摘要
目的:观察依据异基因造血干细胞移植前受者巨细胞病毒(CMV)血清学检测结果采取不同的CMV感染防治方案的临床效果。方法:行异基因造血干细胞移植的37例患者,移植预处理前1周依据受者CMV血清学检测结果,对于移植前PP65抗原、CMV抗体及CMV-DNA定量均阴性的受者,应用阿昔洛韦预防CMV感染;移植前PP65、IgM抗体及DNA定量阴性,IgG抗体阳性的受者应用静脉更昔洛韦预防CMV感染。预处理中及移植后均采用阿昔洛韦进行病毒感染的预防,并定期检测PP65及CMV-IgM和CMV-DNA定量,当出现PP65阳性和/或CMV-IgM阳性、病毒复制增加时,给予更昔洛韦或膦甲酸钠联合人免疫球蛋白治疗。结果:36例受者移植后检测CMV抗体IgG均为阳性,巨细胞病毒血症占18.9%(7/37),CMV病占10.8%(4/37),CMV感染的时间为移植后+27～+65d,CMV感染多见于非血缘、HLA不全相合及发生aGVHD的患者,经更昔洛韦和或膦甲酸钠治疗后无一例因CMV病死亡。应用不同预防CMV感染方法的患者间造血重建时间无明显差异。结论:依据受移植前受者血清学检测结果给予不同的预防方案并结合预先治疗方案防治CMV感染可以明显减少CMV潜伏感染转变为CMV病的概率,且对造血重建无影响。
Objective：To investigate the clinical effects of prevention and treatment of cytomegalovirus （CMV） latent infection in allogeneic peripheral blood stem cell transplantation （allo PBS（＇T） according to the different se rologic test results of cytomegalovlrus. Method：Thirty seven patients received allo-PBSCT in First Affiliated Hos pital of Xi＇an Jiao Tong University between January 2008 and October 2012. Their clinical charateristics were analyzed retrospectively. Patients with CMV IgG positive were given ganciclovir intravenously, while patients with negative CMV PP65 antigen and CMV-DNA were given acyclovir for prevention of CMV disease for one week before allo-PBSCT. All patients were given acyclovir during allo PBSCT. CMV infection was periodically tested. If CMV PP65 antigen,CMV-lgM or CMV DNA was positive, patients were given ganciclovir or forscarne1 sodium with immunoglobin. Result：Thirty six patients were with positive CMV Ig（;,seven cases were with positive CMY-DNA,and four cases suffered from CMV diseases after allo-PBSCT. The time of CMV infection ranged from twen ty seven to sixty five days post transplantation. CMV infection occurred more often in patients with unrelated do nors, HLA mismatched donors or a（;VHD. No patient died after treatment. There was no difference of hematopoieric reconstruction between patients receiving different anti CMV treatment. Conclusion：CMV diseases significantly decreased but hcmatopoietic reconstruction was not affected by preventing and treating CMV latent infection ac cording to different serologic test results in patients undergoing allo PBSCT.
出处
《临床血液学杂志》
CAS
2013年第3期298-300,304,共4页
Journal of Clinical Hematology
关键词
异基因造血干细胞移植
巨细胞病毒潜伏感染
CMV病
allogeneic peripheral blood stem cell transplantation
cytomegalovirus latent infection
cytomegalo virus disease
