异基因造血干细胞移植后EB病毒感染的危险因素及预后分析  

An analysis of risk factors and prognosis of Epstein-Barr virus infection after allogeneic hematopoietic stem cell transplantation

作　　者：张钦 邹秉含 楼晓 刘皓 张斌 陈虎 

机构地区：[1]解放军第三○七医院造血干细胞移植科全军造血干细胞研究所,北京100071

出　　处：《中华内科杂志》2016年第8期619-623,共5页Chinese Journal of Internal Medicine

摘　　要：目的 分析异基因造血干细胞移植后EB病毒感染的发生率,并探讨发生EB病毒感染的危险因素及预后.方法 回顾性分析2011年11月至2014年11月在我院行异基因造血干细胞移植的402例病例资料,采用Kaplan-Meier模型分析EB病毒感染的累积发生率及预后特征,以logistic回归模型分析发生EB病毒血症的危险因素.结果 异基因造血干细胞移植后EB病毒血症和移植后淋巴细胞增殖性疾病的1年累积发生率分别为42.0％、1.5％.发生EB病毒血症的危险因素为预处理中使用抗胸腺细胞球蛋白（ATG）（P＜0.001,OR=9.92）和发生Ⅲ-Ⅳ度急性移植物抗宿主病（P＜0.01,OR =2.42）.具有2个危险因素的患者的EB病毒血症1年累积发生率明显高于无危险因素的患者（87.5％比24.6％,P＜0.001）.发生EB病毒血症患者的3年总生存率明显低于未发生EB病毒血症的患者（58.5％比75.4％,P ＜0.001）.结论 造血干细胞移植后EB病毒感染的发生率较高,影响患者预后,使用ATG与发生重度急性移植物抗宿主病是发生EB病毒血症的危险因素。Objective To analyze the incidence of Epstein-Barr virus （EBV） infection in patients after allogeneic hematopoietic stem cell transplantation （HSCT）,and investigate its risk factors and prognosis.Methods A total of 402 patients receiving HSCT were retrospectively studied from November 2011 to November 2014 in the 307th Hospital of Chinese People＆#39;s Liberation Army.The cumulative incidence （CI） of EBV infection and survival rate were analyzed by Kaplan-Meier method,while risk factors were assessed by logistic regression model.Results The one-year CI of EBV viremia and post-transplant lymphoproliferative disease （PTLD） were 42.0% and 1.5%,respectively.Using antithymocyte globulin （ATG） （P 〈 0.001,OR =9.92） and acute graft-versus-host disease （GVHD） grade Ⅲ to Ⅳ （P 〈 0.01,OR =2.42） were related risk factors of EBV viremia.There was a higher CI of EBV viremia in patients with 2 risk factors compared with those without （87.5% vs 24.6%,P 〈0.001）.Patients with EBV viremia had significant shorter three-year overall survival than patients without （58.5% vs 75.4%,P 〈 0.001）.Conclusions The incidence of EBV infection in patients undergoing HSCT is high,which poses a threat on prognosis.Risk factors of EBV viremia include administration of ATG and severe acute GVHD.

关 键 词：造血干细胞移植 EB病毒感染 危险因素 预后 

分 类 号：R457.7[医药卫生—治疗学]