摘要
目的：了解人腺病毒（ HAdv）在异基因造血干细胞移植（ allo－HSCT）后患者中的感染情况及临床特点，探讨allo－HSCT后进行HAdv监测的临床意义。方法按入选标准回顾性的纳入2012年10月至2014年8月在北京大学人民医院进行HAdv感染监测的allo－HSCT患者共845例，收集患者临床资料，采用实时荧光定量PCR（ real－time PCR）法监测患者外周血HAdv载量，监测频率为1周2次（＜100 d）或进行必要时监测（＞100 d），同时对患者粪便、尿、肺泡灌洗液HAdv感染情况进行必要时监测，随访时间至少allo－HSCT 后6个月，结合临床资料进行分析。结果共29例患者HAdv检测阳性，阳性率为3．4％（29／845），儿童（＜18岁）高于成人（≥18岁），分别为3．8％（6／155），3．3％（23／690）。 allo－HSCT后在100 d内检出HAdv阳性占总阳性例数的72．4％（21／29）。外周血HAdv阳性的患者19例，粪便16例，尿9例，肺泡灌洗液阳性1例，其中有1例患者外周血、粪便和尿均为阳性。 HAdv检出阳性的总体中位时间为69（13～189） d，粪便检出的中位时间56（53～144）d，早于外周血、尿。29例HAdv阳性患者中，17例合并巨细胞病毒血症，11例合并EB病毒血症，25例HAdv检测阳性前合并急性移植物抗宿主病（ GVHD ），4例合并慢性GVHD。临床以HAdv肠炎最为常见（14例），其次为出血性膀胱炎（7例），2例合并多器官损伤（＞2个），1例为肺炎，8例患者临床死亡。结论 HAdv是导致allo－HSCT后患者感染的重要病原体，且累及多器官，常合并巨细胞病毒和EB病毒感染，预后差，allo－HSCT后进行HAdv监测可指导临床及早治疗。（中华检验医学杂志，2017，40：133－137）
Objective To investigate the clinical characteristics of the human Adenovirus （HAdv） infections in allogeneic hematopoietic stem cell transplantation （ allo-HSCT） patients and explore the clinical significance of HAdv monitoring .Methods A total of 845 cases underwent allo-HSCT were included retrospectively in Perking University People′s Hospital from October 2012 to August 2014.Peripheral blood HAdv load were monitored twice weekly within 100 days after allo-HSCT, or whenever necessary quantitatively by real-time PCR. Meanwhile, other clinical samples such as stool , urine, and bronchoalveolar lavage fluid （ BLAF ） were also detected qualitatively whenever necessary .The follow-up period was at least six months after allo-HSCT.All clinical data were collected and analyzed .Results The total positive rate of HAdv was 3.4% （ 29/845 ） .The incidence of HAdv infection was higher in children [3.8%（6/155）, 〈18y] than that of adults [3.3%（23/690）,≥18y].HAdv infection diagnosed within 100 days after allo-HSCT accounted for 72.4%（21/29） of the total number of positive cases .There were 19 cases detected positive in peripheral blood , 16 cases in stool , 9 cases in urine , and 1 cases in BLAF , respectively.One patient was positive in peripheral blood , stool and urine.The overall median time of HAdv was 69 （13-189） d.The median time was 56 （53 -144） d in stool ,which was earlier than that of in＆amp;nbsp;peripheral blood , urine and stool.Among 29 cases of HAdv positive patients , 17 patients were coinfected with Cytomegalovirus（CMV） and 11 casess with Epstein-Barr virus（EBV）.Twenty-five cases of HAdv were diagnosed with acute graft-versus-host disease（aGVHD） before HAdv infection, and 4 cases were diagnosed with chronic graft-versus-host disease （ cGVHD ） . The most common clinical manifestation was HAdv enteritis （14 cases）, followed by hemorrhagic cystitis （7 cases）.Two cases complicated with multiple organ injury （ 〉2 ） clinically, 1 cases with
出处
《中华检验医学杂志》
CAS
CSCD
北大核心
2017年第2期133-137,共5页
Chinese Journal of Laboratory Medicine
关键词
腺病毒感染
人
造血干细胞移植
移植
异基因
Adenovirus infections,human
Hematopoietic stem cell transplantation
Transplantation,allogene
