摘要
目的 :巨细胞病毒 (CMV)感染和巨细胞病毒疾病是异基因造血干细胞移植 (allo HSCT)术后的主要并发症 ,如发现和处理不及时则病死率高。我院对 70例异基因造血干细胞移植患者于移植后进行巨细胞病毒血症监测 ,以指导CMV感染防治。方法 :采用CMVpp65单克隆抗体免疫组化法监测。结果 :移植后CMV抗原血症见于 94 .3% (6 6 / 70 )患者。 6 1.4 % (43/ 70 )发展为CMV疾病。其中 35例为CMV相关性间质性肺炎 (CMV IP)。随访 2～ 2 4个月 ,2 5例 (2 5/ 70 ,35.7% )病故 ,其中CMV疾病相关性死亡率为 19例 (19/ 2 5,76 % )。巨细胞病毒感染和急性移植物抗宿主病 (GVHD)之间密切相关。CMV疾病伴Ⅲ～Ⅳ度急性GVHD或慢性GVHD者占CMV疾病例数的 54.3% (19/4 3)。症状前治疗组与CMV疾病组比较显示 ,CMV疾病组的CMV疾病发生率 ,继发细菌、真菌感染 ,严重GVHD发生率以及死亡率均显著高于症状前治疗组 (P <0 .0 0 1) ;随访 2～ 2 4个月 ,CMV疾病组的总体生存率仅为 31.3% (10 / 32 ) ,而症状前治疗组为 93.8% (30 / 32 )。结论 :HSCT后CMV感染和CMV疾病常见 ,于CMV疾病之前的症状前期及时进行抗CMV治疗多可挽救患者生命 。
Objective: To investigate the incidence of CMV infection(CMV I) and CMV related diseases (CMV D) after allogeneic hematopoietic stem cells transplantation in 70 consecutive allogeneic hematopoietic stem cells transplantation(allo HSCT) patients and to search for the optimal prophylactic strategy.Methods: Blood samples were monitored using the CMV pp 65 antigenemia assay.Of the 70 patients observed,30 patients with chronic myeloid leukemia[CML:CP(27),AP(2),BC(1)],12 with acute myeloblastic leukemia(AML),10 with acute lymphoblastic leukemia(ALL)and other cases were NHL(3), AA(5), MDS(7), SCLC with pancytopenia (1),CLL(1), and MF (1). Sixty six patients received HLA identical siblings transplantation and four received tranplants from their HLA haploidentical donors. Seventy cases included allo PBPCT (64 cases) , allo BMT (4 cases) and allo PB+BMT (2). Before transplantation, all patients and donors received CMV serological examination except 4 pairs of donors/recepients. All 66 patients (3 cases were CMV IgM positive) and 64/66 donors were CMV IgG positive. Results:After transplantation, 64/70 patients developed CMV viremia during monitoring period. Forty three of 70 patients developed CMV D.Thirty five of them suffered from CMV associated interstitial pneumonia(CMV IP). The high peak levels of CMV antigenemia were associated with development of CMV disease. Close correlation was found between acute graft vs host disease (GVHD) and CMV disease. The patients were followed up for 2 to 24 months. The patients who received preemptive therapy(group A)had significantly better outcome than CMV disease group(group B, P= 0.0001) . Conclusions: The results suggest that CMV antigenemia has high predictive value for subsequent CMV disease and CMV pp 65 antigenemia guided early therapy has particular advantage for avoiding morbidity and mortality caused by CMV disease. [
出处
《军事医学科学院院刊》
CSCD
北大核心
2001年第1期50-53,共4页
Bulletin of the Academy of Military Medical Sciences
基金
全军面上课题基金资助项目! (98M130 )
关键词
巨细胞病毒感染
造血干细胞
骨髓移植
移植物抗宿主病
cytomegaloviruses
infection
hematopoietic stem cells
bone marrow transplantation
graft vs host disease
