重型再生障碍性贫血异基因造血干细胞移植术后CMV感染的临床分析  

Clinical Analysis of CMV Infection after Allogeneic Hematopoietic Stem Cell Transplantation in Severe Aplastic Anemia

作　　者：王乐玲 莫文健[1] 张玉平[1] 陈小卫[1] 王彩霞[1] 周铭[1] 王顺清[1] WANG Le-Ling;MO Wen-Jian;ZHANG Yu-Ping;CHEN Xiao-Wei;WANG Cai-Xia;ZHOU Ming;WANG Shun-Qing(Department of Hematology,Guangzhou NO.1 People's Hospital,Guangzhou Medical University,Guangzhou 510180,Guangdong Province,China;Department of General Internal Medicine,Guangzhou Chest Hospital,Guangxhou 510095,Guangdong Province,China)

机构地区：[1]广州医科大学附属广州市第一人民医院血液内科,广东广州510180 [2]广州市胸科医院综合内科,广东广州510095

出　　处：《中国实验血液学杂志》2021年第3期944-950,共7页Journal of Experimental Hematology

基　　金：广州市基础研究计划(202002030035)。

摘　　要：目的:探讨重型再生障碍性贫血(SAA)患者行异基因造血干细胞移植(allo-HSCT)后巨细胞病毒(CMV)感染的临床特点及其相关高危因素。方法:回顾性分析270例SAA患者行allo-HSCT的临床资料,包括108例同胞全相合和162例替代供者(68例非亲缘全相合和94例亲缘单倍体)。不同移植方式选择不同预处理方案。同胞全相合和单倍体的移植物均为骨髓和外周血干细胞,非亲缘供者移植物为外周血干细胞。待粒细胞植入后,定期监测血液CMV-DNA。同时采用流式细胞术测定移植术后第1、2、3、6、12个月的CD3^(+)、CD4^(+)T淋巴细胞、CD19^(+)B淋巴细胞的绝对数。结果:270例SAA患者移植后229例发生了CMV病毒感染,发生率为84.8%,其中有18例患者进展为巨细胞疾病。单因素分析显示,替代供者(非亲缘全相合及亲缘单倍体供者)、吗替麦考酚酯的应用以及急性移植物抗宿主病的发生与CMV感染相关,差异具有统计学意义(P <0.05)。多因素分析则显示,替代供者与CMV感染相关。替代供者6个月内CD3^(+)、CD4^(+)恢复较前同胞全相合组延迟。结论:Allo-HSCT后替代供者比同胞全相合供者移植更易发生CMV感染,且替代供者移植术后免疫功能重建延迟。Objective:To investigate the clinical characteristics and risk factors of cytomegalovirus(CMV) infection after allogeneic hematopoietic stem cell transplantation(allo-HSCT) in patients with severe aplastic anemia(SAA).Methods:Clinical data from 270 SAA patients with allo-HSCT were retrospectively analyzed,including 108 sib congruence patients and 162 substitute donors(68 unrelated donor congruence patients and 94 related haploid patients).Different pretreatment schemes were selected for different transplantation modes.The HLA-identical sibling and haploid grafts were all bone marrow and peripheral blood stem cells,and the grafts from unrelated donors were peripheral blood stem cells.After granulocyte implantation,blood CMV-DNA was regularly monitored.Flow cytometry was also used to determine the absolute number of CD3^(+),CD4^(+)T lymphocytes and CD19^(+)B lymphocytes at 1,2,3,6 and 12 months after transplantation.Results:CMV infection occurred in 229 of 270 patients with an incidence of 84.8%.Among them,18 patients developed giant cell disease.Univariate analysis showed that alternative donors(unrelated total and haploid donors),mycophenolate mofetil and acute graft-versus-host disease were statistically significantly associated with CMV infection(P <0.05).Multivariate analysis showed that alternative donors were associated with CMV infection.The recovery of CD3^(+) and CD4^(+) in 6 months in the substitute donors was delayed in comparison with that in the full sib group.Conclusion:After allo-HSCT,substitute donors are more easily to develop CMV infection than full-sibling donors,and the reconstruction of immune function is delayed after transplantation.

关 键 词：再生障碍性贫血 异基因造血干细胞移植术 替代供者(非亲缘全相合+单倍体供者) 巨细胞病毒感染 急性移植物抗宿主病 

分 类 号：R457.7[医药卫生—治疗学] R556.6[医药卫生—临床医学]