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1.
目的观察在不同类型造血干细胞移植中巨细胞病毒感染状况。方法应用半巢式PCR技术定期检测了2001-03~2003-07苏州大学附属第一医院住院病人55例移植病人外周血标本,比较不同类型移植CMV-DNA阳性率的差别。结果在检测的462份标本中,有285份为阳性,33/55(60%)患者CMV-DNA阳性,非清髓性造血干细胞移植(NST)的阳性检出率为15/17(88·2%),亲缘间外周血造血干细胞移植(PBSCT)的阳性检出率为3/7(42·9%),非亲缘性骨髓移植(UR-BMT)的阳性检出率为7/11(63·6%),亲缘性骨髓移植(R-BMT)的阳性检出率为8/20(40·0%)。NST与PBSCT、R-BMT的巨细胞病毒感染率差别显著(χ~2=5·44,P<0·05;χ~2=9·14,P<0·05),NST与UR-BMT(χ~2=2·39,P>0·05)间的差别无统计学意义。结论巨细胞病毒感染在不同的造血干细胞移植方式可能存在差异。  相似文献   

2.
Ganciclovir预防异基因造血干细胞移植后巨细胞病毒感染   总被引:12,自引:0,他引:12  
目的 :评价Ganciclovir在异基因造血干细胞移植 (allo HSCT)后预防巨细胞病毒 (CMV)感染的效果。方法 :观察allo HSCT患者 46例 ,全部病例均系移植前受者和 (或 )供者的CMV IgG阳性 ,分为预防组 2 4例 ,对照组 2 2例。allo HSCT后当患者血中性粒细胞 >1.0× 10 9/L时 ,预防组开始用GCV 10mg·kg-1·d-1,分两次静滴 ,连续 5d ;然后改为 5mg·kg-1·d-1,每周用 5d ,直至 +10 0d。对照组未预防性使用GCV。结果 :在 +10 0d内 ,预防组和对照组的CMV感染率分别为 8% (2 / 2 4)、32 % (7/ 2 2 ) ,P <0 .0 5 ;CMV病发病率分别为 0 %、18% (4 / 2 2 ) ,P <0 .0 5。两组患者在 +10 0d和 +180d内的死亡率分别为 4% (1/ 2 4)和 5 % (1/ 2 2 ) ,P >0 .0 5 ;12 .5 % (3/ 2 4)和 9% (2 / 2 2 ) ,P >0 .0 5。预防组的死因分别为并发细菌和真菌感染、CMV间质性肺炎或原发病复发 ;对照组的死因均是CMV间质性肺炎。结论 :allo HSCT后预防性使用GCV能明显抑制CMV感染 ,减少CMV病发病率。GCV的主要毒副作用是导致中性粒细胞减少 ,使患者继发感染甚至死亡的机率增加。GCV预防性使用的最佳剂量、用药方案及持续时间均有待进一步探讨  相似文献   

3.
目的:分析异基因造血干细胞移植(allo-HSCT)术后巨细胞病毒(CMV)感染的发生情况及其危险因素,为allo-HSCT后患者CMV感染提供防治依据。方法:回顾性分析徐州医科大学附属医院血液科于2013年1月—2021年12月收治的180例allo-HSCT患者的临床资料。统计allo-HSCT患者移植后CMV感染发生情况,将患者分为非CMV感染组和CMV感染组,比较2组间性别、年龄、移植前病毒感染情况、移植类型、人类白细胞抗原相合程度、急性移植物抗宿主病(aGVHD)发生情况等差异,并对CMV感染的危险因素进行分析。结果:180例患者中男92例,女88例,中位年龄33(6~66)岁,发生CMV感染101例,发生的中位时间为34(17~120) d, 1年内累积发生率为56.1%,发生在移植后100 d内100例,占全部CMV感染者的99%。多因素分析提示预处理过程中应用抗胸腺细胞球蛋白、单倍体移植、aGVHD、β2微球蛋白的水平降低及移植后EB病毒感染为CMV感染的独立危险因素。结论:通过对CMV感染发生的相关危险因素进行分析,可及时为CMV感染做出预防治疗,减少CMV血症向CM...  相似文献   

4.
[摘要] 目的 探讨实时荧光定量聚合酶链反应(PCR)方法监测造血干细胞移植(HSCT)患者人巨细胞病毒(HCMV)感染的临床意义。方法 应用实时荧光定量PCR方法动态监测32例造血干细胞移植患者血标本HCMV-DNA载量,并与30名健康对照者进行对比分析。结果 32例患者阳性率为21.9%(7/32),病死率为3.13%(1/32)。30名对照者阳性率为3.33%(1/30)。7例阳性患者均经CMV抗病毒治疗,其中1例在第56天死亡,1例在监测到70 d持续阳性,其余5例转阴。结论 实时荧光定量PCR方法检测HCMV-DNA对造血干细胞移植患者人巨细胞病毒感染的早期诊断及动态监测具有重要的临床意义。  相似文献   

5.
目的探讨应用实时定量聚合酶链反应(RQ-PCR)法对异基因造血干细胞移植(allo—HSCT)后巨细胞病毒(CMV)感染的诊断价值及对临床用药的指导意义。方法33例行allo-HSCT的患者于造血重建后,应用RQ-PCR法对其外周血CMV DNA进行动态检测,根据检测结果决定抗CMV治疗的开始、减量和终止,观察治疗效果和临床转归。结果共检出13例CMV感染患者,21次感染发作;除1次是患者中途放弃治疗外,余20次治疗中CMV DNA拷贝迅速转阴或下降至转阴,有临床表现者症状消失、器官功能恢复;且抗CMV疗程短于常规疗程。结论应用RQ—PCR法不但可以早期诊断CMV感染,及时干预治疗,还可以直观指导治疗的减量和终止、缩短疗程、减轻药物不良反应。  相似文献   

6.
马劼  牟海霞 《内科》2008,3(3):433-436
造血干细胞移植成为近年来治疗血液病、自身免疫性疾病等的有效手段。但是巨细胞病毒(cytomegalovirus,CMV)感染引起的间质性肺炎是移植后患者的主要感染并发症及死亡原因。因此早期诊断、早期预防性治疗CMV感染,降低移植受者的死亡率极为重要。本文对近年来造血干细胞移植后CMV的检测方法的研究进展做一简要综述。  相似文献   

7.
目的 回顾性分析抢先治疗异基因造血干细胞移植(allo-HSCT)后巨细胞病毒(CMV)感染的临床意义.方法 allo-HSCT治疗的患者103例,采用荧光定量PCR法监测CMV-DNA,并根据其结果抢先治疗CMV相关疾病,分析抢先治疗对于阻止CMV血症发展为CMV相关疾病的意义.结果 103例患者中检测出63例次(51例)CMV-DNA阳性,CMV血症发生率为49.5%,经抢先治疗19例发生CMV相关疾病,发生率为18.4%.60例次CMV血症经更昔洛韦和(或)膦甲酸治疗转阴,1例不可评价疗效,治疗的总有效率为96.8%(60/62).CMV相关疾病的治疗总有效率为89.5%(17/19),2例患者因CMV相关肺炎伴急性GVHD而死亡,CMV相关疾病的直接死亡率为1.9%(2/103).结论 在不进行预防性治疗的前提下,CMV血症和CMV相关疾病发生率未见升高.抢先治疗能有效阻止大部分CMV血症患者发病,并能有效控制CMV相关疾病的进展.  相似文献   

8.
目的:探讨异基因造血干细胞移植(allo-HSCT)后,巨细胞病毒(CMV)感染的发病情况及抗病毒治疗的疗效。方法:对在我所接受allo-HSCT的患者23例进行回顾性分析,均应用荧光定量PCR法(FQ-PCR法)检测外周血CMV-DNA含量。CMV感染应用更昔洛韦(GCV)10mg.kg-1.d-1进行治疗。结果:23例患者中7例移植后发生CMV感染,占30.43%。GCV治疗的总有效率约为85.71%。6例在GCV治疗过程中出现白细胞和血小板减少。结论:FQ-PCR法可以应用于allo-HSCT后早期准确诊断CMV感染。GCV对allo-HSCT后CMV感染的预防及治疗效果可靠。  相似文献   

9.
目的 回顾性分析抢先治疗异基因造血干细胞移植(allo-HSCT)后巨细胞病毒(CMV)感染的临床意义.方法 allo-HSCT治疗的患者103例,采用荧光定量PCR法监测CMV-DNA,并根据其结果抢先治疗CMV相关疾病,分析抢先治疗对于阻止CMV血症发展为CMV相关疾病的意义.结果 103例患者中检测出63例次(51例)CMV-DNA阳性,CMV血症发生率为49.5%,经抢先治疗19例发生CMV相关疾病,发生率为18.4%.60例次CMV血症经更昔洛韦和(或)膦甲酸治疗转阴,1例不可评价疗效,治疗的总有效率为96.8%(60/62).CMV相关疾病的治疗总有效率为89.5%(17/19),2例患者因CMV相关肺炎伴急性GVHD而死亡,CMV相关疾病的直接死亡率为1.9%(2/103).结论 在不进行预防性治疗的前提下,CMV血症和CMV相关疾病发生率未见升高.抢先治疗能有效阻止大部分CMV血症患者发病,并能有效控制CMV相关疾病的进展.  相似文献   

10.
目的 回顾性分析抢先治疗异基因造血干细胞移植(allo-HSCT)后巨细胞病毒(CMV)感染的临床意义.方法 allo-HSCT治疗的患者103例,采用荧光定量PCR法监测CMV-DNA,并根据其结果抢先治疗CMV相关疾病,分析抢先治疗对于阻止CMV血症发展为CMV相关疾病的意义.结果 103例患者中检测出63例次(51例)CMV-DNA阳性,CMV血症发生率为49.5%,经抢先治疗19例发生CMV相关疾病,发生率为18.4%.60例次CMV血症经更昔洛韦和(或)膦甲酸治疗转阴,1例不可评价疗效,治疗的总有效率为96.8%(60/62).CMV相关疾病的治疗总有效率为89.5%(17/19),2例患者因CMV相关肺炎伴急性GVHD而死亡,CMV相关疾病的直接死亡率为1.9%(2/103).结论 在不进行预防性治疗的前提下,CMV血症和CMV相关疾病发生率未见升高.抢先治疗能有效阻止大部分CMV血症患者发病,并能有效控制CMV相关疾病的进展.  相似文献   

11.
Allogeneic stem cell transplantation (SCT) using a myeloablative (MA) conditioning regimen is limited to relatively young patients because of increased transplant-related mortality in elderly patients. Nonmyeloablative (NMA) conditioning regimens have been developed aiming to reduce transplant mortality. In this study, we set out to evaluate the post-transplant occurrence of infectious complications in recipients of grafts from human leukocyte antigen (HLA)-identical sibling donors treated with either NMA or MA conditioning regimens. Data of 78 consecutively treated patients were analyzed. An NMA conditioning regimen was used in 40 patients and an MA regimen in 38 patients. A significantly lower rate of episodes of febrile neutropenia (0% vs. 34%, P<0.01) and post-transplant Epstein-Barr virus reactivations (0% vs. 18%, P<0.05) was found in SCT recipients treated with an NMA conditioning regimen compared with an MA conditioning regimen. Furthermore, fewer invasive fungal infections (2% vs. 12%, not significant) were diagnosed in the NMA group. The incidence of cytomegalovirus (CMV) reactivations and bacterial infections was low in both groups (CMV reactivations: 13% in both groups; bacterial infections: 10% in the NMA group vs. 8% in the MA group), while CMV disease developed in only 1 patient. Overall, compared to our MA regimen, we found a very low rate of infectious complications after NMA SCT.  相似文献   

12.
The aim of this prospective observational study was to evaluate the incidence of hemophagocytic syndrome (HPS) after hematopoietic stem cell transplantation (HSCT). Between July 2006 and December 2007, all patients who received a HSCT in our institution were included in this study. All the following criteria were needed for the diagnosis of HPS: sustained fever over 7 days; cytopenia (neutropenia and/or thrombocytopenia); presence of more than 3% mature macrophages in bone marrow; hyperferritinaemia (>1,000 ng/mL). During this study, 171 patients received a HSCT (68 allogeneic and 103 autologous). The median age was 32 years (3–62). We observed six cases of HPS (6/68; 8.8%) after allogeneic stem cell transplantation (ASCT): one case of EBV-related HPS, two cases of CMV-related HPS, and three cases with no evidence of bacterial, fungal or viral infections. We observed only one case of CMV-related HPS (1/103; 0.9%) after autologous stem cell transplantation. Four patients died despite aggressive supportive care. To our knowledge, this is the first prospective observational study conducted with the aim to evaluate the incidence of HPS after HSCT. This study provides a relatively high incidence of HPS after ASCT. When sustained fever with progressive cytopenia and hyperferritinaemia are observed, HPS should be suspected, and bone marrow aspirate considered. The rapid diagnosis of HPS and the early initiation of an appropriate treatment are essential for patient management.  相似文献   

13.
Cytomegalovirus (CMV) remains a serious problem after hematopoietic stem cell transplantation (HSCT). To investigate the incidence of CMV infection and outcome we retrospectively analyzed 70 consecutive pediatric allogeneic HSCTs monitored by CMV polymerase chain reaction (PCR), with at least 1-year follow-up or until death. All patients at risk for CMV infection (CMV-seropositive patients and CMV-seronegative recipients transplanted from CMV-seropositive donors) received hyperimmune anti-CMV globulins whereas in the group of HSCT patients with both donor and recipient CMV negativity, polyvalent immunoglobulins were given, both at a dose of 400 mg/kg. All patients received acyclovir at prophylactic doses for at least 6 months. Patients were monitored twice a week by CMV PCR. Patients with 2 positive results for CMV DNAemia received ganciclovir for 14 days and continued until 2 consecutive negative results were obtained. The incidence of CMV DNAemia was 12.8% (9/70) in the whole group, with significant higher risk for patients with CMV-seropositive recipient status, 8 out of 22 (36%), vs. patients with seronegative status, 1 out of 48 (2%) (P=0.0002). Three out of 9 patients with DNAemia developed CMV disease despite adequate preemptive treatment. The transplant-related mortality was higher in the CMV-seropositive recipient group (P=0.05). Age, use of hyperimmune anti-CMV globulins at a high dose, and the low incidence of graft-versus-host disease might be contributing factors to this low incidence.  相似文献   

14.
目的:探讨血浆荧光定量聚合酶链反应(Q—PCR)法对人巨细胞病毒(HCMV)活动性感染的诊断价值及对临床用药的指导意义。方法:收集15例患者共204份标本,应用荧光Q-PCR方法对其干细胞移植术后外周血浆HCMV-DNA进行动态监测。结果:血浆Q-PCR共检出8例患者共48份(23.52%)标本阳性;治疗有效者Q-PCR提示DNA拷贝迅速转阴,治疗耐药者Q-PCR提示DNA拷贝在停药后短期转阳或不转阴。结论:血浆Q-PCR是一种新的敏感、特异、快速的诊断方法,其HCMV-DNA的量化有助于早期诊断治疗,另对HCMV活化状态评估及药物疗效监测、减少药物滥用方面有重要的指导作用。  相似文献   

15.
16.
应用微卫星标志进行脐血干细胞移植后的植活检测   总被引:2,自引:0,他引:2  
目的:应用微卫星标志进行脐血干细胞移植后的植活检测,动态检测植活类型。方法:对12例脐血移植患者进行植活检测,其中10例作动态检测。另2例作随访检测。选用D12s2257、D12s2398、Dxs991、Dxs1199、D17s1292、D5s8186个微卫星位点为引物进行PCR扩增,扩增产物经8%聚丙烯酰胺凝胶电泳作银染色分析。取供者脐血或外周血及受者口腔黏膜DNA做为对照。结果:10例动态检测者移植后14d,6例为混合性嵌合(MC);第21天,7例为MC或完全性嵌合(CC),其中4例为CC;第28天,6例为CC。2例植活失败的病例始终未检测出嵌合表达。2例随访检测结果为CC。结论:应用微卫星标志进行脐血移植后的植活检测,能早期检测是否植活及嵌合类型。为临床治疗提供可靠的判断依据。  相似文献   

17.
Wu XJ  Wu DP  Sun AN  Ma X  Chang HR  Zhu ZL 《中华内科杂志》2005,44(4):290-292
目的初步探讨造血干细胞移植(HSCT)后巨细胞病毒(CMV)感染患者CMV糖蛋白(G)B基因分型及其与致病性的关系。方法研究了2001年3月至2003年12月在我院行HSCT的患者38例,均采用巢式PCR方法检测CMV GBDNA为阳性,对PCR产物用RsaⅠ和HinfⅠ内切酶进行了酶切分型。结果Ⅰ型19/38例(50.0%),Ⅱ型3/38例(7.9%),Ⅲ型14/38例(36.8%),Ⅰ与Ⅲ混合型2例。Ⅰ型感染预后良好,Ⅲ型与致死性间质性肺炎(IP)发生有明显的相关性。Ⅰ、Ⅲ型患者移植物抗宿主病(GVHD)的发生率差异无统计学意义。结论CMVGB蛋白的基因分型与CMV的IP发生有关,与GVHD的发生无明显相关性。  相似文献   

18.
Reactivation of varicella zoster virus (VZV) is a common event after stem cell transplantation (SCT). When activated in the abdominal cavity, the infection may be life threatening. Visceral presentation with VZV infection is uncommon, although probably an under-diagnosed event in post-SCT patients. The interval from onset of abdominal pain to the development of skin eruptions may delay the initiation of specific antiviral therapy and symptoms may be incorrectly diagnosed as surgical disease or graft-versus-host disease. We describe the case of a 53-year-old man who had undergone stem cell autograft for multiple myeloma and developed visceral VZV infection with hepatitis, melaena and subileus 7 months later.  相似文献   

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