PDF(Pubmed)
Abstract：
BACKGROUND: Fatigue is a common complication of stroke that has a significant impact on quality of life. The biological mechanisms that underly post-stroke fatigue are currently unclear, however, reactivation of latent viruses and their impact on systemic immune function have been increasingly reported in other conditions where fatigue is a predominant symptom. Epstein-Barr virus (EBV) in particular has been associated with fatigue, including in long-COVID and myalgic encephalomyelitis/chronic fatigue syndrome, but has not yet been explored within the context of stroke.
OBJECTIVE: We performed an exploratory analysis to determine if there is evidence of a relationship between EBV reactivation and post-stroke fatigue.
METHODS: In a chronic ischemic stroke cohort (> 5 months post-stroke), we assayed circulating EBV by qPCR and measured the titres of anti-EBV antibodies by ELISA in patients with high fatigue (FACIT-F < 40) and low fatigue (FACIT-F > 41). Statistical analysis between two-groups were performed by t-test when normally distributed according to the Shapiro-Wilk test, by Mann-Whitney test when the data was not normally distributed, and by Fisher\'s exact test for categorical data.
RESULTS: We observed a similar incidence of viral reactivation between people with low versus high levels of post-stroke fatigue (5 of 22 participants (24%) versus 6 of 22 participants (27%)). Although the amount of circulating EBV was similar, we observed an altered circulating anti-EBV antibody profile in participants with high fatigue, with reduced IgM against the Viral Capsid Antigen (2.244 ± 0.926 vs. 3.334 ± 2.68; P = 0.031). Total IgM levels were not different between groups indicating this effect was specific to anti-EBV antibodies (3.23 × 105 ± 4.44 × 104 high fatigue versus 4.60 × 105 ± 9.28 × 104 low fatigue; P = 0.288).
CONCLUSIONS: These data indicate that EBV is not more prone to reactivation during chronic stroke recovery in those with post-stroke fatigue. However, the dysregulated antibody response to EBV may be suggestive of viral reactivation at an earlier stage after stroke.
OBJECTIVE: We performed an exploratory analysis to determine if there is evidence of a relationship between EBV reactivation and post-stroke fatigue.
METHODS: In a chronic ischemic stroke cohort (> 5 months post-stroke), we assayed circulating EBV by qPCR and measured the titres of anti-EBV antibodies by ELISA in patients with high fatigue (FACIT-F < 40) and low fatigue (FACIT-F > 41). Statistical analysis between two-groups were performed by t-test when normally distributed according to the Shapiro-Wilk test, by Mann-Whitney test when the data was not normally distributed, and by Fisher\'s exact test for categorical data.
RESULTS: We observed a similar incidence of viral reactivation between people with low versus high levels of post-stroke fatigue (5 of 22 participants (24%) versus 6 of 22 participants (27%)). Although the amount of circulating EBV was similar, we observed an altered circulating anti-EBV antibody profile in participants with high fatigue, with reduced IgM against the Viral Capsid Antigen (2.244 ± 0.926 vs. 3.334 ± 2.68; P = 0.031). Total IgM levels were not different between groups indicating this effect was specific to anti-EBV antibodies (3.23 × 105 ± 4.44 × 104 high fatigue versus 4.60 × 105 ± 9.28 × 104 low fatigue; P = 0.288).
CONCLUSIONS: These data indicate that EBV is not more prone to reactivation during chronic stroke recovery in those with post-stroke fatigue. However, the dysregulated antibody response to EBV may be suggestive of viral reactivation at an earlier stage after stroke.
摘要：
背景：疲劳是中风的常见并发症，对生活质量有重大影响。目前尚不清楚卒中后疲劳的生物学机制，然而,在疲劳是主要症状的其他疾病中，潜伏病毒的再激活及其对全身免疫功能的影响越来越多地被报道。特别是EB病毒（EBV）与疲劳有关，包括长期COVID和肌痛性脑脊髓炎/慢性疲劳综合征，但尚未在中风的背景下进行探索。
目的：我们进行了探索性分析，以确定是否有证据表明EBV再激活与卒中后疲劳之间存在关系。
方法：在慢性缺血性卒中队列（>卒中后5个月）中，我们通过qPCR检测了高疲劳(FACIT-F<40)和低疲劳(FACIT-F>41)患者的循环EBV，并通过ELISA检测了抗EBV抗体的滴度。根据Shapiro-Wilk检验，当两组之间呈正态分布时，采用t检验进行统计学分析。通过Mann-Whitney检验，当数据不是正态分布时，并通过费舍尔对分类数据的精确检验。
结果：我们观察到卒中后疲劳程度低和高的患者之间病毒再激活的发生率相似（22名参与者中有5名（24%）与22名参与者中有6名（27%））。尽管循环EBV的数量相似，我们在高度疲劳的参与者中观察到循环抗EBV抗体谱的改变，对病毒衣壳抗原的IgM减少（2.244±0.926vs.3.334±2.68；P=0.031）。两组之间的总IgM水平没有差异，表明这种作用对抗EBV抗体具有特异性（3.23×105±4.44×104高疲劳与4.60×105±9.28×104低疲劳；P=0.288）。
结论：这些数据表明，在卒中后疲劳患者的慢性卒中恢复过程中，EBV并不更容易再激活。然而,对EBV的抗体应答失调可能提示卒中后早期的病毒再激活.
目的：我们进行了探索性分析，以确定是否有证据表明EBV再激活与卒中后疲劳之间存在关系。
方法：在慢性缺血性卒中队列（>卒中后5个月）中，我们通过qPCR检测了高疲劳(FACIT-F<40)和低疲劳(FACIT-F>41)患者的循环EBV，并通过ELISA检测了抗EBV抗体的滴度。根据Shapiro-Wilk检验，当两组之间呈正态分布时，采用t检验进行统计学分析。通过Mann-Whitney检验，当数据不是正态分布时，并通过费舍尔对分类数据的精确检验。
结果：我们观察到卒中后疲劳程度低和高的患者之间病毒再激活的发生率相似（22名参与者中有5名（24%）与22名参与者中有6名（27%））。尽管循环EBV的数量相似，我们在高度疲劳的参与者中观察到循环抗EBV抗体谱的改变，对病毒衣壳抗原的IgM减少（2.244±0.926vs.3.334±2.68；P=0.031）。两组之间的总IgM水平没有差异，表明这种作用对抗EBV抗体具有特异性（3.23×105±4.44×104高疲劳与4.60×105±9.28×104低疲劳；P=0.288）。
结论：这些数据表明，在卒中后疲劳患者的慢性卒中恢复过程中，EBV并不更容易再激活。然而,对EBV的抗体应答失调可能提示卒中后早期的病毒再激活.
