恶性血液病患者异基因造血干细胞移植后巨细胞病毒感染的监测及危险因素分析

 目的　探讨应用流式细胞术（FCM）检测急性白血病（AL）患者骨髓微小残留病（MRD）对预测复发及指导治疗的临床意义。方法　选择2005年7月至2008年6月于该院住院经MIC分型确诊的初治获完全缓解（CR）的43例AL患者，应用FCM和单克隆抗体直接荧光标记法检测骨髓MRD，并动态随访。结果　对初次受检MRD阳性患者动态观察骨髓形态学，平均1～3个月复查骨髓1次，所有复发患者均在MRD阳性后4～6个月出现形态学复发。MRD随访结果显示：43例AL患者CR时MRD阴性26例，6例复发，持续阴性20例。CR时MRD阳性17例，10例复发（58.82 %）。4例经加强化疗后MRD转阴达1年以上。43例患者CR时按MRD值水平分为三组，并观察1年复发率。＜1×10-4组和5×10-3～1×10-4组1年复发率差异无统计学意义（P＝0.37），5×10-3～1×10-4组和＞5×10-3组1年复发率差异有统计学意义（P＝0.02）。结论　应用FCM动态检测MRD对及时预测复发、指导治疗有重要的临床意义。

Dectection and risk factor analysis of cytomegalovirus infection after allogeneic hematopoietic stem cell transplantation

Objective To examine the frequency and the course of cytomegalovims infection after allogeneic hematopoietic stem cell transplantation, and correlation of transplant factors with Cytomegalovirus (CMV) infection and viral load. Methods Using real-time polymerase chain reaction, we detected the copies of CMV-DNA in blood samples of the 62 patients after allo-HSCT. Furthermore, we studied the relationship between transplant factors and CMV infection. Results Among the total, 23 cases were contracted with CMV infection, 4 cases developed to CMV disease. 22 cases were cured and 1 case died. Course of CMV infection influenced the viral load significantly. Donor type, stem cell source, use of ATG, Ⅱ-Ⅳ grade aGVHD, use of glucocorticoid, complicating with other infection and use of cellular filter significantly influenced CMV infection. However, in multivariate analysis, none of them was the independent risk factors. Conclusion Real-time polymerase chain reaction may be used to early diagnose of the CMV infection and to guide treatment. Many factors influenced CMV infection. Early diagnosis and treatment could decrease the morbidity and mortality of CMV infection.