异基因造血干细胞移植病毒感染的临床特点及防治

The clinical feature and strategy for the management of virus infection after allogeneic hematopoietic stem cell transplantation

目的:分析异基因造血干细胞移植(allo-HSCT)患者病毒感染的发生特点及防治策略。方法:选择2002年3月-2009年5月在我院接受allo-HSCT患者75例,其中急、慢性白血病等恶性血液病71例,重型再障4例,预处理-9~2 d常规予更昔洛韦预防病毒感染。移植后早、中期用实时定量PCR法(RT-PCR)每周对巨细胞病毒(CMV)、腺病毒(ADV)、EB病毒(EBV)等进行DNA监测至+90 d。出现病毒血症即行早期干预性治疗。结果:75例患者出现89例次相关病毒感染,其发病率依次为CMV 44%,带状疱疹(VZV)34.7%,ADV 26%,EBV 17.3%及呼吸道合胞病毒(RSV)16.2%。其中ADV发病时间最早,CMV次之且好发于急性移植物抗宿主病(aGVHD)患者,而RSV易迅速恶化且常并发其他病原体感染。以上病例除1例死于RSV肺炎外,其他病例经及时治疗最终均得以控制。结论:应用RT-PCR法进行早期诊断及干预性治疗是控制移植后病毒感染的关键。

Objective：To analyze the clinical feature and strategy for the prophylaxis and treatment of virus infection after allogeneic hematopoietic stem cell transplantation（allo HSCT）.Method：Seventy five cases（71 cases with hematologic malignancies,4 cases with severe aplastic anemia）undergoing allo-HSCT in our hospital from March 2002 to April 2009 were included.Ganciclovir was administered on day-9^-2 for virus prevention.CMV,ADV and EBV DNA were monitored every week by real-time PCR（RT-PCR） until day ＋90.Preemptive treatment was given once viremia was defined.Result：89 episodes of virus infections occurred in 75 cases with CMV 44%,VZV 34.7%,ADV 26%,EBV 17.3% and RSV 16.2%.The ADV viremia happened earliest among all the virus infections.CMV infection was mostly common in patients with aGVHD.RSV infection appeared more quickly and aggressively and was often combined with other pathogens.All the patients recovered from virus infections except one patient who died of RSV pneumonia.Conclusion：Early diagnosis and preemptive treatment are the principal strategies to control virus infection after allo-HSCT.