造血干细胞移植患者巨细胞病毒感染危险因素和疗效分析

目的 :了解造血干细胞移植 (hematopoieticstemcelltransplantation ,HSCT)后巨细胞病毒 (Cy tomegalovirus,CMV)感染的发生率、相关危险因素及抗病毒药物疗效。 方法 :选择 1 998年 1月至 2 0 0 0年 1 2月在我所行HSCT的 2 0 2例患者进行回顾性分析。移植前预处理采用化疗联合全身照射或马利兰联合环磷酰胺方案。多数异基因HSCT移植后移植物抗宿主病 (graft versushostdisease,GVHD)预防采用环孢菌素A联合短程甲氨喋呤。CMV感染预防采用更昔洛韦 (ganciclovir,DHPG) 1 0mg·kg-1 ·d-1 ,分两次静点 ,移植前第 9天至移植前第 2天连续 8d。移植后应用多聚酶链反应 (PCR)定期进行病毒DNA监测 ,CMV阳性或发生CMV病的患者应用DH PG或 /和膦甲酸钠或联合这两种制剂进行治疗。结果 :HSCT后CMV活动性感染率为 35 .6 % (72 /2 0 2 ) ;间质性肺炎最常见占感染人数的 4 4 .4 % (32 /72 ) ,单纯病毒血症占 33.3% (2 4 /72 ) ,CMV肠炎占 1 3.9% (1 0 /72 )。感染的高峰时间为移植后第 6 0～ 90天。DHPG或 /和膦甲酸钠治疗的总有效率约为 6 0 %。经单因素分析证明异基因HSCT ,急、慢GVHD是HSCT后CMV感染的重要危险因素 ,而年龄、性别、疾病种类、移植前CMV血清学状态、预处理方案与CMV感染无显著相关性。结论 :CMV感

Risk factors of cytomegalovirus infection and antiviral efficacy in recepients of hematopoietic stem cell transplantation

OBJECTIVE: To analyze the incidence, risk factors and antiviral effect of cytomegalovirus infection after hematopoietic stem cell transplantation (HSCT). METHODS: Two hundred and two patients who underwent HSCT in our institution from Jan, 1998 to Dec, 2000 were analyzed in a retrospective way. Conditioning regimens consisted of total body irradiation (TBI) or busulfan plus cyclophosphomide. Allo-HSCT patients received cyclosporn A and short-term methotrexate as graft-versus host disease (GVHD) prophylaxis. As prophylaxis of CMV infection, 10 mg x (kg(-1) x d(-1)) ganciclovir were used per day for eight days before HSCT. Cytomegalovirus was detected after HSCT once a week using polymerase chain reaction (PCR) method. If CMV was positive or patients had signs of CMV disease, ganciclovir or/and foscarnet was used for the treatment. RESULTS: The incidence of CMV infection was 35.6% (72/202). Among these active infections, interstitial pneumonia accounted for 44.4%, viraemia 33.3% and CMV enteritis 13.9%. The peak interval of infection was from 60 to 90 days after HSCT. Effective rate of anti-CMV treatment was about 60%. Allo-HSCT, acute and chronic GVHD were important risk factors for CMV infection. Age, sex, disease status before HSCT, pre-conditioning regimen were not significantly associated with the occurrence of CMV infection. CONCLUSION: CMV infection is one of the important complications of allo-HSCT.Effective prevention and treatment may improve the survival rate for these patients.