异基因造血干细胞移植术后EB病毒感染的临床分析  

Clinical Analysis of Epstein-Barr Virus Infection after Allogeneic Hematopoietic Stem Cell Transplantation

作　　者：刘兰香[1] 汪晶[1] 王利[1] 刘林[1] 王欣[1] 张红宾[1] 唐晓琼[1] 熊艺颖[1] LIU Lan-Xiang;WANG Jing;WANG Li;LIU Lin;WANG Xin;ZHANG Hong-Bin;TANG Xiao-Qiong;XIONG Yi-Ying(Department of Hematology,The First Affiliated Hospital of Chongqing Medical Univerity,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院血液内科,重庆400016

出　　处：《中国实验血液学杂志》2024年第4期1217-1223,共7页Journal of Experimental Hematology

基　　金：重庆医科大学附属第一医院学科创新基金学科培育项目(03010203XKTS192)。

摘　　要：目的:分析异基因造血干细胞移植(allo-HSCT)后EB病毒(EBV)感染发生的危险因素及对生存的影响。方法:回顾性分析2014年1月-2021年6月于本院进行首次allo-AHCT患者的临床资料。共纳入347例接受allo-HSCT的患者,根据是否感染EB病毒(EBV)将其分为EBV组(n=114)和Non-EBV组(n=233)。统计患者allo-HSCT术后EBV感染的发生情况并分析EBV感染的危险因素。结果:有114例(32.8%)患者发生EBV感染(外周血EBV-DNA均阳性),其中,88例(77.2%)发生在移植后100 d内。5例(1.44%)确诊为PTLD(post-transplant lymphoproliferative disorder)。中位发病时间为移植后57(7-486)d。多因素分析结果显示,ATG/ATG-F的使用、CMV血症和Ⅲ-Ⅳ度aGVHD的发生是EBV感染的危险因素;此外,相对于BuCy,应用包含FA/CA的强化预处理方案者EBV感染的风险显著增高。结论:EBV感染是allo-HSCT术后常见并发症,强化预处理方案、ATG/ATG-F的使用、CMV血症和Ⅲ-Ⅳ度aGVHD的发生会增加allo-HSCT后EBV感染的风险。Objective:To analyze the risk factors of Epstein-Barr virus(EBV)infection after allogeneic hematopoietic stem cell transplantation(allo-HSCT)and its impact on survival.Methods:The clinical data of 347 patients who underwent their first allo-HSCT in our hospital from January 2014 to June 2021 were retrospectively analyzed.Patients were divided into EBV(n=114)and Non-EBV(n=233)groups according to whether they were infected with EBV.The incidence of EBV infection after allo-HSCT was calculated,and the risk factors of EBV infection were analyzed.Results:A total of 114(32.8%)patients presented EBV infection(all peripheral blood EBV-DNA were positive).EBV infection occurred in 88 patients within 100 days after transplantation,which accounted for 77.2%of all patients with EBV infection.5 cases(1.44%)were confirmed as post-transplant lymphoproliferative disorder(PTLD).The median onset time of patients was 57(7-486)days after transplantation.Multivariate analysis showed that the use of ATG/ATG-F,occurrence of CMV viremia,and gradeⅢ-ⅣaGVHD were risk factors for EBV infection.Furthermore,compared to BUCY,the use of intensified preconditioning regimens containing FA/CA was significantly increased the risk of EBV infection.Conclusion:EBV infection is a common complication after allo-HSCT.Intensified preconditioning regimens,use of ATG/ATG-F,CMV viremia and gradeⅢto IV aGVHD increase the risk of EBV infection after allo-HSCT.

关 键 词：异基因造血干细胞移植 EB病毒感染 危险因素 

分 类 号：R457.7[医药卫生—治疗学]