摘要
目的探讨异基因造血干细胞移植后低载量巨细胞病毒（CMV）血症抢先治疗的时机。方法选择2014年9月1日—2015年2月28日北京大学血液病研究所行异基因造血干细胞移植后的新发低载量CMV血症且不伴明显CMV相关临床症状的患者作为研究对象。采用实时定量聚合酶链反应（RQ-PCR）技术检测血浆CMV DNA，每周检测2次，直至移植后3-6个月。CMV DNA〉1×10^3 copies/ml定义为CMV阳性（CMV血症）；＂低载量＂定义为CMV DNA 1×10^3-5×10^3 copies/ml。2014年9月1日—10月31日的37例患者作为对照组，确认CMV血症后即刻开始抗病毒治疗；2014年11月6日—2015年2月28日的58例患者作为试验组，初始未行干预。观察两组的病情演变及抗病毒治疗情况。结果（1）试验组自行转阴者17例（29.3%）。（2）试验组41例患者先后接受药物干预，26例（44.8%）在第2次CMV检测阳性后接受抗病毒药物干预，其中18例CMV DNA〉5×10^3 copies/ml，8例低载量病例中，合并发热2例，合并膀胱炎2例，无症状者4例；11例（19.0%）患者在第3次CMV检测阳性时开始药物干预，其中5例CMV DNA〉5×10^3 copies/ml，6例低载量病例中，合并发热＋腹泻1例，无症状者5例；分别在第4次及第5次CMV检测阳性时开始抗病毒治疗者各2例，CMV DNA均〉5×10^3 copies/ml；需药物干预的这41例患者中，首选更昔洛韦者35例，膦甲酸钠者6例。（3）病程中的中性粒细胞最低值试验组[（1.63±0.41）×10^9/L]与对照组[（1.58±0.36）×10^9/L]的差异无统计学意义（P〉0.05）；试验组发病1周内CMV DNA〉5×10^3 copies/ml的例数为19例（32.8%），对照组为12例（32.4%），差异无统计学意义（P〉0.05）；试验组CMV转阴中位时间为21 d，对照组为18 d，差异无统计学意义（P〉0.05）。（4）两组病程中均未出现进展为CMV病者及CMV相关死亡者。结论对于异基因造血干细胞移植后的低载量CM
Objective To investigate the threshold of cytomegalovirus （CMV） DNAemia for preemptive antiviral therapy in patients with allogeneic hematopoietic stem cell transplantation （allo-HSCT）. Methods Viral load between 1 × 10^3 copies/ml and 5 × 10^3 copies/ml was defined as low viral load by real time Q-PCR. Clinical data and outcome were collected. Results A total of 95 allo-HSCT reeipients with low viral load from September 2014 to February 2015 were recruited in this study. The control group included 37 patients who received preemptive initial antiviral therapy. The other 58 patients didn＇t received antiviral treatment after positive viremia was confirmed. During monitoring, CMV viremia was cleared spontaneously in 17 patients of study group. Among 41 patients with continuous positive viremia in study group, 26 patients received antiviral therapy after second positivity including 18 with viral load 〉5 ×10^3 copies/ml, 2 with fever hut still low viral load, 2 with hemorrhagic cystitis and low viral load, 4 with continuous low viral load. Eleven patients received antiviral therapy after the third positivity including 5 with viral load 〉5×10^3 copies/ml, 1 low viral load patient with fever and diarrhea, 5 with continuous low viral load. Only 4 patients received antiviral therapy after the fourth positivity of 〉5×10^3 copies/ml. In the study group, 35 eases received ganeiclovir and 6 eases received fosearnet. The incidence of neutropenia did not differ significantly between study and control groups [minimum of neutrophil count： （1.63±0.41）× 10^9/L vs. （1.58 ± 0.36） ×10^9/L]. The proportion of viral load greater than 5 × 10^3 eopies/ml in the first week was comparable in two groups. Successful viral clearance rate was not statistically different （P=0.87）. Of all 95 patients, no CMV diseases developed, neither did patient die of CMV infection. Conclusions Spontaneous clearance of viremia occurs in some patients receiving allo-HSCT with low CMV viral load. Delayed antiviral treatmen
出处
《中华内科杂志》
CAS
CSCD
北大核心
2018年第3期191-195,共5页
Chinese Journal of Internal Medicine
关键词
造血干细胞移植
巨细胞病毒感染
抢先抗病毒治疗
Hematopoietic stem cell transplantation
Cytomegalovirus infections
Preemptive antiviral therapy
