摘要
目的:探讨异基因造血干细胞移植(Allo-HSCT)中对巨细胞病毒(CMV)感染的监测及早期干预性治疗的可行性.方法:10例急性白血病患者,移植物抗宿主病(GVHD)的预防:均采用环胞菌素A和短程甲氨蝶呤,部分加用霉酚酸酯、抗胸腺细胞球蛋白、抗CD3单抗.CMV感染的预防方案:移植前d 9～2 静滴更昔洛韦(GCV)(5 mg/kg)1次/12 h,以后每周测血尿CMV抗原,一旦检测结果阳性即予GCV,直到抗原转为阴性.CMV间质性肺炎(CMV-IP)则在上述治疗方案的基础上加用膦甲酸钠和丙种球蛋白[0.4 g/(kg·d)].结果:6例合并CMV感染者均存在Ⅱ～Ⅳ度GVHD,其中4例为活动性感染,2例发展成CMV-IP(1例治疗无效死亡).GCV治疗过程出现一过性WBC、血小板下降,但均为可逆性.结论:GCV对Allo-HSCT合并CMV感染的预防及治疗的疗效可靠.对于CMV感染的高危人群,定期监测及早期干预性治疗,可以提高移植成功率.
Objective： To explore the feasibility of detection and pre-emptive therapy of eytomegalovirus（CMV） infection in aUogeneic hematopoietic stem cell transplantation（Allo-HSCT）. Methods： There were ten patients with acute leukemia. All the patients received cyclosporine and methotrexate, some of them received mycophenodate mofetil and antithymocyte globulin in the preventation of acute graft-versus-host disease（aGVHD）. Acyclovir was given pre-emptive therapy to 10 patients at dose of 5 mg/kg, twice daily from day - 9 to day - 2. CMV in blood and urine was examined every week after transplantation. Treatment started as positive report was given. CMV interstitial pneumonia（CMV-IP） was treated with ganciclovir and large number of globulin[ the dose of 0.4 g/（ kg·d） ]. Results： Six patients of CMV infection occurred Ⅱ-Ⅳ GVHD, 2 of 6 patients occurred CMV-IP and one died. The most common adverse events of GCV were leukopenia and thrombocytopenia, but were reversible. Conclusion： GCV is effective for prophylaxis and treatment of CMV infection in allogeneic hematopoietic stem cell.Pre-emptive therapy can receive change of successful transplantation in dangerous patients.
出处
《汕头大学医学院学报》
2005年第3期144-146,共3页
Journal of Shantou University Medical College
关键词
造血干细胞移植
异基因
巨细胞病毒感染
hematopoietic stem cell transplantation
allogene
cytomegalovirus infection
