儿童造血干细胞移植后EB病毒感染48例研究分析

Analysis of 48 cases of Epstein-Barr virus infection in children after hematopoietic stem cell transplantation

目的探讨儿童造血干细胞移植术后EB病毒感染的发生率和相关危险因素,为儿童造血干细胞移植术后的防治提供依据。方法回顾性分析2014年1月—2020年12月于我院儿科接受造血干细胞移植术治疗的48例恶性和非恶性血液疾病患儿,均接受清髓预处理方案和减低强度的预处理方案。结果(1)移植前采用定量PCR检测,EB病毒感染阳性率为12.50%(6/48);移植后3个月内采用定量PCR检测,EB病毒感染阳性率为41.67%(20/48),导致淋巴细胞增殖疾病1例(2.08%)。(2)移植前EB病毒阳性患儿,在移植后EB病毒感染阳性率为77.08%(37/48);而移植前未感染EB病毒的阴性患儿,在移植后EB病毒感染阳性率为50.00%(24/48),虽然感染率低于前者,但二者差异无显著性(P=0.058)。结论儿童在进行造血干细胞移植后监测EB病毒PCR的指南尚未完善,常规病毒PCR监测结果可提高医疗保健利用率和医源性失血量,并能够有效预防儿童在进行造血干细胞移植后EB病毒感染。

Objective To investigate the incidence and related risk factors of Epstein-Barr virus(EBV)infection after pediatric hematopoietic stem cell transplantation,and to provide evidence for the prevention and treatment of pediatric hematopoietic stem cell transplantation.Methods A retrospective study of 48 pediatric patients undergoing hematopoietic stem cell transplantation for malignant and non-malignant disease at our hospital from January 2014 and December 2020.All of them received pulp removal preconditioning and reduced-intensity preconditioning.Results(1)The positive rate of EBV infection was 12.50%(6/48)by quantitative PCR before transplantation.The positive rate of EBV infection was41.67%(20/48).Within 3 months after transplantation,there was 1 case of lymphocyte proliferative diseases(2.08%).(2)The positive rate of EB infection rate was 77.08%(37/48).The positive rate of EBV infection in the negative children who were not infected before transplantation was50.00%(24/48)after transplantation,although the infection rate was lower than that of the former,there was no significant difference between them(P=0.058).Conclusion The guidelines for monitoring EB virus PCR in children after hematopoietic stem cell transplantation are not yet perfected,and routine viral PCR monitoring results can improve healthcare utilization and iatrogenic blood loss,and effectively prevent EBV infection in children after hematopoietic stem cell transplantation.