造血干细胞移植后难治性/耐药性巨细胞病毒感染诊疗进展  

Refractory or resistant cytomegalovirus infections after hematopoietic stem cell transplantation:diagnosis and management

作　　者：张潇予 姜尔烈 Zhang Xiaoyu;Jiang Erlie(State Key Laboratory of Experimental Hematology,National Clinical Research Center for Blood Diseases,Tianjin Key Laboratory of Cell Therapy for Blood Diseases,Haihe Laboratory of Cell Ecosystem,Institute of Hematology&Blood Diseases Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Tianjin 300020,China;Tianjin Institutes of Health Science,Tianjin 301600,China)

机构地区：[1]中国医学科学院血液病医院(中国医学科学院血液学研究所)北京协和医学院,血液与健康全国重点实验室,国家血液系统疾病临床医学研究中心,天津市血液病细胞治疗研究重点实验室,细胞生态海河实验室,天津300020 [2]天津医学健康研究院,天津301600

出　　处：《中华血液学杂志》2024年第11期1058-1064,共7页Chinese Journal of Hematology

摘　　要：巨细胞病毒(CMV)感染是造血干细胞移植(HSCT)后最常见的机会性感染之一。尽管预防和抢先治疗可以降低CMV感染和CMV病的发生率,但仍有部分患者发展为难治性/耐药性(R/R)CMV感染,严重影响预后。对抗CMV治疗药物不耐受和发生耐药是患者发展为难治的重要原因。在CMV DNA定量PCR的基础上联合使用CMV特异性免疫介导(CMI)监测可以优化R/R CMV感染的诊断并指导个性化治疗。近年来,新型抗病毒药物、免疫治疗包括免疫球蛋白和病毒特异性T细胞治疗的探索,有望为该类患者提供更多的治疗选择。Cytomegalovirus(CMV)infection is one of the most prevalent opportunistic infections after hematopoietic stem cell transplantation(HSCT).Prophylaxis and preemptive therapy have demonstrated promise in reducing the incidence of CMV infection and CMV disease,but the management of refractory/resistant(R/R)CMV infections after HSCT remains a challenge that significantly affects the prognosis of patients undergoing HSCT.Intolerance and resistance to antivirals are the primary reasons for developing refractory CMV infections.CMV DNA quantification PCR combined with CMV-specific cellmediated immunity monitoring may help to optimize diagnosis and enable personalized management of R/R CMV infection.Novel antiviral drugs and other immunotherapies,including intravenous immunoglobulin and adoptive CMV T cell therapy,constitute an appealing option.

关 键 词：巨细胞病毒感染 机会性感染 个性化治疗 CMV感染 DNA定量 病毒特异性 免疫介导 抗病毒药物 

分 类 号：R457.7[医药卫生—治疗学]