading to their failure. The pathogenesis of this disease remains unclear, the disease progresses continuously, Life-threatening complications such as hemophagocytic syndrome, multiple organ failure, lymphoma, opportunistic infections may occur during the course of the disease. Chronic active EB virus infection has a poor prognosis and high mortality, allogeneic hematopoietic stem cell transplantation proved to be the only effective treatment. Chronic active EB virus infection is rare in clinic, more likely to occur in children and adolescents, and is rare in adults. There are few domestic studies on adult-onset Chronic active EB virus infection, This article reviews the clinical characteristics, diagnosis and treatment of adult-onset Chronic active EB virus infection, To improve the clinical diagnosis and treatment of the disease.

Key words: Adult; Chronic Active EB Virus Infection; Treatment

参考文献 References

[1] PLUMMER M, DE MARTEL C, VIGNAT J, et al. Global burden of cancers attributable to infections in 2012: a synthetic analysis [J]. Lancet Glob Health, 2016, 4(9): e609-16 

[2] LUZURIAGA K, SULLIVAN J L. Infectious mononucleosis [J]. N Engl J Med, 2010,362(21): 1993-2000. 

[3] RICKINSON A B, LONG H M, PALENDIRA U, et al. Cellular immune controls over Epstein-Barr virus infection: new lessons from the clinic and the laboratory [J]. Trends Immunol, 2014, 35(4): 159-69.  

[4] TAYLOR G S, LONG H M, BROOKS J M, et al. The immunology of Epstein-Barr virus-induced disease [J]. Annu Rev Immunol, 2015, 33: 787-821.  

[5] COHEN J I. Epstein-Barr virus infection [J]. N Engl J Med, 2000, 343(7): 481-92.  

[6] FUGL A, ANDERSEN C L. Epstein-Barr virus and its association with disease - a review of relevance to general practice [J]. BMC Fam Pract, 2019, 20(1): 62.  

[7] WILLIAMS H, CRAWFORD D H. Epstein-Barr virus: the impact of scientific advances on clinical practice [J]. Blood, 2006, 107(3): 862-9.  

[8] OKANO M, KAWA K, KIMURA H, et al. Proposed guidelines for diagnosing chronic active Epstein-Barr virus infection [J]. Am J Hematol, 2005, 80(1): 64-9.  

[9] OHSHIMA K, KIMURA H, YOSHINO T, et al. Proposed categorization of pathological states of EBV-associated T/natural killer-cell lymphoproliferative disorder (LPD) in children and young adults: overlap with chronic active EBV infection and infantile fulminant EBV T-LPD [J]. Pathol Int, 2008, 58(4): 209-17.  

[10] SWERDLOW S H, CAMPO E, PILERI S A, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms [J]. Blood, 2016, 127(20): 2375-90.  

[11] COHEN J I, JAFFE E S, DALE J K, et al. Characterization and treatment of chronic active Epstein-Barr virus disease: a 28-year experience in the United States [J]. Blood, 2011, 117(22): 5835-49.  

[12] KERR J R. Epstein-Barr virus (EBV) reactivation and therapeutic inhibitors [J]. J Clin Pathol, 2019, 72(10): 651-8. 

[13] KIMURA H, HOSHINO Y, HARA S, et al. Differences between T cell-type and natural killer cell-type chronic active Epstein-Barr virus infection [J]. J Infect Dis, 2005, 191(4): 531-9. 

[14] FISCHER E, DELIBRIAS C, KAZATCHKINE M D. Expression of CR2 (the C3dg/EBV receptor, CD21) on normal human peripheral blood T lymphocytes [J]. J Immunol, 1991, 146(3): 865-9 

[15] STINCHCOMBE J C, BOSSI G, BOOTH S, et al. The immunological synapse of CTL contains a secretory domain and membrane bridges [J]. Immunity, 2001, 15(5): 751-61.  

[16] TABIASCO J, VERCELLONE A, MEGGETTO F, et al. Acquisition of viral receptor by NK cells through immunological synapse [J]. J Immunol, 2003, 170(12): 5993-8.  

[17] ANAGNOSTOPOULOS I, HUMMEL M, KRESCHEL C, et al. Morphology, immunophenotype, and distribution of latently and/or productively Epstein-Barr virus-infected cells in acute infectious mononucleosis: implications for the interindividual infection route of Epstein-Barr virus [J]. Blood, 1995, 85(3): 744-50 

[18] ARAI A, YAMAGUCHI T, KOMATSU H, et al. Infectious mononucleosis accompanied by clonal proliferation of EBV-infected cells and infection of CD8-positive cells [J]. Int J Hematol, 2014, 99(5): 671-5. 

[19] ARAI A. Chronic active Epstein-Barr virus infection: a bi-faceted disease with inflammatory and neoplastic elements [J]. Immunol Med, 2018, 41(4): 162-9.  

[20] SCOTT L M, GANDHI M K. Deregulated JAK/STAT signalling in lymphomagenesis, and its implications for the development of new targeted therapies [J]. Blood Rev, 2015, 29(6): 405-15.  

[21] ONOZAWA E, SHIBAYAMA H, TAKADA H, et al. STAT3 is constitutively activated in chronic active Epstein-Barr virus infection and can be a therapeutic target [J]. Oncotarget, 2018, 9(57): 31077-89.  

[22] COHEN J I, NIEMELA J E, STODDARD J L, et al. Late-onset severe chronic active EBV in a patient for five years with mutations in STXBP2 (MUNC18-2) and PRF1 (perforin 1) [J]. J Clin Immunol, 2015, 35(5): 445-8.  

[23] COHEN J I. GATA2 Deficiency and Epstein-Barr Virus Disease [J]. Front Immunol, 2017, 8: 1869.  

[24] RODRIGUEZ R, FOURNIER B, CORDEIRO D J, et al. Concomitant PIK3CD and TNFRSF9 deficiencies cause chronic active Epstein-Barr virus infection of T cells [J]. J Exp Med, 2019, 216(12): 2800-18.  

[25] KIMURA H, HOSHINO Y, KANEGANE H, et al. Clinical and virologic characteristics of chronic active Epstein-Barr virus infection [J]. Blood, 2001, 98(2): 280-6.  

[26] ARAI A, IMADOME K I, WATANABE Y, et al. Clinical features of adult-onset chronic active Epstein-Barr virus infection: a retrospective analysis [J]. Int J Hematol, 2011, 93(5): 602-9.  

[27] 卢根,谢正德,叶玲君,吴润晖,刘春艳,杨双,金颖康,申昆玲. 儿童慢性活动性EB病毒感染的临床特征和危险因素分析[C]//.中华医学会第五次全国儿科中青年学术交流大会论文汇编(上册).[出版者不详],2008:850-854. 

[28] LUO L, WANG H, FAN H, et al. The clinical characteristics and the features of immunophenotype of peripheral lymphocytes of adult onset chronic active Epstein-Barr virus disease at a Tertiary Care Hospital in Beijing [J]. Medicine (Baltimore), 2018, 97(9): e9854.  

[29] LIN J, WU H, GU L, et al. Clinicopathologic findings of chronic active Epstein-Barr virus infection in adults: A single-center retrospective study in China [J]. Clin Exp Med, 2021, 21(3): 369-77.  

[30] KAWAMOTO K, MIYOSHI H, SUZUKI T, et al. A distinct subtype of Epstein-Barr virus-positive T/NK-cell lymphoproliferative disorder: adult patients with chronic active Epstein-Barr virus infection-like features [J]. Haematologica, 2018, 103(6): 1018-28.  

[31] KIMURA H, KWONG Y L. EBV Viral Loads in Diagnosis, Monitoring, and Response Assessment [J]. Front Oncol, 2019, 9: 62. DOI:10.3389/fonc.2019.00062 

[32] FUJII N, TAKENAKA K, HIRAKI A, et al. Allogeneic peripheral blood stem cell transplantation for the treatment of chronic active Epstein-Barr virus infection [J]. Bone Marrow Transplant, 2000, 26(7): 805-8.  

[33] UEHARA T, NAKASEKO C, HARA S, et al. Successful control of Epstein-Barr virus (EBV)-infected cells by allogeneic nonmyeloablative stem cell transplantation in a patient with the lethal form of chronic active EBV infection [J]. Am J Hematol, 2004, 76(4): 368-72.  

[34] SATO E, OHGA S, KURODA H, et al. Allogeneic hematopoietic stem cell transplantation for Epstein-Barr virus-associated T/natural killer-cell lymphoproliferative disease in Japan [J]. Am J Hematol, 2008, 83(9): 721-7.  

[35] KAWA K, SAWADA A, SATO M, et al. Excellent outcome of allogeneic hematopoietic SCT with reduced-intensity conditioning for the treatment of chronic active EBV infection [J]. Bone Marrow Transplant, 2011, 46(1): 77-83.  

[36] SAWADA A, INOUE M, KAWA K. How we treat chronic active Epstein-Barr virus infection [J]. Int J Hematol, 2017, 105(4): 406-18. DOI:10.1007/s12185-017-2192-6 

[37] LUO Y H, YANG J, WEI A, et al. Haploidentical hematopoietic stem cell transplantation for pediatric patients with chronic active Epstein-Barr virus infection: a retrospective analysis of a single center [J]. World J Pediatr, 2021, 17(6): 626-36.  

[38] COHEN J I. Epstein-barr virus vaccines [J]. Clin Transl Immunology, 2015, 4(1): e32. DOI:10.1038/cti.2014.27 

[39] JIN Z, WANG Y, WANG J, et al. Long-term survival benefit of ruxolitinib in a patient with relapsed refractory chronic active Epstein-Barr virus [J]. Ann Hematol, 2019, 98(8): 2003-4. 

[40] ITO T, KAWAZU H, MURATA T, et al. Role of latent membrane protein 1 in chronic active Epstein-Barr virus infection-derived T/NK-cell proliferation [J]. Cancer Med, 2014, 3(4): 787-95.  

[41] HUE S S, OON M L, WANG S, et al. Epstein-Barr virus-associated T- and NK-cell lymphoproliferative diseases: an update and diagnostic approach [J]. Pathology, 2020, 52(1): 111-27.  

[42] KIMURA H, ITO Y, KAWABE S, et al. EBV-associated T/NK-cell lymphoproliferative diseases in nonimmuno- compromised hosts: prospective analysis of 108 cases [J]. Blood, 2012, 119(3): 673-86.  

[43] KIMURA H, MORISHIMA T, KANEGANE H, et al. Prognostic factors for chronic active Epstein-Barr virus infection [J]. J Infect Dis, 2003, 187(4): 527-33.  

[44] GOTOH K, ITO Y, SHIBATA-WATANABE Y, et al. Clinical and virological characteristics of 15 patients with chronic active Epstein-Barr virus infection treated with hematopoietic stem cell transplantation [J]. Clin Infect Dis, 2008, 46(10): 1525-34.  

[45] KAWANO Y, IWATA S, KAWADA J, et al. Plasma viral microRNA profiles reveal potential biomarkers for chronic active Epstein-Barr virus infection [J]. J Infect Dis, 2013, 208(5): 771-9.  

引用本文

王龙飞, 邢昊, 张传辉, 张倩, 金珍婧, 成人慢性活动性EB病毒感染诊疗进展[J]. 国际临床研究杂志, 2022; 6: (7) : 4-9.