预防及抢先治疗下异基因干细胞移植后巨细胞病毒感染现状分析

发布时间：2018-05-20 18:15

本文选题：巨细胞病毒 + 异基因造血干细胞移植　；参考：《广东医学》2017年S2期

【摘要】：目的了解预防及抢先治疗下异基因干细胞移植后巨细胞病毒(CMV)感染现状,为改进治疗措施、提高治疗效果提供依据。方法统计进行异基因干细胞移植且针对CMV进行预防、监测及抢先治疗的患者310例,分析CMV感染特点。结果异基因干细胞移植310例,发生CMV感染81例,感染率26.1%。其中CMV血症78例,发生率24.3%(78/310)。CMV病3例(视网膜炎2例,CMV脑炎1例),发生率1%(3/310)。CMV感染组移植物抗宿主病发生率高。未发现严重药物不良反应。治疗后,78例CMV转阴,占96.3%(78/81),但其中16例转阴后再次出现阳性,占19.8%(16/81)。3例持续阳性(其中2例死亡,1例放弃后死亡),占3.7%(3/81)。反复或持续阳性者监测淋巴细胞亚群,均显示NK细胞升高,CD4~+T细胞降低,CD8~+T细胞升高。结论预防及抢先治疗是异基因干细胞移植后CMV感染的有效方法,在此治疗方案下病毒复发率仍高,需定期监测,部分持续阳性需寻找新的方法。
[Abstract]:Objective to investigate the current status of CMV infection after allogeneic stem cell transplantation in order to provide evidence for improving treatment measures and therapeutic effects. Methods 310 patients undergoing allogeneic stem cell transplantation and prevention, monitoring and preemptive treatment for CMV were analyzed for the characteristics of CMV infection. Results there were 310 cases of allogeneic stem cell transplantation and 81 cases of CMV infection. There were 78 cases of CMV disease and 3 cases of 24.3%(78/310).CMV disease (2 cases of retinitis and 1 case of 1%(3/310).CMV encephalitis). The incidence of graft-versus-host disease in 1%(3/310).CMV infection group was high. No serious adverse drug reactions were found. After treatment, 78 cases of CMV turned to negative, accounting for 96.3% of 78 / 81%, but 16 cases of them showed positive again after turning negative, accounting for 19.816% 81% of them (2 cases died and 1 case died after giving up, accounting for 3.7% of 81%). The detection of lymphocyte subsets in repeated or persistent positive individuals showed that NK cells increased and CD4- T cells decreased the level of CD8T cells. Conclusion Prevention and preemptive treatment is an effective method for CMV infection after allogeneic stem cell transplantation. The recurrence rate of the virus is still high under this treatment scheme, which needs to be monitored regularly.
【作者单位】：贵阳市妇幼保健院血液科;南方医科大学南方医院儿科;
【分类号】：R457.7

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