异基因造血干细胞移植后巨细胞病毒肺炎34例临床研究  

Clinical study of 34 patients with cytomegalovirus pneumonia after allogeneic hematopoietic stem cell transplantation

作　　者：李肃 沈再红[2] 万理萍 包爱华[2] 杨隽[2] 童茵[2] 王椿[2] Li Su;Shen Zaihong;Wan Liping;Bao Aihua;Yang Jun;Tong Yin;Wang Chun(Nanjin Medical University,Nanjing 211166,China;Department of Hematology,Shanghai General Hospital,Shanghai 200080,China)

机构地区：[1]南京医科大学,211166 [2]上海市第一人民医院血液科,200080

出　　处：《中华血液学杂志》2020年第10期843-847,共5页Chinese Journal of Hematology

基　　金：上海市科委西医引导项目(17411968300、19411970000)。

摘　　要：目的:分析异基因造血干细胞移植(allo-HSCT)后巨细胞病毒(CMV)肺炎的临床特点及预后。方法:对2016年3月1日至2019年6月30日在上海市第一人民医院血液科接受allo-HSCT后并发CMV肺炎的患者进行回顾性分析。结果:①全部411例allo-HSCT患者中,34例(8.3%)移植后发生CMV肺炎,其中男18例,女16例,中位年龄32(8~62)岁;急性髓系白血病14例,急性淋巴细胞白血病10例,骨髓增生异常综合征5例,非霍奇金淋巴瘤3例,再生障碍性贫血2例。②CMV肺炎中位发病时间为移植后53(36~506)d,主要症状为咳嗽(26例,76.5%)、发热(23例,67.6%)及气促(14例,41.2%),仅17.6%(6/34)的患者有咯痰,2例(5.9%)患者早期无明显症状而在常规胸部CT检查时发现。28例(82.4%)患者的影像学表现为小叶中心结节、弥漫毛玻璃影等典型间质性肺炎改变,6例(17.6%)表现为斑片、结节以及实变样不典型影像学改变。③26例(76.5%)患者血浆CMV-DNA阳性,拷贝数低于同期BALF检测结果[1.70×107(5.44×105~4.45×109)拷贝/L对1.45×108(1.10×107~1.10×1011)拷贝/L,P=0.004]。④13例(38.2%)CMV肺炎患者合并其他下呼吸道病原体感染(真菌10株,细菌6株,腺病毒1株)。⑤所有患者中位随访时间12.8(0.4~46.5)个月,总生存率为58.82%,年龄≥40岁、接受高流量通气是CMV肺炎患者独立预后不良因素(P=0.049,P=0.009)。结论:气管镜肺泡灌洗液检测有助于提升allo-HSCT后CMV肺炎病原学诊断的准确性。年龄≥40岁及接受高流量通气是CMV肺炎患者独立预后不良因素。Objective To analyze the clinical features and prognosis of cytomegalovirus pneumonia after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods We reviewed the clinical features and laboratory data of cytomegalovirus pneumonia patients after allogeneic peripheral blood HSCT from March 1,2016 to June 30,2019 at the hematology department of the Shanghai general hospital and analyze the prognostic factors.Results Of the 411 allo-HSCT patients,34(8.3%)developed CMV pneumonia after transplantation,including 18 men and 16 women,with a median age of 32(8-62)y.Total 14 patients had acute myeloid leukemia,10 had acute lymphoblastic leukemia,5 had myelodysplastic syndrome,3 had non-Hodgkin’s lymphoma,and 2 had aplastic anemia.The median onset time for CMV pneumonia was 53(36-506)d after transplantation.The main symptoms were cough(26 cases,76.5%),fever(23 cases,67.6%),and shortness of breath(14 cases,41.2%).Only 17.6%(6/34)patients had expectoration,and 2 cases(5.9%)had no obvious symptoms in the early stage,but were diagnosed on routine chest CT examination.Twenty-eight(82.4%)patients showed signs of typical interstitial pneumonia,such as lobular central nodule and diffuse ground glass opacity;6(17.6%)patients showed atypical imaging changes of patch,nodule,and consolidation.Further,26 patients(76.5%)were positive for CMV-DNA,and the copy number was lower than that of BALF[1.70×107(5.44×105-4.45×109)copies/L vs 1.45×108(1.10×107-1.10×1011)copies/L,P=0.004].Thirteen(38.24%)patients with CMV pneumonia had mixed infection with other lower respiratory tract pathogens(10 strains of fungi,6 strains of bacteria,and 1 of adenoviruses).The median follow-up duration was 12.8(0.4-46.5)months.The OS rate was 58.82%.Age≥40 y and high flow ventilation were independent risk factors for poor prognosis in CMV pneumonia patients(P=0.049,P=0.009).Conclusion Bronchoscopic bronchoalveolar lavage fluid detection helps in improving the accuracy of the etiological diagnosis of CMV pneumonia after allo-HSCT.Age≥40 y

关 键 词：异基因造血干细胞移植 巨细胞病毒肺炎 肺泡灌洗液 预后 

分 类 号：R563.1[医药卫生—呼吸系统]