儿童造血干细胞移植后EB病毒感染的临床分析

Clinical analysis of EB virus infection after hematopoietic stem cell transplantatation

目的探讨儿童造血干细胞移植(HSCT)术后EB病毒(EBV)感染的发生率、危险因素,为儿童HSCT后EBV感染的防治提供依据。方法回顾性分析2011年2月-2016年6月在北京儿童医院进行EBV感染检测的HSCT患儿共253例,收集患儿临床资料,分析儿童HSCT术后EBV感染的发病特点。结果 253例患儿中男153例,女100例,中位年龄4(1~16)岁。移植前采用定量PCR检测方法EBV-DNA阳性率17.8%,移植后90d内定量PCR检测EBV-DNA阳性共102例(40.3%)。移植后淋巴细胞增殖性疾病(PTLD)4例(1.6%)。移植前EBV-DNA阳性患儿移植后EBV-DNA阳性率(72%)高于移植前EBV-DNA阴性患儿(55%),但差异无显著性(P=0.066)。自体移植90d内EBV-DNA阳性率(17.9%)明显低于异体移植(69.6%)(P<0.01)。同胞全相合移植(MRD-HSCT)、无血缘移植(MUD-HSCT)与单倍体移植(Haplo-HSCT),移植后90 d内EBV-DNA阳性率差异有显著性(P<0.05),MRD、MUD及Haplo-HSCT的EBV-DNA阳性率依次升高。应用ATG的患儿移植后90d内EBV-DNA阳性率(57.6%)明显高于未应用ATG患儿(30.2%)(P<0.01)。结论儿童HSCT后EBV感染是常见并发症,移植前EBV阳性、Haplo-HSCT、MUD-HSCT及ATG应用是移植后发生EBV感染的高危因素。

Objective To investigate the incidence and risk factors of Epstein-Barr virus（EBV）infection in children after hematopoietic stem cell transplantation, and to provide evidence for prevention and treatment of EB virus infection after hematopoietic stem cell transplantation in children. Methods We retrospectively analyzed 253 children after hematopoietic stem cell transplantation in Beijing Children s Hospital from February 2011 to July 2016. The clinical data were collected and the features of pediatric hematopoietic stem cell transplantation patients with EBV infection were analyzed. Results Of 253 patients（153 male and 100 females） with a median age of 4（1 to 16） years old. EBV-DNA positive rate was 17. 8% before transplantation and 102 cases（40. 3%） of EBV-DNA positive within 90 days after transplantation. There were 4 cases（1.6%） of post-transplantation lymphoproliferative disease（ PTLD）.The positive rate of EBV-DNA（72%） in EB-DNA positive children before transplantation was higher than that in EBV-DNA negative children（55%） before transplantation, but there was no significant difference（P=0. 066）. The positive rate of EBV-DNA（ 17. 9%） in autologous transplantation was significantly lower than that in allograft（69.6%）（P〈0.01）. The positive rate of EBV-DNA in MRD,MUD and Haplo was significantly different（P〈0. 05）, and the positive rate of EBV-DNA was increased after 90 days of transplantation. The positive rate of EBV-DNA（57. 6%） in children with ATG was significantly higher than that in patients without ATG（30. 2%）（P〈0. 01）. Conclusions Epstein-Barr virus infection is common in children after hematopoietic stem cell transplantation. EB virus positive before transplantation, Haplo-HSCT, MUD-HSCT and ATG application are the high risk factors for EB virus infection after transplantation.