造血干细胞移植术后并发巨细胞病毒相关嗜血细胞综合征1例并文献复习  

CMV-associated haemophagocytic syndrome following haematopoietic stem cell transplant:a case report and review of literature

作　　者：郭荣[1] 杜欣[1] 翁建宇[1] 陆泽生[1] 邓程新[1] 罗成伟[1] 

机构地区：[1]广东省医学科学院,广东省人民医院血液科,广州市510080

出　　处：《实用医学杂志》2010年第16期2968-2970,共3页The Journal of Practical Medicine

基　　金：广东省医学科学技术研究基金(编号:A2007016);广东省自然科学基金资助项目(编号:06020896);国家自然科学基金资助项目(编号:30571771)

摘　　要：目的:国内造血干细胞移植患者尚无合并嗜血细胞综合征(HPS)的报道,有待于提高对该并发症的认识。方法:本文报告1例32岁急性淋巴细胞白血病(ALL-CR2)患者,在无关造血干细胞移植术后53d并发嗜血细胞综合征(HPS)。同时对国外相关文献14例复习。结果:患者移植后+28d合并轻度出血性膀胱炎,经碱化、输注丙球及抗感染处理后加重,最后给予赛美维抗CMV病毒治疗后缓解。患者移植后45d出现CMV抗原血症,随后高热、脾大及血象三系减低,经骨穿确诊为HPS。经丙球输注、赛美维抗CMV病毒治疗后仍然加重,于移植后90d死亡。结论:造血干细胞移植后出现持续发热、进行性血细胞减少及高铁蛋白血症,应行骨穿排除HPS可能。Objective Hemophagocytic syndrome （HPS） has not been reported in haematopoietic stem cell transplant（HSCT） recipients in China, which needs to promoting the awareness of it. Methods We present here a case of HPS occurring after HLA （8/10） unrelated HSCT for acute lymphoblastic leukemia in a 32-year-old patient in second complete remission （ALL-CR2）. And review 14 cases of related literature. Results After bone marrow engraftment and haematological recovery on day 21, slight hemorrhagic cystitis developed on day 28. This patient was treated with Cymevene in addition to alkalization, immunoglobulin and antibiotics, and hemorrhagic cystitis showed complete improvement. CMV antigenaemia was observed on day 45, and HPS was not diagnosed untill bone marrow aspirate was done on day 76. Despite administration of Cymevene and immunoglobulin, HPS showed no improvement and died on day 90. Conclusion When sustained fever with progressive cytopenia and hypefferritinaemia are observed, HPS should be suspected, and bone marrow aspirate considered.

关 键 词：嗜血细胞综合征 巨细胞病毒 造血干细胞移植 

分 类 号：R733.71[医药卫生—肿瘤]