儿童异基因造血干细胞移植后巨细胞病毒感染的危险因素分析  

Analysis of risk factors for cytomegalovirus infection in children after allogeneic hematopoietic stem cell transplantation

作　　者：毛彦娜[1] 刘炜[1] 李彦格 屈钰华 段勇涛 王亚峰[1] 高海丽 王朝荣 田亮[1] 江华 MAO Yanna;LIU Wei;LI Yange;QU Yuhua;DUAN Yongtao;WANG Yafeng;GAO Haili;WANG Chaorong;TIAN Liang;JIANG Hua(Department of Hematology and Oncology,Children's Hospital Affiliated to Zhengzhou University,Henan Zhengzhou 450000,China;Department of Hematology and Oncology,Guangzhou Women and Children's Medical Center,Guangdong Guangzhou 510000,China)

机构地区：[1]郑州大学附属儿童医院血液肿瘤科,河南郑州450000 [2]广州市妇女儿童医疗中心血液肿瘤科,广东广州510000

出　　处：《现代肿瘤医学》2021年第21期3812-3815,共4页Journal of Modern Oncology

基　　金：河南省医学科技攻关计划资助项目(编号:LHGJ20190890)。

摘　　要：目的:分析儿童异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT)后患者巨细胞病毒(cytomegalovirus,CMV)感染的发生率及其危险因素,为CMV感染的监测及治疗提供参考。方法:通过回顾性分析2018年01月至2020年01月在郑州大学附属儿童医院血液肿瘤科、广州市妇女儿童医疗中心血液肿瘤科行异基因造血干细胞移植患者81例,应用χ^(2)检验及Logistics回归模型,分析CMV感染的发生率及其发生的危险因素。结果:81例患者中49例发生CMV感染,累计发生率为60.4%,首次发生CMV感染的时间为移植后37天(13~135天),所有患者经抗病毒后转为阴性,转阴中位时间为14天(7~51天)。单因素分析提示,CMV感染的发生与性别、疾病类型、供体来源、Ⅰ-Ⅱ度急性移植物抗宿主病(acute graft versus host disease,aGVHD)无明显相关性(P>0.05),与Ⅲ-Ⅳ度aGVHD的发生呈明显相关性(P<0.05);多因素分析提示aGVHD的发生是CMV感染的危险因素。结论:Allo-HSCT后aGVHD的发生增加了CMV感染的发生率,是CMV感染的危险因素。Objective:To analyze the incidence and risk factors of cytomegalovirus(CMV)infection in children after allogeneic hematopoietic stem cell transplantation(allo-HSCT),and to provide evidence for the monitoring and treatment of CMV infection in patients after allo-HSCT.Methods:A retrospective analysis of 81 patients treated byallo-HSCT in the hematology and oncology department of the Children's Hospital Affiliated to Zhengzhou University,and the hematology and oncology department of Guangzhou Women and Children's Medical Center from January 2018 to January 2020,were analyzed the incidence and risk factors of CMV infection by usingχ^(2) test and Logistic regression.Results:In the 81 cases,49 patients developed CMV infection with a cumulative incidence of 60.4%.The time for the first CMV infection was 37 days(13~135 days)after transplantation.All CMV positive patients turned negative after antiviral treatment and the median time for the CMV to turn negative is 14 days(7~51 days).Univariate analysis suggested that the occurrence of CMV infection has no significant correlation with gender,disease type,donor origin and the occurrence ofⅠ-Ⅱdegree acute graft versus host disease(aGVHD)(P>0.05),and has a significant correlation with the occurrence ofⅢ-Ⅳdegree aGVHD(P<0.05).Multivariate analysis showed that the occurrence of aGVHD was a risk factor for CMV infection.Conclusion:The occurrence of aGVHD after allo-HSCT increased the incidence of CMV infection and was a risk factor for CMV infection.

关 键 词：异基因造血干细胞移植 巨细胞病毒感染 危险因素 

分 类 号：R733.2[医药卫生—肿瘤]