异基因移植患者RQ-PCR监测巨细胞病毒感染并指导抢先治疗的临床研究(英文)  

Surveillance of CMV Infection in allo-HSCT Recipients and Guidance on Preemptive Therapy by RQ-PCR

作　　者：李艳[1] 高丽[1] 王莉莉[1] 丁一[1] 徐媛媛[1] 李红华[1] 靖彧[1] 薄剑[1] 黄文荣[1] 王全顺[1] 高春记[1] 于力[1] 

机构地区：[1]中国人民解放军总医院血液科,北京100853

出　　处：《中国实验血液学杂志》2013年第1期161-168,共8页Journal of Experimental Hematology

基　　金：Key Program of Capital Development Foundation(编号2007-2040)

摘　　要：本研究旨在评价血浆巨细胞病毒(CMV)-DNA实时荧光定量PCR(RQ-PCR)用于异基因造血干细胞移植(allo-HSCT)患者CMV感染的诊断监测和指导抢先治疗的临床作用及特点。通过回顾性统计2008年1月至2010年6月在我院血液科行allo-HSCT的141例患者的病例资料及CMV检测数据并随访至移植后180 d,分析患者特征、RQ-PCR检测结果、CMV感染及治疗情况和相关危险因素。结果显示,患者CMV感染和CMV肺炎发生率为81.5%和2.9%,主要发生在移植后2个月内。发生CMV感染后63例患者接受单药更昔洛韦、6例接受单药膦甲酸钠抢先抗病毒治疗,治疗的总有效率为87.8%,并表现出不同的疗效反应模式。女性、预处理中使用ATG或巴利昔单抗以及发生急性移植物抗宿主病(GVHD)的患者更容易感染CMV。使用ATG或巴利昔单抗以及发生急性GVHD的患者中CMV感染发生的时间更早(P<0.05)。急性GVHD、病毒DNA最大负荷量、阳性次数及治疗疗程与疗效有关(P<0.05)。结论:allo-HSCT患者的CMV感染发生率仍然很高,RQ-PCR检测血浆CMV-DNA与临床转归有很强的相关性,是监测allo-HSCT患者CMV感染情况并指导抢先抗病毒治疗的有效方式。In order to study the epidemiological characteristics of cytomegalovirus （CMV） infection in allogeneic hematopoietic stem cell transplantation （allo-HSCT） recipients by means of plasma real time quantitative polymerase chain reaction （RQ-PCR）, 141 adult patients undergoing allo-HSCT between January 2008 and June 2010 were serially monitored by RQ-PCR for detecting CMV and guiding the preemptive therapy followed up to 180 days post-HSCT. The results showed that the incidence of CMV infection and CMV pneumonia was 81.5% and 2.9% respectively, which mainly occurred within 2 months post-HSCT. Single-therapy with ganciclovir （GCV） for 63 patients or foscamet 6 patients was performed for preemptive therapy. The total efficacy was 87.8%, and the response patterns were different. CMV infection was more frequent in female patients （ P = 0.044）, and those with aGVHD （ P = 0.043 ）, using ATG or basiliximab in conditioning regimens （ P = 0.049）, as well as earlier in patients using ATG or basiliximab or those with aGVHD （ P = 0.007 ; P = 0.000 ）. The aGVHD, maximum load, positive times of CMV-DNA detection and therapy duration all correlated with the efficacy （ P 〈 0.05）. It is concluded that the incidence of CMV infection is still high after HSCT. Plasma RQ-PCR assay for CMV-DNA shows a strong correlation with the clinical outcome of CMV infection, which is useful and suitable for management of CMV infection in HSCT.

关 键 词：异基因造血干细胞移植 巨细胞病毒感染 实时荧光定量PCR 抢先治疗 

分 类 号：R457.7[医药卫生—治疗学] R373[医药卫生—临床医学]