异基因造血干细胞移植患者脑脊液EB病毒检测的临床意义  

Clinical significance of Epstein-Barr Virus detection in the cerebrospinal fluid of patients who underwent hematopoietic stem cell transplantation

作　　者：何云[1] 马瑞 王慧芳 莫晓冬[1] 张圆圆[1] 吕萌[1] 闫晨华[1] 王昱[1] 张晓辉[1] 许兰平[1] 刘开彦[1] 黄晓军[1] 孙于谦[1] He Yun;Ma Rui;Wang Huifang;Mo Xiaodong;Zhang Yuanyuan;Lyu Meng;Yan Chenhua;Wang Yu;Zhang Xiaohui;Xu Lanping;Liu Kaiyan;Sun Yuqian;Huang Xiaojun(Peking University People's Hospital,Peking University Institute of Hematology,National Clinical Research Center for Hematologic Disease,Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation,Beijing 100044,China)

机构地区：[1]北京大学人民医院血液科,北京大学血液病研究所,国家血液系统疾病临床医学研究中心,造血干细胞移植治疗血液病北京市重点实验室,北京100044

出　　处：《中华血液学杂志》2023年第9期737-741,共5页Chinese Journal of Hematology

基　　金：国家自然科学基金(8227010768);科技部国家重点研发计划(2021YFC2500300)。

摘　　要：目的分析异基因造血干细胞移植患者脑脊液EB病毒检出情况及其临床意义。方法2017年1月至2022年6月,1100例在北京大学人民医院接受异基因造血干细胞移植的血液病患者因出现中枢神经系统症状送检脑脊液病毒检测,其中19例脑脊液EB病毒检测阳性,回顾性分析其临床特征、治疗及预后。结果19例脑脊液EB病毒阳性患者中男12例,女7例,年龄<18岁5例,≥18岁12例,中位年龄27(5~58)岁。急性髓系白血病7例,急性淋巴细胞白血病8例,再生障碍性贫血2例,霍奇金淋巴瘤1例,噬血细胞综合征1例。全部19例患者均为单倍体造血干细胞移植,其中二次移植1例。19例患者均有神经系统症状(头痛、头晕、抽搐或癫痫发作),其中13例患者伴发热。10例头颅影像学检查未见异常。19例患者中6例诊断为EB病毒相关中枢神经系统疾病,中位诊断时间为移植后50(22~363)d。9例(47.3%)患者外周血EB病毒检测阳性,均予以利妥昔单抗静脉滴注治疗(其中2例患者行腰椎穿刺鞘内注射给药),治疗后7例患者血EB病毒转为阴性。19例患者中2例复发,2例死于EB病毒感染,2例死于其他原因。结论异基因造血干细胞移植患者出现中枢神经系统症状时,应进行EB病毒检测;脑脊液EB病毒检测阳性提示存在EB病毒感染,但不能作为确诊依据。Objective To analyze the detection rate,clinical significance,and prognosis of Epstein-Barr virus(EBV)in the cerebrospinal fluid(CSF)of patients following allogeneic hematopoietic stem cell transplantation.Methods A retrospective analysis was performed on 1100 patients who underwent the CSF virus test after allogeneic hematopoietic stem cell transplantation in Peking University People’s Hospital between January 2017 and June 2022.Among them,19 patients were screened positive for EBV in their CSF,and their clinical characteristics,treatment,and prognosis were analyzed.Results Among 19 patients with EBV-positive cerebrospinal fluid,12 were male and 7 were female,with 5 patients aged<18 years and 12 aged≥18 years,with a median age of 27(5–58)years old.There were 7 cases of acute myeloid leukemia,8 of acute lymphocytic leukemia,2 of aplastic anemia,1 of Hodgkin’s lymphoma,and 1 of hemophagocytic syndrome.All 19 patients underwent haploid hematopoietic stem cell transplantation,including 1 secondary transplant.Nineteen patients had neurological symptoms(headache,dizziness,convulsions,or seizures),of which 13 had fever.Ten cases showed no abnormalities in cranial imaging examination.Among the 19 patients,6 were diagnosed with EB virus-related central nervous system diseases,with a median diagnosis time of 50(22–363)days after transplantation.In 9(47.3%)patients,EBV was detected in their peripheral blood,and they were treated with intravenous infusion of rituximab(including two patients who underwent lumbar puncture and intrathecal injection of rituximab).After treatment,EBV was not detected in seven patients.Among the 19 patients,2 died from EBV infection and 2 from other causes.Conclusion In patients who exhibited central nervous system symptoms after allogeneic hematopoietic stem cell transplantation,EBV should be screened as a potential pathogen.EBV detected in the CSF may indicate an infection;however,it does not confirm the diagnosis.

关 键 词：造血干细胞移植 EB病毒 脑脊液 

分 类 号：R457.7[医药卫生—治疗学]