恶性血液病患者异基因造血干细胞移植后巨细胞病毒感染的监测及危险因素分析

Dectection and risk factor analysis of cytomegalovirus infection after allogeneic hematopoietic stem cell transplantation

目的探讨异基因造血干细胞移植（allo-HSCT）后巨细胞病毒（CMV）感染状况，分析CMV感染的高危因素及各因素对病毒负荷的影响。方法以62例接受allo-HSCT的恶性血液病患者为研究对象，应用定量PCR方法定期检测移植后患者外周血CMV-DNA，并动态观察，对相关因素与CMV感染的关系进行统计学分析。结果62例患者中，23例在移植后感染CMV，其中CMV病4例，仅CMV-DNA阳性19例。经治疗22例CMV-DNA转阴，1例死亡；CMV-DNA拷贝数与疾病严重程度相关，并可作为治疗效果判定的指标；供者类型、干细胞来源、抗人胸腺细胞球蛋白（ATG）应用、发生Ⅱ度以上移植物抗宿主病（GVHD）、应用糖皮质激素治疗、合并其他感染、白细胞滤器应用均显著影响CMV感染率；但未发现CMV感染的独立危险因素。结论定量PCR方法检测外周血CMV-DNA是监测CMV感染的可靠手段，多种因素影响CMV感染率，早期干预可减少CMV病的发生并降低死亡率。

Objective To examine the frequency and the course of cytomegalovirus infection after allogeneic hematopoietic stem cell transplantation, and correlation of transplant factors with Cytomegalovirus （CMV） infection and viral load. Methods Using real-time polymerase chain reaction, we detected the copies of CMV-DNA in blood samples of the 62 patients after allo-HSCT. Furthermore, we studied the relationship between transplant factors and CMV infection. Results Among the total, 23 cases were contracted with CMV infection, 4 cases developed to CMV disease. 22 cases were cured and 1 case died. Course of CMV infection influenced the viral load significantly. Donor type, stem cell source, use of ATG, Ⅱ-Ⅳ grade aGVHD, use of glucocorticoid, complicating with other infection and use of cellular filter significantly influenced CMV infection. However, in multivariate analysis, none of them was the independent risk factors. Conclusion Real-time polymerase chain reaction may be used to early diagnose of the CMV infection and to guide treatment. Many factors influenced CMV infection. Early diagnosis and treatment could decrease the morbidity and mortality of CMV infection.