儿童异基因造血干细胞移植术后巨细胞病毒感染临床分析  

Clinical analysis of cytomegalovirus infection after allogeneic hematopoietic stem cell transplantation in children

作　　者：朱成琳 陈广华[2] 翟宗 杨琪瑜 吕慧[1] 李捷[1] 王易[1] 胡绍燕[1] ZHU Chenglin;CHEN Guanghua;ZHAI Zong;YANG Qiyu;LYU Hui;LI Jie;WANG Yi;HU Shaoyan(Department of Hematology and Oncology,Children’s Hospital Affiliated to Soochow University,Suzhou 215000,Jiangsu,China;Jiangsu Institute of Hematology,The First Affiliated Hospital of Soochow University,Suzhou 215000,Jiangsu,China)

机构地区：[1]苏州大学附属儿童医院血液肿瘤科,江苏苏州215000 [2]苏州大学附属第一医院江苏省血液研究所,江苏苏州215000

出　　处：《临床儿科杂志》2020年第9期641-646,共6页Journal of Clinical Pediatrics

基　　金：苏州市科技计划项目(No.SS 2019065);江苏省妇幼健康科研项目(No.F201815);国家自然科学基金项目(No.81300444);江苏省自然科学基金项目(No.BK20130273);苏州市“科教兴卫”青年科技项目(No.KJXW2019024)。

摘　　要：目的探讨儿童异基因造血干细胞移植(allo-HSCT)后巨细胞病毒(CMV)感染的危险因素及临床相关特征。方法收集2016年1月至2018年12月共269例allo-HSCT患儿的临床资料。监测移植后全血CMV-DNA拷贝数,分析移植患儿CMV感染发生率、发生时间、危险因素及预后。结果269例患儿中,男167例、女102例,中位年龄65个月(33~115个月),其中165例发生CMV感染,感染率为61.3%,感染发生时间为移植后23 d(15~34 d),感染持续时间38 d(25~66 d)。Logistic回归分析发现患儿移植年龄>65个月、移植后发生Ⅱ~Ⅳ级aGVHD是发生CMV感染的危险因素,而亲缘全相合移植能降低CMV感染发生风险(P<0.05)。发生Ⅱ~Ⅳ级急性移植物抗宿主病(aGVHD)及使用脐血移植与发生难治性CMV感染相关(P<0.05)。难治性CMV感染组与非难治性CMV感染组总体生存率及无病生存率的差异有统计学意义(P<0.05)。结论移植患儿年龄大、Ⅱ~Ⅳ级aGVHD能增加CMV感染的发生风险,亲缘全相合移植能降低CMV感染的发生风险。脐血移植后易发生难治性CMV感染;难治性CMV感染初次检测到CMV感染时间早,峰值高。Objective To explore the risk factors and clinical characteristics of cytomegalovirus(CMV)infection after allogeneic hematopoietic stem cell transplantation(allo-HSCT)in children.Methods The clinical data of allo-HSCT in 269 children from January 2016 to December 2018 were collected.The copies of CMV-DNA in whole blood after transplantation were monitored.The incidence,time,risk factors,and prognosis of CMV infection were analyzed.Results A total of 269 cases(167 males and 102 females)were included and median age was months(33-115 months).Among them,165 cases had CMV infection and the infection rate was 61.3%.The infection occurred 23 days(15-34 days)after transplantation,and the infection lasted 38 days(25-66 days).Multivariate logistic regression analysis showed that transplantation age>65 months and gradeⅡ-ⅣaGVHD after transplantation were risk factors for CMV infection,while sibling donor hematopoietic stem cell transplantation(Sib-HSCT)could reduce the incidence of CMV infection(P<0.05).The occurrence of gradeⅡ-ⅣaGVHD and the use of cord blood transplantation are associated with the incidence of refractory CMV infection(P<0.05).The difference of the overall survival rate and disease-free survival rate between the refractory CMV infection group and the non-refractory CMV infection group was statistically significant(P<0.05).Conclusion The risk of CMV infection can be increased by older children andⅡ-ⅣaGVHD,while the risk can be reduced by Sib-HSCT.Refractory CMV infection was likely to occur after umbilical cord blood transplantation,and the initial detection time of refractory CMV infection was early and the peak value was high.

关 键 词：异基因造血干细胞移植 巨细胞病毒感染 危险因素 儿童 

分 类 号：R725.1[医药卫生—儿科] R457.7[医药卫生—临床医学]