异基因造血干细胞移植后巨细胞病毒及多瘤病毒感染相关临床特征

目的探讨异基因造血干细胞移植(allo-HSCT)术后人巨细胞病毒(HCMV)和多瘤病毒(BKV和JCV)感染相关临床特征。方法收集2016年6月—2017年12月共53例行allo-HSCT的恶性血液病患者临床资料。移植当天开始监测患者外周血与尿的HCMV、BKV和JCV核酸载量,每周一次至100 d。分析病毒感染的发生率、发生时间、相关临床表现及危险因素。结果 51例患者发生病毒感染,感染率为96.23%。其中,HCMV感染率为54.72%(29/53)、BKV感染率为77.36%(41/53)、JCV感染率为28.30%(15/53)。肺部感染、急性移植物抗宿主病(aGVHD)和出血性膀胱炎(HC)的发生率分别为54.72%、58.49%和20.75%。危险因素分析显示:发生aGVHD(OR=24.61,95%CI:2.30～46.24)、预处理采用全身照射(OR=33.39,95%CI:1.57～79.13)及使用ATG(OR=24.77,95%CI:1.16～52.58)是影响HCMV血症的独立危险因素,HLA全相合(OR=0.003,95%CI:0.00～0.10)可降低发生HCMV血症的风险;预处理采用全身照射(OR=15.10,95%CI:1.14～39.27)是影响BKV尿症的独立危险因素,供受者血型相合(OR=0.07,95%CI:0.01～0.64)可降低发生BKV尿症的风险。结论移植术后应尽早监测受者血及尿中HCMV及多瘤病毒感染情况,以期及时预防及减少并发症的发生。

Clinical characteristics of human cytomegalovirus and polyomavirus infection after allogeneic hematopoietic stem cell transplantation

Objective To explore clinical characteristics of human cytomegalovirus (HCMV) and polyomavirus (BKV and JCV) infection after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods Clinical data of 53 patients with hematologic malignancies who underwent allo-HSCT from June 2016 to December 2017 were collected. HCMV, BKV and JCV loads in patients' peripheral blood and urine were monitored once a week from day 1 to day 100 after transplantation. Incidence, occurrence time, clinical manifestations, and risk factors of viral infection were analyzed. Results A total of 51 patients had viral infection, infection rate was 96.23%. HCMV, BKV, and JCV infection rates were 54.72% (29/53), 77.36% (41/53), and 28.30% (15/53) respectively. Incidences of pulmonary infection, acute graft-versus-host disease (aGVHD), and hemorrhagic cystitis (HC) were 54.72%, 58.49%, and 20.75% respectively. Analysis on risk factors showed that aGVHD (OR, 24.6195% CI, 2.30-46.24]), pretreatment with total body irradiation (TBI) (OR, 33.3995% CI, 1.57-79.13]), and use of antithymocyte globulin (ATG) (OR, 24.7795% CI, 1.16-52.58]) were independent risk factors affecting HCMV. Human leukocyte antigen (HLA) coincidence (OR, 0.00395% CI, 0.00-0.10]) could reduce the risk of HCMV viruria; pretreatment with TBI (OR, 15.1095% CI, 1.14-39.27]) was an independent risk factor for BKV viruria, compatible blood group of donor and recipient (OR, 0.0795% CI, 0.01-0.64]) could reduce the risk of BKV viruria. Conclusion HCMV and polyomavirus infection in blood and urine of recipient should be monitored as soon as possible after transplantation, so as to prevent and reduce complications in time.