异基因造血干细胞移植后巨细胞病毒抗原血症检测指导巨细胞病毒感染的防治  

Detection of Cytomegalovirus Antigenemia Guides Prophylaxis of Cytomegalovirus Infection after Allogeneic Hematopoietic Stem Cell Transplantation

作　　者：范炜 李欲航[2] 董陆佳[2] 骈淮媛[3] 卢淑鹃[3] 

机构地区：[1]解放军359医院检验科,镇江211001 [2]军事医学科学院附属医院造血干细胞移植中心,北京100039 [3]军事医学科学院附属医院血液科,北京100039

出　　处：《中国实验血液学杂志》2001年第2期149-152,共4页Journal of Experimental Hematology

摘　　要：人巨细胞病毒感染及巨细胞病毒疾病是异基因造血干细胞移植后的常见并发症 ,巨细胞病毒性间质性肺炎是移植后巨细胞病毒疾病的主要类型 ,如未能及时检出和救治则病死率极高。为探讨采用免疫组化法测定人巨细胞病毒的方法学 ,指导临床治疗 ,我们采用免疫组化法对 4 5例(慢性粒细胞白血病 2 3例 ,急性髓性白血病 7例 ,急性淋巴细胞白血病 6例 ,骨髓增生异常综合征4例 ,非何杰金氏淋巴瘤 3例 ,再生障碍性贫血 2例 )进行造血干细胞移植后巨细胞病毒抗原血症的检测 ,并与巨细胞病毒血清学检测进行了对比。 4 5例中 38例患者进行了异基因外周血干细胞移植 ,2例骨髓移植 ,5例外周血与骨髓共移植。移植前 ,对供 受者均进行巨细胞病毒抗体检查 ;移植后 ,受者采用本方法进行抗原检查。结果表明 ,有 2 5例患者发生巨细胞病毒相关性间质性肺炎 ,移植后随访时间为 6 - 2 8个月 (平均时间为 18个月 ) ,根据巨细胞病毒检测结果进行预防性治疗的患者预后较未进行预防性治疗的患者有明显差异。预防组巨细胞病毒相关的死亡率为 1 2 9,未预防组为 12 16。提示采用免疫组化法对异基因造血干细胞移植患者进行定期随访监测可更早期、快速的检出巨细胞病毒感染 ,对患者预后有重要意义。Cytomegalovirus infection(CMV I) and CMV related diseases (CMV D) occurred after allogeneic hematopoietic stem cell transplantation(Allo HSCT) seem to be with high morbidity and mortality. This study is a retrospective analysis of the incidence of CMV infection and diseases in Allo HSCT patients known to be CMV seropositive before transplantation. To review the efficacy of CMV pp65 antigen guided ganciclovir prophylaxis in preventing CMV infection and to search the optimal determination methods, 45 consecutive Allo HSCT patients have been observed. Using the CMV pp65 antigenemia assay and serological analysis monitored blood samples from 23 patients with chronic myeloid leukemia(CML), 7 acute myeloblastic leukemia(AML), 6 acute lymphoblastic leukemia(ALL); other: 4 myelodysplastic syndrome(MDS), 3 non Hodgkin′s lymphoma(NHL) and 2 aplastic anemia. Forty three patients received HLA identical siblings transplantation and 2 from their HLA haploidentical donors. Forty five cases included Allo PBPCT (38 cases), Allo BMT (2 cases) and Allo PBPCT+BMT 5 cases. Before transplantation, all donors/recipients have taken CMV serological detection. All donor/recipients were CMV IgG positive and one donor and one recipient with CMV IgM positive, respectively. After transplantation, all patients developed CMV antigenemia during monitoring period. Twenty five patients developed CMV related interstitial pneumonia(CMV IP). Patients have been followed from 6 to 28 months (median of 18 months) after transplantation. The patients who received preemptive therapy had a significantly better outcome than patients who did not received preemptive therapy. CMV related mortality was 1/29 cases in preemptive group vs. 12/16 cases in non preemptive group. The results suggest that prompt and early institution of effective therapy with ganciclovir upon detection of CMV pp65 antigenemia, provides optimal protection against progress of CMV disease for patients undergoing Allo HSCT.

关 键 词：异基因造血干细胞移植 巨细胞病毒抗原血症 巨细胞病毒感染 CMVpp65恶性血液病 

分 类 号：R457.7[医药卫生—治疗学] R733[医药卫生—临床医学]