全血EB病毒DNA载量对异基因造血干细胞移植后淋巴增殖性疾病的诊断价值  

The diagnostic value of whole blood Epstein-Barr virus DNA load in lymphoproliferative diseases after allogeneic hematopoietic stem cell transplantation

作　　者：牛燕燕 董玉君[1] 尹玥[1] 许蔚林[1] 梁赜隐[1] 王倩[1] 李渊[1] 刘微[1] 欧晋平[1] 任汉云[1] Niu Yanyan;Dong Yujun;Yin Yue;Xu Weilin;Liang Zeyin;Wang Qian;Li Yuan;Lili Wei;Ou Jinping;Ren Hanyun(Department of Hematology Peking University First Hospital,Beijing 100034,China;Department of Hematology,Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences,Taiyuan 030032,China)

机构地区：[1]北京大学第一医院血液科,北京100034 [2]山西白求恩医院山西医学科学院血液科,太原030032

出　　处：《中华血液学杂志》2021年第11期904-910,共7页Chinese Journal of Hematology

摘　　要：目的探讨全血定量PCR法检测EB病毒(EBV)DNA载量对于异基因造血干细胞移植(allo-HSCT)后淋巴增殖性疾病(PTLD)的诊断价值。方法对2004年4月至2019年4月于北京大学第一医院血液科行allo-HSCT的694例血液病患者进行回顾性分析。结果①694例allo-HSCT患者中29例(4.2%)发生PTLD,其中男22例,女7例,中位年龄22(1~52)岁,中位发病时间为移植后2.1(0.8~20.6)个月。②单因素分析显示年龄<30岁、再生障碍性贫血、HLA配型不合、预处理方案中含有ATG、EBV再活化是PTLD发生的危险因素,多因素分析显示EBV再活化为PTLD发生的独立危险因素。③对于EBV再活化病例进一步分析发现PTLD组中位EBV-DNA载量峰值明显高于非PTLD组(P<0.001),且随EBV-DNA拷贝增高PTLD发生率有增高的趋势。ROC曲线分析提示当EBV-DNA载量>1.19×10^(6)拷贝/ml时诊断PTLD的可能性较大(灵敏度为0.800,特异度为0.768)。④全部PTLD病例均接受以利妥昔单抗为基础的治疗,总反应率为86.2%,总生存率为54.3%。结论allo-HSCT后PTLD的发生与EBV再活化高度相关,EBV-DNA载量越高发生PTLD的风险越大,动态监测EBV-DNA载量对预测PTLD发生有重要作用。Objectives To investigate the diagnostic value of whole blood quantitative PCR forDNA load of Epstein-Barr virus(EBV)in post-transplant lymphoproliferative diseasc(PTLD)afterallogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods A total of 694 patients withhematologic diseases who underwent allo-HSCT at the Hematology Department of Peking University FirstHospital from April 2004 to April 2019 were included,and their data were retrospectively analyzed.Results①Among the 694 cases,29 cases(22 males and 7 females,with a median age of 22(1-52)years)developed PTLD after allo-HSCT with a cumulative incidence of 4.2%and a median onset time of2.1(0.8-20.6)months.②Univariate analysis showed that age<30 years,diagnosis with aplastic anemia,human leukocyte antigen(HLA)mismatch,use of antithymocyte globulin(ATG)in preconditioningregimens,and EBV reactivation were the risk factors for the occurrence of PTLD.Multivariate analysisshowed that EBV reactivation was an independent risk factor for the occurrence of PTLD.③Furtheranalysis of EBV reactivation cascs showed that the peak value of EBV-DNA load was significantly higherin the PTLD group than that in the non-PTLD group(P<0.001)and the incidence of PTLD increased with the increase of EBV-DNA load.Receiver operating characteristic(ROC)curve analysis indicated thatPTLD was more likely to be diagnosed when the EBV-DNA load was>1.19×10^(6) copies/ml(sensitivity0.800 and specificity 0.768).④All patients with PTLD received rituximab-based treatment,with an overallresponse rate of 86.2%and an overall survival rate of 54.3%.Conclusion The PTLD occurrence afterallo-HSCT is highly correlated with EBV reactivation,and the higher the EBV-DNA load,the greater therisk of PTLD occurrence.The dynamic monitoring of EBV-DNA load plays an important role in predictingPTLD occurrence.

关 键 词：淋巴组织增殖性疾病 异基因造血干细胞移植 EB病毒再活化 

分 类 号：R551.2[医药卫生—血液循环系统疾病]