定量PCR检测CMV在异基因造血干细胞移植中的临床意义

Clinical significance of quantitative PCR detection of cytomegalovirus in allogeneic hematopoietic stem cell transplantation

目的通过监测造血干细胞移植后患者的外周血CMV DNA含量,探讨对患者进行抗病毒治疗的有效性。方法采用实时定量PCR方法对接受异基因造血干细胞移植（Allogeneic HCT）患者进行外周血CMV DNA定期检测。可评价患者57例,其中男38例,女19例,年龄13-59岁（中位年龄31岁）;含急性白血病30例（ALL 11例、AML 19例）,慢粒（CML）11例,淋巴瘤（NHL）8例,骨髓增生异常综合征（MDS）5例,急性重症再障（SAA）3例。在移植后每周检测1次,CMV DNA拷贝数〉102为阳性,连续2次〉103或1次〉1×10^4时行抗病毒治疗。结果57例患者中有32例（56.1%）在病程中检测到CMV DNA阳性,拷贝数1.2×10^2-7.8×10^5,行抗病毒治疗26例,死亡11例,仅1例与CMV感染有关。结论CMV DNA的定期检测可以使患者在病毒血症时及时接受治疗,减少CMV疾病的发生,有利于改善患者的生存。

Objective To study the effect of anti-virus therapy by monitoring the cytomegalovirus （CMV） level in peripheral blood of patients after hematopoietic stem cell transplantation （HSCT）. Methods CMV DNA in peripheral blood of patients after aUogenic HSCT was regularly detected by quantitative real-time PCR. Of the 57 patients （38 males, 19 females） at the age of 13-59 years （a median age of 31 years） who could be evaluated, 30 had acute leukemia, 11 had chronic myeloid leukemia （CML）, 8 had non Hodgkin lymphoma （NHL）, 5 had myeloid dysplastic syndrome （MDS）, and 3 had severe aplastic anemia （SAA）. CMV DNA was detected once a week after HSCT. Anti-virus therapy started when the CMV DNA copy number was over 10^3 twice or over 10^4 once. The treatment was lasted till one week after CMV DNA became negative. Results Of the 57 patients, 32（56.1%） were found to be positive for CMV DNA, the copy number of CMV DNA ranged 1.2 × 10^2-7.8 ×10^5. Of the 26 patients who received antivirus therapy, 11 died. Only one of the dead patients was found to be associated with CMV infection. Conclusion Regular detection of CMV DNA contributes to the timely treatment of viremia patients, decreases the occurrence of CMV disease, and prolongs their survival time.