膦甲酸钠治疗血液病患者合并EB病毒感染的临床疗效

Efficacy and safety of foscarnet in the treatment of hematonosis complicated with Epstein-barr virus infection

目的探讨膦甲酸钠治疗血液病合并EBV感染患者,改善患者EBV血症的临床疗效、安全性及临床意义。方法回顾性分析2014年1月至2015年10月收治的血液病合并EBV感染患者112例,其中男70例,女42例,分为恶性血液病组(n=94例)和非恶性血液病组(n=18例),根据有无巨细胞病毒(CMV)感染以及是否接受骨髓移植治疗,恶性血液病组分为单纯EBV感染和合并CMV感染组,化疗组和骨髓移植组。以上患者均给予膦甲酸钠,60 mg/(kg·d),每12 h给药,每次静脉滴注至少3 h;疗程14 d,每周复查血常规、EBV病毒DNA定量和肝肾功,评价其治疗效果及不良反应。结果应用膦甲酸钠治疗血液病合并EBV感染患者总有效率72.3%,其中恶性血液病组有效率72.3%,非恶性血液病组有效率72.2%。两组差异无统计学意义(P>0.05)。采用非参数秩和检验进行不同年龄、性别之间的疗效比较,各组差异无统计学意义(P>0.05)。在恶性血液病组中,合并CMV感染组疗效比单纯EBV感染组好,差异有统计学意义(P<0.05),而化疗组和骨髓移植组相比疗效差异无统计学意义(P>0.05)。治疗后各组患者EBV的DNA拷贝数有不同程度下降,用药达到有效中位时间为10.3~14.5 d。不良反应主要有恶心、心慌等症状,均可耐受。结论膦甲酸钠治疗血液病患者的EBV感染具有较好的有效性,不良反应较少,安全可耐受。

Objective To investigate the efficacy of foscarnet in the treatment of hematonosis plus Epstein-barr virus （EBV） infection. Methods The clinical data of 112 cases of hematonosis complicated with EBV infection treated dur- ing Jan. 2014 and Oct. 2015 were retrospectively analyzed, including 70 males and 42 females. The patients were di- vided into malignant group （n = 84 ） and non-malignant group （n = 18 ）. Based on the presence of cytomegalovirus （CMV） infection and bone marrow transplantation, the malignant group was subdivided into 4 groups： simple EBV group, EBV plus CMV group, chemotherapy group, and bone marrow transplantation group. All patients were givenfoscarnet 60 mg/kg per 12 hours for 14 days. Peripheral blood samples were collected weekly for blood routine test, DNA quantity of EBV and liver-kidney function analysis, to evaluate the effect and adverse reactions of the treatment. Results The total effective rate was 72.3%, which was 72.3% and 72.2% respectively for the malignant group and non-malignant group, with no statistical difference （ P 〉 0.05 ）. There was no statistically significant difference in the effective rate between male and female groups and different age groups （ P 〉 0.05 ）. In the malignant group, EBV plus CMV group had higher effective rate than the simple EBV group, with statistically significant difference （ P 〈 0.05 ）, while there was no difference between the chemotherapy group and bone marrow transplantation group （ P 〉 0.05 ）. The copies of DNA of EBV decreased after treatment. The median time for effectiveness was 10.3 to 14.5 days. Adverse reactions such as nausea and palpitation were observed, but all were tolerable. Conclusion Foscarnet is safe and effec- tive in the treatment of EBV infection in patients with malignant hematonosis, with a few tolerable adverse reactions.