异基因造血干细胞移植后EB病毒感染情况分析

Prevalence of EBV infection in patients with allogeneic hematopoietic stem cell transplantation

目的分析异基因造血干细胞移植（allo-HSCT）后EB病毒感染情况。方法回顾性分析2010年1月至2011年12月于北京大学血液病研究所行allo-HSCT患者的临床资料。结果720例患者中男469例，女251例，中位年龄30（2～67）岁，其中66例患者发生EBV感染，累积发生率为（9．3±1．1）％，中位发生时间54．5（18～253）d。在HLA全相合、HLA半相合及非血缘移植患者中移植后1年EBV感染累积发生率分别为（1．3±0．7）％、（13．7±1．7）％和（9．1±4．4）％。在其中HLA半相合移植中EBV血症、临床诊断EBV病及淋巴细胞增殖性疾病（PTLD）的累积发生率分别为（5．8±1．1）％、（5．7±1．1）％和（2．3±0．7）％。所有感染EBV患者的总病死率为（33．9±5．9）％，不同EBV疾病患者的病死率：PTLD为（63．6±15．8）％，临床诊断的EBV病为（42．3±9．9）％，单纯EBV血症为（13．8±6．5）％。单因素和多因素分析均显示预处理过程中使用抗胸腺细胞球蛋白（ATG）是allo—HSCT后EBV感染及EBV病发生的独立危险因素。结论EBV感染是allo-HSCT后常见的合并症，尤其是EBV相关疾病及PTLD的患者病死率高，其发生的独立危险因素是预处理过程中使用ATG。

Objective To analyze the prevalence of Epstein Barr Virus （EBV） in patients following allogeneic hematopoietic stem cell transplantation （allo-HSCT）. Methods We retrospectively analyzed the clinical characteristics of 720 patients received allo-HSCT from January 2010 through December 2011 in the Stem Cell Transplant Center of People＇s Hospital. Results Of 720 patients （469 male presented and 251 females）, with a median age of 30 years （range, 2 to 67 years） old, 66 patients were presented with EBV reactivation. The cumulative incidence of EBV reactivation was （9.3±1.1）%, with a median days of 54.5 （range, 18 to 253 days）. During one-year post-transplantation, the cumulative incidences of EBV reactivation in sibling allo-HSCT, haplo-identical HSCT and unrelated donor HSCT were （1.3±0.7）%, （13.7±1.7）%, and （9.1±4.4）%, respectively. In patients with haplo-identical HSCT, the cumulative incidences of EBV viremia, probable EBV disease, and post-transplant lymphoproliferative disease （PTLD） were （5.8±1.1）%, （5.7±1.1）%, and （2.3±0.7）%. The mortality was （33.9±5.9）% in all patients with EBV infection： （63.6±15.8）% in PTLD, （42.3±9.9）% in probable EBV disease, （13.8±6.5）% in EBV viremia. By univariate and multivariate analysis, the use of ATG was an independent risk factor for EBV infection. Conclusion EBV reactivation is a common complication in patients with allo-HSCT, especially high mortality in PTLD and probable EBV disease. The use of ATG was an independent risk factor for EBV infection.