异基因造血干细胞移植后HHV-6病毒感染的临床特征分析  

Clinical characteristics of HHV-6 infection after allogeneic hematopoietic stem cell transplantation

作　　者：黄莉 韩婷婷[1] 魏芳芳[1] 赵晓甦 孙于谦[1] 莫晓冬[1] 吕萌[1] 程翼飞[1] 许兰平[1] 张晓辉[1] 黄晓军[1] 王昱[1] Huang Li;Han Tingting;Wei Fangfang;Zhao Xiaosu;Sun Yuqian;Mo Xiaodong;Lyu Meng;Cheng Yifei;Xu Lanping;Zhang Xiaohui;Huang Xiaojun;Wang Yu(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;Hainan General Hospital,Hainan Affiliated Hospital of Hainan Medical University,Haikou 570311,China)

机构地区：[1]北京大学人民医院、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 [2]海南省人民医院/海南医科大学附属海南医院,海口570311

出　　处：《中华血液学杂志》2024年第11期991-997,共7页Chinese Journal of Hematology

基　　金：国家重点研发计划(2023YFC2508905);国家自然科学基金(82470214、82270227、82070189)。

摘　　要：目的分析异基因造血干细胞移植(allo-HSCT)后100 d内人类疱疹病毒6型(HHV-6)激活的临床表现,研究HHV-6病毒载量对临床表现的影响及抗病毒治疗对HHV-6激活转归的影响。方法回顾性研究2016年2月至2023年2月在北京大学血液病研究所接受allo-HSCT后100 d内HHV-6阳性的患者,分析患者的年龄、移植类型等基本特征以及临床表现,同时对移植后合并症等情况进行分析。结果研究纳入305例HHV-6感染患者,HHV-6检测阳性中位时间为移植后20 d。有15例患者无症状,其余患者根据临床表现发生率由高到低依次是:发热、皮疹、腹泻、出血性膀胱炎、血小板延迟植入、中枢神经系统症状、腹痛、肺炎和口周麻木。189例患者合并急性GVHD(其中45例HHV-6感染发生在急性GVHD之前,120例HHV-6感染发生在急性GVHD之后)。45例患者有HHV-6定量检测结果,病毒滴度高低在临床表现中差异无统计学意义。108例(35.41%)患者存在与其他病毒共激活情况,合并感染的病毒包括巨细胞病毒、BK病毒、EB病毒等,其中合并EB病毒激活是影响总生存(OS)的独立危险因素。抗病毒治疗与未抗病毒治疗组患者HHV-6转阴时间差异无统计学意义[7(5~10)d对8(4~14)d,P=0.199],5年OS率差异也无统计学意义[(82.7±2.6)%对(91.3±3.1)%,χ^(2)=3.304,P=0.069]。结论allo-HSCT后HHV-6感染患者临床表现以发热、皮疹和腹泻多见,与病毒滴度高低无明显相关性,且是否抗病毒治疗在HHV-6转阴时间与移植后5年OS率中未见显著性差异。Objective This study aimed to analyze the clinical manifestations of human herpesvirus 6(HHV-6)infection within 100 days after allogeneic hematopoietic stem cell transplantation(allo-HSCT)and to investigate the association of HHV-6 viral load with clinical outcomes as well as the effect of antiviral treatment on the course of HHV-6 infection.Methods This retrospective study included patients who tested positive for HHV-6 within 100 days after allo-HSCT at the Peking University Institute of Hematology from February 2016 to February 2023.The study analyzed the patients'baseline characteristics,including age and transplantation type,as well as their clinical manifestations.Additionally,post-transplant complications were examined.Results This study detected that 305 patients with HHV-6 infection were positive with a median time of 20 days post-transplant.Fifteen patients were asymptomatic,whereas the remaining patients exhibited the following symptoms:fever,rash,diarrhea,hemorrhagic cystitis,delayed platelet engraftment,central nervous system symptoms,abdominal pain,pneumonia and perioral numbness.Acute graft-versus-host disease(aGVHD)was diagnosed in 189 patients,with 45 cases of HHV-6 infection occurring before the onset of aGVHD and 120 cases occurring after aGVHD developed.Quantitative HHV-6 detection was available for 45 patients,and no statistically significant differences were found in the clinical manifestations according to the viral titer.A total of 108(35.41%)patients experienced coactivation with other viruses,including cytomegalovirus,BK virus,and Epstein-Barr virus(EBV).Notably,coinfection with EBV was determined as an independent risk factor for overall survival(OS).No statistically significant difference in the time to HHV-6 viral clearance was observed between the antiviral treatment and non-treatment groups[7(5–10)days vs 8(4–14)days,P=0.199].Similarly,the 5-year OS rates between the two groups were not significantly different[(82.7±2.6)%vs(91.3±3.1)%,χ^(2)=3.304,P=0.069].Discussion The most

关 键 词：异基因造血干细胞移植 HHV-6病毒 移植物抗宿主病 血小板延迟植入 

分 类 号：R457.7[医药卫生—治疗学]