异基因造血干细胞移植后CMV重激活与闭塞性细支气管炎相关性探讨  

Study on the correlation between CMV reactivation and bronchiolitis obliteans after allogeneic hematopoietic stem cell transplantation

作　　者：徐静[1] 陈广华[2] 宋铁梅[2] 朱子玲[2] 冯宇锋[2] 常惠荣[2] 陈峰[2] 马骁[2] 吴德沛[2] 

机构地区：[1]苏州大学附属第一医院娄葑分院血液科,215006 [2]苏州大学附属第一医院、江苏省血液研究所,卫生部血栓与止血重点实验室

出　　处：《中华血液学杂志》2015年第5期389-392,共4页Chinese Journal of Hematology

基　　金：国家自然科学基金（81300444）;江苏省自然科学基金（BK20130273）

摘　　要：目的 探讨异基因造血干细胞移植（allo-HSCT）术后CMV重激活与闭塞性细支气管炎（BO）的相互关系.方法 2011年1月至2013年12月行allo-HSCT的769例患者,通过荧光定量PCR方法检测CMV-DNA水平,免疫荧光染色白细胞PP65抗原血症两种检测方法诊断CMV感染,将CMV感染患者出现BO与未发生CMV感染患者出现BO进行比较,分析CMV感染与BO相关性,并将符合CMV感染患者中出现BO与未出现BO者进行对照分析.结果 诊断CMV感染259例患者中出现BO 32例（12.35％）,而未感染CMV的510例患者发生BO 8例（1.56％）,二者差异有统计学意义（P＜0.001）.将诊断CMV感染259例患者,发生BO 32例与未发生BO 227例的二组临床资料进行CMV相关临床分析比较.CMV病毒载量在105拷贝数/ml较低病毒载量102拷贝数/ml出现BO差异有统计学意义.结论 在allo-HSCT后导致BO的风险因素中,CMV感染是值得注意的相关因素之一,其中高病毒载量和CMV重激活和CMV肺炎是可能危险因素.Objective To investigate the correlation between CMV reactivation and obliterative bronchiolitis （BO） after allogeneic hematopoietic stem cell transplantation （allo-HSCT）.Methods From January 2011 to December 2013,769 patients underwent allo-HSCT.The CMV infection was diagnosed by fluorescence quantitative PCR method for detecting the level of CMV-DNA and immunofluorescence staining of PP65 antigen in white blood cell.The frequency of BO in patients with and without CMV infection was compared,and the correlation between CMV infection and BO was analyzed.The clinical data of CMV infection patients with and without BO were analyzed and compared.Results Of 259 diagnosed CMV infection patients,BO occurred in 32 cases,the incidence rate was 12.35%,while in 510 cases without CMV infection,BO occurred in 8 cases,the incidence was 1.56%.The incidence rate of BO is significantly higher in patients with CMV infection than that in patients without CMV infection （P〈 0.001）.The CMV related clinical data between the 32 cases with BO and 227 cases without BO were analyzed among the 259 cases of diagnosed CMV infection patients.BO incidence is higher in patients with more than 105 copies/ml CMV-DNA than that in patients with less than 102 copies/ml CMV-DNA.Conclusion Among the risk factors related to BO post allo-HSCT,CMV infection is one of them to be worthy of attention.CMV reactivation with high virus titer,multiple CMV reactivations and CMV pneumonia are the risk factors.

关 键 词：造血干细胞移植 巨细胞病毒 重激活 细支气管炎 闭塞性 

分 类 号：R457.7[医药卫生—治疗学]