非清髓异基因外周血造血干细胞移植后巨细胞病毒感染的危险因素分析  

Risk Factors Analysis of Cytomegalovirus Infection after Nonmyeloablative Allogeneic Peripheral Blood Stem Cell Transplantation

作　　者：张永平[1,2] 胡凯勋[2] 孙琪云[2] 乔建辉[2] 郭梅[2] 艾辉胜[2] 余长林[2] 

机构地区：[1]安徽医科大学研究生院,安徽合肥230032 [2]解放军307医院血液科,北京100071

出　　处：《中国实验血液学杂志》2014年第2期458-463,共6页Journal of Experimental Hematology

基　　金：首都特色临床研究项目(Z1211070001012082)

摘　　要：本研究旨在探讨非清髓异基因外周血造血干细胞移植(NST)后CMV感染及CMV病的发生特点及其危险因素,为NST后CMV感染的诊断、监测和抢先治疗提供参考。用实时定量聚合酶链反应(RT-PCR)方法检测了80例在本院血液科行NST患者外周血白细胞巨细胞病毒(CMV)DNA载量,并对其临床资料进行了回顾性分析。结果表明,NST后62/80例发生CMV感染(77.5%),首次检出CMV-DNA阳性的中位时间为移植后35 d(17-133),经抢先治疗后,移植后100 d内CMV病累积发生率为11.3%。单因素分析及多因素分析均显示,预处理方案中使用抗人胸腺细胞免疫球蛋白(ATG)、合并其它疱疹病毒感染(单纯疱疹病毒、EB病毒、水痘-带状疱疹病毒等)及移植前有真菌感染病史均为CMV感染的危险因素。单因素分析提示,CMV血症及预处理方案中使用ATG是CMV病的危险因素。合并Ⅱ-Ⅳ度aGVHD 23例患者CMV感染率为91.3%(21/23),但与0-I度aGVHD组的CMV感染率71.9%相比,无统计学差异(P=0.06)。多因素分析未发现与CMV病相关的危险因素。结论:预处理过程中使用ATG有可能增加NST后CMV感染和CMV病的发生率,CMV感染容易与其它疱疹病毒感染及真菌感染伴发。移植后亦应当重视对其它疱疹病毒及真菌的监测及预防。The aim of this study was to analyze the risk factors of cytomegalovirus （CMV） infection and CMV disease after nonmyeloablative allogeneic hematopoietic stem cell transplantation （NST） and develop a rational strategy for the diagnosis, monitoring and preemptive treatment of CMV infection. The Clinical data of 80 patients undergoing NST from November 2009 to November 2012 in the hospital 307 were retrospectively analyzed. The cytomegalovins load in peripheral blood of patients was detected by using RT-PCR. The results indicated that the incidence of CMV infection was 77.5% （62/80）, and the median time for the positive CMV-DNA firstly detected by RT-PCR was day 35 （17 - 133 ） after NST. The total of 100 - day cumulative incidence of CMV disease was 11.3 % （9/80） after early preemptive therapy. Both univariate and multivariate analysis showed thymoglobulin （ATG） used in preconditioning regimen, other herpesvirus infection and fungai infection in medical history before NST were the risk factors of CMV infection after NST. Univariate analysis revealed that CMV viremia and ATG used in preconditioning regimen were the risk factors for CMV disease, while the same result was not found in the multivariate analysis. The incidence of CMV infection in patients with Ⅱ-Ⅳgrade of aGVHD was 91.3% ,while the incidence of CMV infectin in patients with 0 - 1 grade of aGVHD was 71.9% （P =0.06）, it seems that Ⅱ-Ⅳ grade of aGVHD was not the risk factor of CMV infection for NST. It is concluded that the ATG used in preconditioning regimen may increase the incidence of both CMV infection and CMV disease after NST. CMV infection easily accompanies by other herpesvirus infection and fungal infection. Therefore other herpesvirus infectien and fungal infection should be attentively monitored and prevented after trans- plantation.

关 键 词：非清髓异基因外周血造血干细胞移植 巨细胞病毒感染 巨细胞病毒病 危险因素 抢先治疗 

分 类 号：R457.7[医药卫生—治疗学]