儿童造血干细胞移植后巨细胞病毒感染的临床研究

Clinical study on children with cytomegalovirus infection after hematopoietic stem cell transplanta-tion

目的了解儿童造血干细胞移植后巨细胞病毒的感染率和防治方法。方法对从2001年8月到2007年3月北京儿童医院血液病中心37例作造血干细胞移植的血液肿瘤及先天遗传性疾病患儿进行回顾性分析。结果31例可研究病例中,5例自体造血干细胞移植及5例同基因造血干细胞移植患儿无人类巨细胞病毒(HCMV)感染,21例异基因造血干细胞移植患儿,发生HCMV感染7例,感染率为33.3%,大剂量阿昔洛韦加丙种球蛋白预防及早期更昔洛韦加大剂量静脉丙种球蛋白治疗,仅1例发生巨细胞病毒相关性间质性肺炎(CMV-IP),无1例发生巨细胞病毒感染相关死亡。结论巨细胞病毒感染是儿童造血干细胞移植术后的主要并发症,临床上进行定期监测、前瞻性预防、早期诊断和及时合理治疗,对降低移植术后巨细胞病毒感染和提高移植成功率至关重要。

Objectives To investigate the prevalence and prophylaxis of cytomegalovirus （CMV） infection after hematopoietic stem cell transplantation （HSCT） in children. Methods Retrospective analysis was performed on 37 cases which received HSCT for hematological malignancies and inheritory diseases from August 2001 to March 2007 in our centre. Results In the 31 recruited cases, HCMV infection was not detected in 5 eases of autologous HSCT and 5 cases of syngeneic HSCT. Among 21 patients undergoing allogeneic HSCT, 7 patients （33.3%） developed CMV infection. Using high dose acyclovir, intravenous immunoglobulin and pre-emptive ganciclovir, only one patient developed CMV interstitial pneumonia （CMV-IP） and there was not CMV-associated death. Conclusions CMV infection is a major complication after HSCT in children. Regular monitoring, prophylactic prevention, early diagnosis and timely treatment are important in reducing CMV infection and improving the success rate in children undergoing HSCT.