异基因造血干细胞移植后巨细胞病毒感染患者临床及免疫特征分析  

Clinical and immunological characteristics of patients with CMV infection after allogeneic hematopoietic stem cell transplantation

作　　者：陈曼 赵玮 王榕 同格乐 傅旻婧 周静 李婷 王改玲 韩年举 王卉 Chen Man;Zhao Wei;Wang Rong;Tong Gele;Fu Minjing;Zhou Jing;Li Ting;Wang Gailing;Han Nianju;Wang Hui(Department of Laboratory Medicine,Hebei Yanda Lu Daopei Hospital,Langfang 065201,China;Transplantation Department,Beijing Lu Daopei Hospital,Beijing 100176,China;Department of Clinical Microbiology and Immunology,School of Medical Laboratory,Guizhou Medical University,Guiyang 550000,China;Department of Pathology and Medical Laboratory,Beijing Lu Daopei Hospital,Beijing100176,China)

机构地区：[1]河北燕达陆道培医院检验科,廊坊065201 [2]北京陆道培医院移植科,北京100176 [3]贵州医科大学检验医学院临床微生物与免疫学教研室,贵阳550000 [4]北京陆道培医院病理与医学检验科,北京100176

出　　处：《中华检验医学杂志》2024年第12期1442-1449,共8页Chinese Journal of Laboratory Medicine

基　　金：河北省医学科学研究课题(20232042)。

摘　　要：目的探讨异基因造血干细胞移植(allo-HSCT)后患者外周血淋巴细胞亚群特征在发生巨细胞病毒(CMV)感染鉴别中的意义及价值。方法回顾性研究。收集2021年5月31日至2023年1月30日北京陆道培医院收治的allo-HSCT患者。本研究收集了CMV感染组50例及非CMV感染组47例。采用流式细胞技术检测患者allo-HSCT后第30(+30)天时间点外周血淋巴细胞亚群,分析淋巴细胞绝对数及亚群在发生CMV感染组患者鉴别中的意义。采用Mann-Whitney U检验和χ^(2)检验。对单因素分析有统计学意义的指标再进行二元Logistic回归分析,并绘制ROC曲线。不同结局下各单因素的生存曲线采用Kaplan-Meier法,Log-rank检验。结果1.在CMV感染组患者中22%(11/50)明确CMV病毒血症合并CMV病,其外周血全血CMV病毒最高拷贝数1600(1400,5800)拷贝数/ml高于未明确合并CMV病患者970(670,2300)拷贝数/ml,差异有统计学意义(Z=-2.281,P=0.029)。2.CMV感染组患者随访终点OS为80%(40/50),非CMV感染组患者随访终点OS为87.2%(41/47)。两组随访终点OS上差异无统计学意义(χ^(2)=0.231,P=0.630)。3.在二元逻辑斯回归模型中,患者回输的CD34细胞数、移植后亚群CD3+CD38+T细胞占CD3+T细胞百分比、CD4+CD38+T细胞占CD4+淋巴细胞百分比为发生感染的重要独立危险因素,接受者操作特性曲线(ROC)曲线结果显示CMV感染的独立危险因素曲线下面积AUC=0.914(>0.7,P<0.001),决断值为0.702,敏感度0.857,特异度0.844。结论allo-HSCT移植后,CMV感染组免疫亚群显示较非CMV感染组有较低的T细胞和CD4+T细胞百分比,在T细胞分化上以TEM增多,NaiveT细胞减少为表现。并表明活化指标CD38在T细胞上的表达水平对于CMV感染有较好的判断价值。Objective:To investigate the significance and value of peripheral blood lymphocyte subset characteristics in patients following allogeneic hematopoietic stem cell transplantation(allo-HSCT)for distinguishing cytomegalovirus(CMV)infection.Methods:This retrospective study gathered data from allo-HSCT patients treated at Beijing Ludaopei Hospital between May 2021 and January 2023.This study included 50 patients in the CMV infection group and 47 patients in the non-CMV infection group.Flow cytometry was used to detect peripheral blood lymphocyte subsets 1 month after the allo-HSCT.The absolute lymphocyte count and their subsets were analyzed to assess their predictive significance in the occurrence of CMV infection.Mamn-whiney U test and χ^(2) test were used.Indicators with statistical significance in univariate analysis were further subjected to binary logistic regression analysis and receiver operating characteristic(ROC)curves construction.The generation of survival curves for different outcomes was conducted using the Kaplan-Meier method,and the Log-rank test was applied.A two-sided P-value of<0.05 was considered statistically significant.Results:1.Among patients in the CMV infection group,22%(11/50)were diagnosed with CMV viremia combined with CMV disease.The maximum CMV viral load in peripheral whole blood in these patients was 1600(1400,5800)copies/ml,which was significantly higher than that in patients without confirmed CMV disease 970(670,2300)copies/ml,with a statistically significant difference(Z=-2.281,P=0.029).2.The overall survival(OS)at the follow-up endpoint was 80%(40/50)in the CMV infection group and 87.2%(41/47)in the non-CMV infection group.There was no statistically significant difference in OS between the two groups at the follow-up endpoint(χ^(2)=0.231,P=0.630).3.In the binary logistic regression model,the number of CD34 cells transfused into the patient,the percentage of CD3+CD38+T cells in CD3+T cells,and the percentage of CD4+CD38+T cells in CD4+lymphocytes were identified as important ind

关 键 词：巨细胞病毒 异基因造血干细胞移植 淋巴细胞亚群 流式细胞术 

分 类 号：R457.7[医药卫生—治疗学] R511[医药卫生—临床医学]