异基因造血干细胞移植后患者巨细胞病毒感染的临床观察与危险因素探讨

Clinical observation of cytomegalovirus infection after allogeneic hematopoietic stem cell transplantation

目的总结异基因造血干细胞移植(allo-HSCT)后患者巨细胞病毒(CMV)感染发生特点、危险因素及抢先治疗的效果。方法收集本院血液科2013年1月-2014年12月165名allo-HSCT患者的临床资料,回顾性分析移植后CMV发生率、发生时间、并发症情况与种类,以及抢先治疗后的转阴情况;应用多因素分析寻找allo-HSCT后患者发生CMV感染的危险因素。结果本组allo-HSCT患者CMV血症发生率39.39%(65/165),首次出现CMV血症的中位时间是移植+43(+11-+507)d,65名CMV感染者中,10名(15.38%)发展为CMV病,其中3人为CMV肺炎、7人为CMV相关性出血性膀胱炎。经抢先治疗后,63名患者转阴,转阴率为96.92%。多因素分析显示:Ⅱ-Ⅳ度急性移植物抗宿主病(a GVHD)、预处理中使用抗人胸腺细胞球蛋白(ATG)、移植后<100 d连续≥2次环孢素(CSA)浓度>300 ng/m L或他克莫司(FK506)浓度>15 ng/m L是发生CMV血症的高危因素。结论 allo-HSCT患者CMV感染发生率较高,在预防a GVHD的同时,定期检测并及时调整免疫抑制剂浓度可能有助于减少CMV感染发生。

Objective To analyze the incidence, the risk factors and preemptive therapy efficacy of cytomegalovirus infection after allogeneic hematopoietic stem cell transplantation （allo-HSCT）. Methods The clinical data of 165 patients undergoing allo-HSCT in our department from January 2013 to December 2014 were retrospectively analyzed. Results The in- fection rate of CMV was 39.4% （65/165）. The median time of the first CMV viremia was 45 days after allo-HSCT. The majority of which occurred within 100 days post-transplantation. 10 patient developed CMV disease （3 with CMV pneumonia and 7 with CMV-related hemorrhagic cystitis）. CMV DNA was Cleared in 96.9% （63/65） patients after preemptive thera- py. The multivariate analysis showed that grade 1I -IV acute graft-versus-host disease （aGYHD）, the use of anti-thymocyte globulin（ATG） in the conditioning regimen, and serum cyclosporin （CSA） concentration 〉 300 ng/ml or tacrolimus （FKS06） 〉 15 nl^mL constitute the risk factors for CMV viremia. Conclusion CMV infection occurs frequently after allo- HSCT. To decrease the rate of CMV infection, the serum concentration of immunosuppressive agents should be monitored in patients who receive GVHD prophylaxis. It is essential to monitor CMV DNA and to strengthen preemptive therapy promptly in order to prevent CMV disease.