造血干细胞移植患者巨细胞病毒感染危险因素和疗效分析  

Risk factors of cytomegalovirus infection and antiviral efficacy in recepients of hematopoietic stem cell transplantation

作　　者：丁昊炜[1] 任汉云[1] 郭乃榄[1] 黄晓军[1] 许兰平[1] 张耀臣[1] 陆道培[1] 

机构地区：[1]北京大学人民医院血液病研究所,北京100044

出　　处：《北京大学学报（医学版）》2003年第6期596-599,共4页Journal of Peking University:Health Sciences

摘　　要：目的 :了解造血干细胞移植 (hematopoieticstemcelltransplantation ,HSCT)后巨细胞病毒 (Cy tomegalovirus,CMV)感染的发生率、相关危险因素及抗病毒药物疗效。 方法 :选择 1 998年 1月至 2 0 0 0年 1 2月在我所行HSCT的 2 0 2例患者进行回顾性分析。移植前预处理采用化疗联合全身照射或马利兰联合环磷酰胺方案。多数异基因HSCT移植后移植物抗宿主病 (graft versushostdisease,GVHD)预防采用环孢菌素A联合短程甲氨喋呤。CMV感染预防采用更昔洛韦 (ganciclovir,DHPG) 1 0mg·kg-1 ·d-1 ,分两次静点 ,移植前第 9天至移植前第 2天连续 8d。移植后应用多聚酶链反应 (PCR)定期进行病毒DNA监测 ,CMV阳性或发生CMV病的患者应用DH PG或 /和膦甲酸钠或联合这两种制剂进行治疗。结果 :HSCT后CMV活动性感染率为 35 .6 % (72 /2 0 2 ) ;间质性肺炎最常见占感染人数的 4 4 .4 % (32 /72 ) ,单纯病毒血症占 33.3% (2 4 /72 ) ,CMV肠炎占 1 3.9% (1 0 /72 )。感染的高峰时间为移植后第 6 0～ 90天。DHPG或 /和膦甲酸钠治疗的总有效率约为 6 0 %。经单因素分析证明异基因HSCT ,急、慢GVHD是HSCT后CMV感染的重要危险因素 ,而年龄、性别、疾病种类、移植前CMV血清学状态、预处理方案与CMV感染无显著相关性。结论 :CMV感?Objective : To analyze the incidence, risk factors and antiviral effect of cytomegalovirus infection after hematopoietic stem cell transplantation (HSCT). Methods :Two handred and two patients who underwent HSCT in our institution from Jan, 1998 to Dec, 2000 were analyzed in a retrospective way. Conditioning regimens consisted of total body irradiation (TBI) or busulfan plus cyclophosphomide. Allo HSCT patients received cyclosporn A and short term methotrexate as graft versus host disease (GVHD) prophylaxis. As prophylaxis of CMV infection, 10 mg·kg -1 ·d -1 ganciclovir were used per day for eight days before HSCT. Cytomegalovirus was detected after HSCT once a week using polymerase chain reaction (PCR) method. If CMV was positive or patients had signs of CMV disease, ganciclovir or/and foscarnet was used for the treatment. Results:The incidence of CMV infection was 35.6% (72/202). Among these active infections, interstitial pnuemonia accounted for 44.4%, viraemia 33.3% and CMV enteritis 13.9%. The peak interval of infection was from 60 to 90 days after HSCT. Effective rate of anti CMV treatment was about 60%. Allo HSCT, acute and chronic GVHD were important risk factors for CMV infection. Age, sex, disease status before HSCT, pre conditioning regimen were not significantly associated with the occurrence of CMV infection. Conclusion: CMV infection is one of the important complications of allo HSCT.Effective prevention and treatment may improve the survival rate for these patients.

关 键 词：造血干细胞移植 巨细胞病毒感染 危险因素 疗效分析 

分 类 号：R457.7[医药卫生—治疗学]