更昔洛韦玻璃体腔注射治疗HSCT术后并发巨细胞病毒性视网膜炎研究进展  

Advances in intravitreal ganciclovir treatment of cytomegalovirus retinitis after hematopoietic stem cell transplantation

作　　者：陈伟彬(综述) 赵明威[1] 苗恒(审校)[1] Chen Weibin;Zhao Mingwei;Miao Heng(Department of Ophthalmology and Clinical Center of Optometry,Peking University People's Hospital,Eye Diseases and Optometry Institute,Beijing Key Laboratory Diagnosis and Therapy of Retina and Choroid Diseases,College of Optometry,Peking University Health Science Center,Beijing 100044,China)

机构地区：[1]北京大学人民医院眼科,北京大学人民医院眼视光中心,北京大学人民医院眼病与视光医学研究所,视网膜脉络膜疾病诊治研究北京市重点实验室,北京大学医学部眼视光学院,北京100044

出　　处：《中华实验眼科杂志》2023年第10期1033-1037,共5页Chinese Journal Of Experimental Ophthalmology

基　　金：国家重点研发计划项目(2020YFC2008200);国家自然科学基金项目(81800847);北京大学人民医院学术新星基金项目(RS2018-05)。

摘　　要：造血干细胞移植术(HSCT)给许多血液病患者带来了延长生存期的可能,但移植术后患者往往因免疫功能低下而并发巨细胞病毒性视网膜炎(CMVR)。更昔洛韦玻璃体腔注射(IVG)是该病的主要治疗手段之一。因HSCT术后CMVR的治疗和随访尚缺乏标准化共识或指南,现存的IVG方案在给药剂量和给药频率上尚存在较大差异。基于房水病毒载量和细胞因子监测的大剂量IVG治疗和随访方案开始被应用于临床,并被证实可显著缩短治疗时长并减少注药次数。IVG造成视网膜毒性的病例报道十分罕见,其治疗HSCT术后CMVR是安全且有效的,但安全剂量范围尚需探索。本文从更昔洛韦的作用机制、系统性应用存在的问题、玻璃体腔注射的治疗方案、玻璃体腔注射的视网膜毒性几个方面就IVG治疗HSCT术后并发CMVR的研究进展进行综述。Hematopoietic stem cell transplantation(HSCT)brings the possibility to prolong survival for patients with different types of hematological diseases,but patients may be complicated with cytomegalovirus retinitis(CMVR)due to immunocompromised state.Intravitreous injection of ganciclovir(IVG)is a major treatment in CMVR after HSCT,but there are significant differences in the dosage and frequency among existing IVG protocols due to lack of standardized consensus or guidelines.High-dose IVG therapy and a follow-up plan based on aqueous humor virus load and cytokine monitoring have been applied in clinical practice,and it has been reported to shorten treatment duration and reduce number of injections.Reports of retinal toxicity caused by IVG are rare,and more exploration is needed to determine the safe dose range of IVG.This article reviewed the advances in IVG treatment of CMVR after HSCT focusing on the acting mechanism of ganciclovir,the problems in systematic application,the treatment plan involving intravitreal injection,and the retinal toxicity of intravitreal injection.

关 键 词：造血干细胞移植术 巨细胞病毒性视网膜炎 更昔洛韦 玻璃体腔注射 临床方案 

分 类 号：R779.6[医药卫生—眼科]