胸腔脏器移植受者巨细胞病毒感染情况及预后分析  

Investigation of cytomegalovirus infection and disease in thoracic organ transplant recipients

作　　者：巨春蓉[1] 练巧燕 蔡宇航 陈奥 徐鑫[1] 韦兵[1] 黄丹霞[1] 陈荣昌 何建行[1] Ju Chunrong;Lian Qiaoyan;Cai Yuhang;Chen Ao;Xu Xin;Wei Bing;Huang Danxia;Chen Rongchang;He Jianxing(Department of Organ Transplantation,First Affiliated Hospital of Guangzhou Medical University,State Key Laboratory of Respiratory Disease,National Clinical Research Center for Respiratory Disease,Guangzhou Institute of Respiratory Health,Guangzhou 510120,China;Department of Respiration,First Affiliated Hospital of Southern University of Science and Technology,Second Clinical Medical College of Jinan University,Shenzhen People′s Hospital,Shenzhen Institute of Respiratory Diseases,Shenzhen 511357,China)

机构地区：[1]广州医科大学附属第一医院器官移植科呼吸疾病国家重点实验室呼吸疾病国家临床研究中心广州呼吸健康研究院 [2]深圳市人民医院呼吸内科深圳市呼吸疾病研究所南方科技大学第一附属医院暨南大学第二临床学院

出　　处：《中华移植杂志（电子版）》2021年第4期193-198,共6页Chinese Journal of Transplantation(Electronic Edition)

基　　金：2019年广州呼吸健康研究院/广医一院临床研究中心临床自主探索项目(2019GIRHZ04)。

摘　　要：目的调查胸腔脏器移植(TOT)供受者CMV-免疫球蛋白G(IgG)匹配情况,以及术后CMV感染及CMV病发生率并分析预后。方法回顾性分析广州医科大学附属第一医院TOT受者资料。收集移植前供、受者血清CMV-IgG检测结果,移植后受者症状、体征和影像学检查结果,以及外周血和支气管肺泡灌洗液CMV-DNA及肺组织病理学等检测结果。符合正态分布的计量资料以均数±标准差(±s)表示,采用单因素方差分析进行比较;不符合正态分布的计量资料以中位数表示。计数资料以构成比表示,采用卡方检验或Fisher确切概率法进行比较。采用Kaplan-Meier法绘制生存曲线,采用log-rank检验比较CMV病组与非CMV病组受者生存情况。结果2003年1月至2020年4月本院共完成TOT 314例,纳入301例受者进行移植前供受者CMV-IgG匹配情况分析;其中,肺移植269例,心脏移植19例,心肺联合移植13例。87.0%(262/301)的受者血清CMV-IgG阳性,85.0%(256/301)的供者血清CMV-IgG阳性。根据原发性CMV感染风险分层,高危(供者阳性/受者阴性,D+/R-)、中危(供者阳性/受者阳性)、低危(供者阴性/受者阳性)和极低危(供者阴性/受者阴性)比例分别为6.0%(18/301)、79.1%(238/301)、8.0%(24/301)和7.0%(21/301),上述分型在不同类型移植受者中的比例差异均无统计学意义(P均>0.05)。剔除12例术后早期(≤2周)死亡受者,对289例受者进一步分析CMV感染和CMV病发生情况。其中,177例(61.2%)受者至少发生1次单纯无症状性CMV感染,49例(17.0%)至少发生1次CMV病。原发性CMV感染危险层级不同的4组发生CMV病的受者比例差异有统计学意义,其中D+/R-组显著高于其他3组,差异有统计学意义(P<0.05)。截至2020年4月30日,289例受者中位随访时间为651 d(14~3652 d)。CMV病组与非CMV病组全因死亡率分别为67.4%和35.8%,差异有统计学意义(χ^(2)=15.4,P<0.05)。结论本院TOT受者中仅少数为原发性CMV感染的高危人群,绝大�Objective To investigate epidemiology of CMV-IgG in thoracic organ transplantation(TOT)donors and recipients,as well as the incidence of CMV infection and CMV disease in recipients and analyze the prognosis.Methods The study retrospectively analyzed the recipients who undergone TOT from January 1,2003 to April 30,2020 at the First Affiliated Hospital of Guangzhou Medical University.Clinical data were collected from the medical records which mainly included:serum CMV-immunoglobin(IgG)between donor(D)and recipient(R)pre-transplants,symptoms and signs,imaging performance,serum and bronchial alveolar lavage fluid levels of CMV-DNA and tissue biopsy.Results With excluding of 13 cases of incomplete data,the study recruited 301 cases with TOT,comprising of 269 lung transplants,19 heart transplants,and 16 heart and lung combined transplants.CMV-IgG information of donors and recipients were analyzed in the 301 cases.Serum CMV-IgG was positive in 87.0%(262/301)of recipients and 85.0%(256/301)of donors.According to the risk stratification of primary CMV infection,the proportions of high-risk(donor positive/recipient negative,D+/R-),intermediate-risk(donor positive/recipient positive),low-risk(donor negative/recipient positive)and very low-risk(donor negative/recipient negative)were 6.0%(18/301),79.1%(238/301),8.0%(24/301)and 7.0%(21/301),respectively,and there were no significant differences in the proportions of the above types in different types of transplant recipients(P>0.05 for all).Another 12 recipients were excluded from the further analysis who were died with 14 days post-transplantation,based on the exclusion criteria of this study.Thus,a total of 289 recipients were analyzed for the epidemiology of CMV infection and CMV diseases.There were 177(61.2%)recipients whose serum CMV-DNA were positive at least once and 49(17.0%)recipients who were diagnosed with CMV disease,with the incidence of CMV disease being presented highest in D+R-group.As of April 30,2020,289 recipients were followed up for 651 days(14-3652 days).

关 键 词：胸腔脏器移植 巨细胞病毒 巨细胞病毒病 

分 类 号：R655[医药卫生—外科学]