异基因造血干细胞移植后带状疱疹的临床分析

Clinical analysis on herpes zoster in patients with allogenic hematopoeitic stem cell transplantation

目的探讨异体基因造血干细胞移植(allo-HSCT)后带状疱疹的发病情况、临床特点、诊治及预后。方法对河南省肿瘤医院血液科allo-HSCT受者带状疱疹的发生时间、临床表现、治疗及预后进行回顾性分析。结果可评估的191例接受allo-HSCT患者中有18例并发带状疱疹,发病率为9.42%,其中14例发生在干细胞移植治疗后3～12个月内。10例合并慢性移植物抗宿主病(GVHD),1例合并急性GVHD。临床表现主要为区域性皮肤疱疹。3例出现严重疱疹后神经痛,需强效止痛。无泛发性疱疹及内脏受累病例。所有患者接受抗病毒药物阿昔洛韦和阿糖腺苷静脉输注治疗,全部治愈,无疱疹相关死亡患者,平均治疗时间为15.5 d。结论带状疱疹是allo-HSCT后常见的病毒感染性疾病,主要发生在干细胞移植治疗后3～12个月,GVHD是其发生的高危因素。阿昔洛韦和阿糖腺苷的疗效较好。

Objective To investigate the incidence, characteristics, treatment, and outcomes of varicella-zoster virus （VZV） infection in patients after a11ogencic hematopoietic stem cell transplantation （allo-HSCT）. Methods The data of patients complicated with VZV after allo-HSCT in our hospital with emphasis on clinical date, treatments, clinical manifestations, follow-up results were analyzed, retrospectively. Results Total of 18 patients （9.42%） among the 191 evaluated patients were complicated with VZV infection after allo-HSCT, 14 of which （77.78%） had VZV infection during 3-12 months after allo-HSCT. Among the 18 patients with VZV, 10 patients occured chronic graft versus host disease （GVHD） and 1 with acute GVHD. Characteristic vesicular skin lesions occurred in a dermatomal distribution in all cases. Three patients developed severe neuralgia and required powerful pain relief. No patient had herpetic dissemination and visceral involvement. All cases were treated with acyclovir and/or arabinosyl adenine through intravenously for 15.5 days averagely. No patient died of VZV infection. Conclusions VZV infection was common in patients after allo-HSCT, which occurred during 3-12 months after treatment. GVHD was a high risk factor to VZV infection, acyclovir and arabinosyl adenine were effective drugs.