造血干细胞移植受者免疫抑制治疗与巨细胞病毒感染的关系

Cytomegalovirus infection and immunosuppressant treatment in allogeneic hematopoietic stem cell transplantation recipients

目的:探讨异基因造血干细胞移植(HSCT)术后免疫抑制治疗个体外周血中巨细胞病毒(CMV)脱氧核糖核酸(DNA)与免疫抑制剂环孢素A(CsA)血药浓度变化的关系,并评价其潜在的临床应用价值。方法:选择行异基因HSCT的32例患者进行回顾性分析。移植前采用更昔洛韦预防CMV感染。移植后应用核酸扩增(PCR)荧光检测法定期进行CMVDNA监测。根据CMVDNA检测结果将患者分为CMVDNA阴性组和CMVDNA阳性组。用酶放大免疫技术(EMIT)定期监测CsA血药浓度,分析CMVDNA与CsA血药浓度的关系。结果:异基因造血干细胞患者CMV感染率为53.13%(17/32);DNA阳性组的CsA血药浓度明显高于CMVDNA阴性组(P<0.05);通过ROC曲线得出异基因干细胞移植患者使用CsA药物第7,14,21天时曲线下面积与0.5比较,差异具有统计学意义(P<0.05),分别对应的血药浓度为203.15,215.55和302.65ng/mL。结论:免疫抑制药物浓度可影响CMVDNA的动态变化,CsA血药浓度偏高可能是导致造血干细胞移植受者移植后对CMV易感的原因之一,适时监测CsA血药浓度对指导临床用药有一定的辅助价值。

Objective To explore the correlation between peripheral blood cytomegalovirus （ CMV） DNA level and cyclosporine A （ CsA） plasma concentration among allogeneic hematopoietic stem cell transplantation （ allo-HSCT） recipients who received immunosuppressant treatment,and to evaluate the potential clinical value. Methods A total of 32 allo-HSCT patients were enrolled and their data were analyzed retrospectively. Ganciclovir was used to prevent CMV infection before the transplantation. Routine fluorescence PCR was admitted to test the blood CMV DNA level. The patients were divided into 2 groups： a CMV DNA positive group and a CMV DNA negative group. Enzyme multiplied immunoassay technique was adopted regularly to monitor the blood CsA concentration. The correlation between CMV DNA level and CsA concentration was analyzed. Results The CMV infection rate in patients who received allo-HSCT was 53. 13% . The blood CsA concentration in the CMV DNA positive group was significantly higher than that in the CMV DNA negative group （ P 0. 05） . Through the ROC curve,the area under the curve on Day 1,7,and 14 had statistical significance compared with 0. 5,and the corresponding blood CsA concentration was 203. 15,215. 55, and 302. 65 ng / mL,respectively. Conclusion Immunosuppressive drug concentration can affect the dynamic changes of CMV DNA. High blood CsA concentration may be one of the reasons for CMV infection. Monitoring the blood CsA concentration may provide guidance for clinical treatment.