多源化巨细胞病毒DNA定量检测在异基因造血干细胞移植后巨细胞病毒肺炎诊断中的应用

Application of quantitative detection of multiple-source cytomegalovirus DNA in diagnosis of cytomegalovirus pneumonia after allogeneic hematopoietic stem cell transplantation

目的研究不同来源[血浆、痰液、支气管肺泡灌洗液(BALF)]标本的巨细胞病毒(CMV)DNA定量检测对异基因造血干细胞移植后CMV肺炎的诊断价值。方法回顾性分析接受异基因造血干细胞移植的405例受者的临床资料,其中诊断为CMV肺炎的19例受者设为CMV肺炎组,选择同期仅发生CMV血症的229例受者、接受纤维支气管镜镜检的11例非CMV肺炎受者及根据病原学证据确诊细菌或真菌性肺炎进行痰培养的16例受者,分别设为对照A、B、C组。总结CMV肺炎的发生情况;分析CMV肺炎受者不同来源(血浆、痰液、BALF)标本的CMV DNA载量;总结CMV肺炎受者的预后情况。结果405例异基因造血干细胞移植受者中有19例发生了CMV肺炎,CMV肺炎总体发生率为4.7%(19/405)。CMV肺炎受者的血浆、痰液、BALF的CMV DNA载量均分别高于对照A、B、C组(均为P<0.05)。19例受者中,有12例经抗病毒治疗后治愈,7例治疗失败死亡(其中3例放弃治疗),病死率为37%(7/19)。结论血浆、痰液、BALF的CMV DNA定量检测可提高CMV肺炎的诊断率,从而改善异基因造血干细胞移植受者的预后。

Objective To evaluate the diagnostic value of quantitative detection of cytomegalovirus(CMV)DNA from different sources[plasma,sputum and bronchoalveolar lavage fluid(BALF)]for CMV pneumonia after allogeneic hematopoietic stem cell transplantation.Methods Clinical data of 405 recipients undergoing allogeneic hematopoietic stem cell transplantation were retrospectively analyzed.Among them,19 recipients diagnosed with CMV pneumonia were assigned into the CMV pneumonia group,and 229 recipients with CMV viremia alone,11 recipients without CMV pneumonia who received fiberoptic bronchoscopy and 16 recipients diagnosed with bacterial or fungal pneumonia based on pathogenic evidence receiving sputum culture were assigned into the control A,B and C groups,respectively.The incidence of CMV pneumonia was summarized.The CMV DNA load of specimens from different sources(plasma,sputum and BALF)of recipients with CMV pneumonia was analyzed.The clinical prognosis of recipients with CMV pneumonia was evaluated.Results Among 405 recipients undergoing allogeneic hematopoietic stem cell transplantation,19 cases developed CMV pneumonia,and the overall incidence of CMV pneumonia was 4.7%(19/405).The CMV DNA load in the plasma,sputum and BALF of recipients with CMV pneumonia was higher than those in the control A,B and C groups(all P<0.05).In the 19 recipients,12 cases were cured after antiviral treatment and 7 died from treatment failure(3 cases abandoned treatment).The fatality was 37%(7/19).Conclusions Quantitative detection of CMV DNA in the plasma,sputum and BALF may increase the diagnostic rate of CMV pneumonia,thereby improving clinical prognosis of recipients undergoing allogeneic hematopoietic stem cell transplantation.