单倍体骨髓移植后巨细胞病毒感染的防治

Prevention and management of cytomegalovirus infection after haploidentical bone manow transplantation

目的:研究单倍型骨髓移植后,巨细胞病毒(CMV)感染的预防策略及发病情况。方法:98例单倍型骨髓移植患者,62例及1例CMVpp65阳性供者,接受更昔若韦预防治疗,受者5 mg／kg,2次／d,移植前-9 d～-2 d,31例移植后出现CMV抗原血症阳性患者,其中18／60例预防组,13／35例非预防组阳性病例,接受更昔若韦5 mg／kg,2次／d×2周,后改为5 mg／kg,1次／d,到CMVpp65转阴。移植后CMVpp65每周检测1次。结果:预防组18／60例移植后出现CMV抗原血症阳性,出现中位时间56(25～84)d。非预防组13／35例CMVpp65阳性,中位时间52(19～75)d,前者1例患者(1．6％)发展为CMV结肠炎,后者4例(11．4％),2例CMV肺炎,1例CMV结肠炎,1例CMV脑炎。结论:单倍型骨髓移植后,用CMVpp65检测CMV抗原血症是一种简便,可靠的方法。低剂量短疗程,静脉注射更昔若韦提前预防CMV病可能是一种有效的方法。

Objective：To investigate the incidence of CMV infection and the method of prevention after haploidentical BMT. Method：In 98 patients receiving haploidentical BMT, 62 patients and one donor with pp65 positive received intravenous low-dose short-course ganciclovir 5 mg/kg twice daily before BMT-9 to-2 days as prophylaxis. 31 pp65 positive patients after-BMT （18/60 prophylaxis group and 13/35 non-prophylaxis） received ganciclovir. They were monitored weekly with CMV pp65 assay. If positive, these patients were given ganciclovir 5 mg/kg twice a day for 2 weeks, then 5 mg/kg once a day until pp65 become negative. Result; 18/60 patients （prophylaxis group） had CMV antigenemia at median of day 56（22-84）days and 13/35 patients （non prophylaxis group） CMV antigenemia occurred at a median of day 52 （19-75） day. Among CMVpp65 positive patients received ganciclovir prophylaxis, one patient developed CMV disese （CMV colitis 1.6%）. In non-prophylaxis group, four patients （11.4 %） developed CMV disease （two pneumonia, one colitis and one encephalitis）. Conclusion：CMV pp65 assay is a simple and reliable method for CMV antigenemia surveillance. Low dose short-course intravenous ganciclovir as prophylaxis for CMV disease is an effective method for patients receiving haploideatical BMT.