预防输血传播巨细胞病毒感染的研究进展  

Recent advances in the prevention of transfusion-transmitted cytomegalovirus infection

作　　者：任少敏 王同显 马保凤[2] REN Shaomin;WANGTongxian;MA Baofeng(Qingdao Blood Center,Qingdao 266071,China;Qingdao Hospital of Infectious Diseases)

机构地区：[1]青岛市中心血站,山东青岛266071 [2]青岛市传染病医院

出　　处：《中国输血杂志》2018年第10期1209-1213,共5页Chinese Journal of Blood Transfusion

基　　金：青岛市医药科研指导计划(2014-WJZD169)

摘　　要：健康成人巨细胞病毒(CMV)血清学阳性率达40%-100%,CMV可经输血传播给免疫功能不全的高危患者,如先天性免疫缺陷病儿童、人类免疫缺陷病毒感染者、器官和/或造血干细胞移植受者、正在进行放/化疗的肿瘤患者、接受宫内输血的胎儿及低出生体重儿等,并导致严重播散性病变,甚至致命。因不同阶段受染献血者CMV可存在于血浆和/或白细胞中,预防输血传播CMV感染(TT-CMV)就变得相对复杂。长期以来,选择CMV血清学阴性血液作为"CMV安全血液"已成为广为接受的"标准策略",但最近核酸检测研究发现CMV-SN献血者的血浆或全血CMV DNA阳性率远高于CMV血清学阳性(CMV-SP)者,可能原因是CMV-SN献血者处于感染窗口期或血清学转换期。有充分的证据证明已在全球广泛开展的保存前全面去除白细胞(ULR)策略降低TT-CMV效果可靠。所谓的"双保险"策略,即采自CMV-SN献血者的血液再经ULR(SN+ULR),被认为与单用CMV-SN或单用ULR相比并无优势,反倒是SP+ULR更优。现有数据显示选择长期血清学阳性献血者血液再经ULR是目前最优方法。当然上述各种策略的优劣尚需高质量临床研究进一步证实。Human cytomegalovirus( CMV) presents a seroprevalence of between 40% and 100% in adult populations and can be transmitted by blood transfusion to the risk groups who are immune-compromised,such as the children with congenital immunodeficiency disorders,the human immunodeficiency virus-infected patients,the recipients of organ allografts and/or stem cells,the patients with cancer undergoing chemotherapy/radiotherapy,the fetuses who receive intrauterine transfusions and the low birth weight newborns. This can lead to severe,even fatal,disseminated disease. Because CMV in blood donors can exist in plasma and/or white blood cells at different stages,it becomes relatively intricate to prevent transfusion-transmitted CMV infections( TT-CMV). Blood from CMV-seronegative( CMV-SN) donors,as CMV-safe blood,has been widely accepted as the"standard strategy". Nonetheless,CMV DNA was found frequently in CMV-SN plasma or whole blood in recent nucleic acid testing( NAT) studies. This is most likely to be caused by window period donation and serological conversion stage donation. There has been sufficient evidence that the world-wide used universal leukoreduction( ULR) is effective and efficient in preventing TT-CMV. Unfortunately,the combined use of CMV-SN and ULR( SN+ULR),referred to as the"belt-and-suspenders"approach,is considered to be no superior to CMV-SN or ULR only. Furthermore,it is believed that the efficacy of the CMV-seropositive plus ULR( SP+ULR) approach is even better than SN+ULR. Current data indicates that leukoreduced blood from long-term seropositive donors processed by ULR is the optimal methods for now. It should be noted that all the approaches mentioned above remain to be further proven by high quality clinical studies.

关 键 词：CMV TT—CMV 预防 血清学筛查 去除白细胞 NAT 

分 类 号：R457.1[医药卫生—治疗学] R373[医药卫生—临床医学]