异基因造血干细胞移植后巨细胞病毒病及其危险因素分析

Cytomegalovirus diseases after allogeneic hematopoietic stem cell transplantation (Allo-HSCT) and related risk factors

目的 分析异基因造血干细胞移植 (Allo HSCT)患者巨细胞病毒 (CMV)病的发生及其高危因素。方法 选择自 1999年 8月至 2 0 0 1年 7月在本所行Allo HSCT患者 131例 ,用Kaplan Meier和Cox回归模型逐步回归方法 ,分析了CMV病的发生率及其相关的危险因素。结果 2 8例患者发生了CMV间质性肺炎 (2 1 35 % ) ;9例发生了CMV肠炎 (6 87% ) ,CMV病的一年累积发生率为 32 5 4 %。在单因素分析中 ,非血缘关系供者、用抗淋巴细胞球蛋白 (ALG)或抗CD3 单克隆抗体、Ⅱ Ⅳ度急性移植物抗宿主病 (GVHD)、因GVHD而加用免疫抑制剂、慢性GVHD、大剂量皮质激素、输血次数、患者血浆CMV阳性均与CMV病发生率增加有关 ;对CMV DNA阳性而无临床症状者进行干预性治疗使CMV DNA阴转 ,则有降低CMV病发生的作用。在多因素分析时 ,因血浆CMV DNA阳性、GVHD加用免疫抑制剂、大量输血使CMV病发生危险增加 (RR分别为 :3 30 9、2 2 4 2、1 0 4 6 ) ,而干预性治疗使CMV DNA转阴降低了发病危险 (RR为 0 346 )。 13例死于CMV病。结论 CMV病是Allo HSCT的常见并发症 ,也是主要致死原因之一。对血浆CMV阳性的患者进行干预性治疗至CMV转阴 ,可能会减少CMV病的发生。对合并II IV度GVHD。

Objective To analyze the incidence of cytomegalovirus (CMV) diseases after allogeneic hematopoietic stem cell transplantation (allo HSCT) and related risk factors. Methods The clinical data of 131 patients undergoing allo HSCT August 1999 to July 2001 were analyzed retrospectively. Results Twenty eight of the 131 patients developed CMV interstitial pneumonia (IP) with an incidence rate of 21.35%, 9 patients developed CMV enteritis with an incidence rate of 6.87%; in total 37 of the 131 patients developed CMV disease with the accumulative one year incidence rate of 32.54%. Thirteen patients (35.14%)died of CMV diseases. Univariate analysis showed that accumulative incidence of CMV disease was associated with unrelated donor, Ⅱ Ⅳ° acute graft versus host disease (aGVHD), additional immunosuppressive therapy for GVHD, chronic graft versus host disease (cGVHD), antilymphocyte globulin (ALG)/ monoclonal antibody (MoAb) administration, high dose of methylprednisolone (MP), plasma viramia PCR (PV PCR) positivity of patients, blood transfusion and pre emptive treatment. Multivariate analysis showed that risk factors for CMV disease included plasma CMV DNA positivity, immense amount of blood transfused, and additional immunosuppressive therapy for aGVHD, and pre emptive therapy capable of turning PV PCR positive reduced the incidence of CMV disease (RR:3.309, 1.046, 2.242, and 0.346 ). Conclusion CMV disease has a high morbidity and mortality in allo HSCT patients. Patients with positive plasma CMV DNA should receive pre emptive therapy till their plasma CMV DNA turns to be negative, especially in condition of severe aGVHD, immense amount of blood transfused, or additional immunosuppressive therapy.