儿童异基因造血干细胞移植后BK病毒脑炎临床研究

BK virus encephalitis in children with hematopoietic stem cell transplantation

目的探讨异基因造血干细胞移植患儿中BK病毒(BKV)脑炎的发病率、病死率、中位发病时间、临床表现、诊治及转归等,以提高临床医师对本病的认识。方法回顾性分析2015年1月1日至2020年12月31日在北京大学人民医院接受单倍型造血干细胞移植治疗的709例儿童患者,其中14例诊断为BKV脑炎,分析其临床特征、治疗过程及转归。结果BKV脑炎发生率为1.97%(14例)。患儿多为男性(12例),中位年龄为11岁,中位发病时间为移植后第55天。最常见的临床表现为意识障碍、抽搐发作(7例)。14例患儿予阿昔洛韦、更昔洛韦单用,或联合丙种球蛋白治疗,9例患儿痊愈,1例患儿死于病毒性脑炎,4例患儿死于其他疾病,病死率为35.7%。结论BKV脑炎主要表现为脑炎或脑膜炎。虽然确诊BKV脑炎后积极予药物治疗,但许多患者仍死于多器官衰竭或其他并发症。当异基因造血干细胞移植患者出现神经系统症状、出血性膀胱炎时,必须高度警惕BKV脑炎,尽早施救,从而改善患者的生存率及生活质量。

Objective To explore the morbidity,mortality,median onset time,clinical characteristics,diagnosis,treatment,and outcome of BK virus(BKV)central nervous system infection in children with allogeneic hematopoietic stem cell transplantation(allo-HSCT),and improve the understanding,clinical diagnosis,and treatment of the disease.Methods Seven hundred and nine children who received haploid HSCT treatment in Peking University People's Hospital from January 1,2015 to December 31,2020 were reviewed.Fourteen patients were diagnosed with BKV central nervous system infection,and their clinical characteristics,treatment process,and prognosis were analyzed.Results The incidence of BKV central nervous system infection was 1.97%(14 cases),mostly in men(12 cases),with a median age of 11 years old and median onset time of 55 d.Additionally,most of the cases showed disturbance of consciousness and seizures(seven cases).Furthermore,14 cases were treated with acyclovir and ganciclovir alone or with gamma globulin.Nine cases were cured,of which one died of viral encephalitis and four of other diseases,with a mortality rate of 35.7%.Conclusion Individuals with central nervous system involvement by BKV infection,usually show signs and symptoms of acute encephalitis,with some cases being accompanied by meningeal involvement.Although BKV encephalitis was diagnosed and actively treated with drugs,many patients still died of multiple organ failure or other complications.Therefore,when there are neurological symptoms and hemorrhagic cystitis in patients with allo-HSCT,it is necessary to be highly vigilant against BKV central nervous system infection.This helps to make clear diagnosis and treatment quickly;thus,improving the survival rate and quality of life of patients with HSCT.