异基因造血干细胞移植术后患者血CMV-DNA的定期监测及危险因素分析

Regular monitoring plasma CMV-DNA level and risk factors analyzing after allogenic hematopoietic stem cell transplantation

目的 观察异基因干细胞移植术（allo-HSCT）后患者血液巨细胞病毒DNA（CMV-DNA）阳性率,探讨巨细胞病毒感染的危险因素。方法 收集30例在2012年7月至2014年9月行allo-HSCT患者,用PCR方法定量检测患者移植术后第1个月（1次/周）、第2-3个月（1次/2周）、第4-6个月（1次/月）静脉血中CMV-DNA的拷贝数,统计各时期的阳性率。结果 30例患者有13例感染巨细胞病毒,感染率为43.3%。第1个月内阳性患者有4例（13.3%）,第2个月有11例（36.7%）,第3个月有2例（6.7%）,第4个月0例,第5个月有2例（6.7%）,第6个月0例。异基因干细胞移植术后半年内第2个月患者CMV-DNA阳性率较高。相关分析提示CMV-DNA阳性率与兔抗人胸腺细胞免疫球蛋白（ATG）、巴利昔单抗（CD25单抗）的使用、急性移植物抗宿主病（GVHD）的发生程度有关,与性别、年龄、原发病危险分层、人类白细胞抗原（HLA）相合情况、预处理方案、中性粒细胞恢复时间等无关。结论 定期监测allo-HSCT后患者血液CMV-DNA可及时干预,减少巨细胞病毒感染并发症。

Objective To observe the positive rate of plasma cytomegalovirus DNA（CMV-DNA）level after allogenic hematopoietic stem cell transplantation（allo-HSCT）,analysis and explore the risk factors related to CMV infection.Methods Choose 30 patients who had performed allo-HSCT in our department from July 2012 to September 2014.PCR were used regularly to detect the plasma CMV-DNA levels in these patients.The regular monitoring times were as follow：the first month（once a week）,the second to third month（twice a week）,the fourth to sixth month（once a month）after allo-HSCT respectively.The positive rates were counted in every period.Results Thirteen patients had CMV infection,and the infection rate were 43.3%.In the first month,there were4cases（13.3%）whose plasma CMV-DNA levels were positive,however,the positive cases in the second month,the third month,the fourth month,the fifth month and the sixth month were 11（36.7%）,2（6.7%）,0,2（6.7%）and 0respectively.Statistical data showed that it was in the second month after allo-HSCT that the CMV-DNA positive rate was higher than other periods.The analysis suggested that the positive rate of CMV-DNA related to the administration of rabbit anti-human thymocyte globulin（ATG）,basiliximab,and the occurrence of acute graft versus host disease（GVHD）,there were no relationship among gender,age,risk stratification of primary disease,HLA condition,preparative project,recovery time of neutrophile granulocyte.Conclusion It is necessary and beneficial to monitor blood CMV-DNA level regularly and take treatment early to avoid CMV related comobidity after alloHSCT.