造血干细胞移植后巨细胞病毒感染临床分析

目的观察各种类型的造血干细胞移植（HSCT）后巨细胞病毒（CMV）感染的发生情况及疗效。方法选择我院59例异基因造血干细胞移植（allo—HSCT）和自体造血干细胞移植（auto—HSCT）患者移植后不同时期血和尿标本，检测CMV—pp65抗原及（或）CMV—DNA（荧光定量PCR法）进行动态观察分析。CMV感染的预防采用更昔洛书（DHPC）5～10mg／kg，1次／12h，分别在移植前第8天至移植当天及当CMV血清学检测阳性或发生CMV病时应用2-4周，并可同时应用大剂量丙种球蛋白。结果CMV感染在allo—HSCT后好发，非亲缘性移植CMV感染率高，9例allo—HSCT出现CMV感染发生在移植后＋42-＋68天，其中5例均存在不同程度的移植物抗宿主病（GVHD），尤其是Ⅱ～Ⅳ度急性GVHD，2例进展为巨细胞间质性肺炎（CMV-1P）；多为既往CMV感染被激活，对CMV—DNA阳性而无症状者进行预防治疗可使CMV—DNA阴转，可降低CMV病的发生。结论CMV病是allo—HSCT的常见并发症及主要致死原因之一；因此积极防治GVHD的发生及发展、定期监测CMV血清学阳性患者、早期干预性治疗可以提高移植的成功率。

Clinical study on cytomegalovirus infection in recipients of hematopoietic stem cell transplantation (HSCT)

Objective To study the incidence of cytomegalovirus(CMV) infection after allo-HSCT and auto-HSCT and its related therapeutic measures.?Methods Fifty-nine patients after allo-HSCT and auto-HSCT were tested for CMV-DNA(PCR) and CMV-pp65 in blood and/or urine at different time.For prophylaxis of CMV infection,ganciclovir 5-10(mg/kg) bid was given from day-8 to day 0.All plasma CMV positive patients were given ganciclovir 5-10 mg/kg bid for 14-28 days and big doses of gamma globulin.?Results CMV infection and CMV disease were especially associated with allo-HSCT patients and after unrelated donor HSCT.Nine allo-HSCT patients were found to be CMV positive 42 to 68 days after transplantation.All of the plasma CMV-DNA positve patients were given pre-emptive therapy until the CMV-DNA turned negative to reduce the incidence of CMV disease.?Conclusion CMV disease has a high morbidity and mortality in allo-HSCT patients.The incidence of CMV infection and CMV disease is associated with unrelated donor and GVHD,especially with severe acute GVHD.Effective prevention of GVHD and pre-emptive therapy for CMV infection may ensure the success of HSCT.