口服阿昔洛韦缓释片预防儿童干细胞移植后巨细胞病毒感染的有效性和安全性探讨

发布时间：2018-06-23 08:26

本文选题：造血干细胞移植术 + 巨细胞病毒　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:探讨阿昔洛韦缓释片预防骨髓异基因造血干细胞移植(Allo-he matopoietic Stem Cell Transplantation,allo-HSCT)术后CMV感染的有效性和安全性。方法:预防组从干细胞移植入仓时确认均无CMV感染(DNA量5.0×102拷贝/ml),即开始口服阿昔洛韦缓释片,体重10~14kg者:0.2g/次,每天二次;体重15~25kg者:0.2g/次,每天三次;体重25kg者:0.4g/次,每天二次。每周连用三天停用四天。对照组为同一时期的干细胞移植患者,未使用任何抗病毒的药物预防CMV感染。两组患者均使用复方磺胺甲基异恶唑口服预防继发细菌性感染,每周连用三天停用四天。以血清CMV病毒DNA量5.0×102/ml评定为CMV感染,比两组的CMV感染率。安全性指标观察包括:移植后血象指标血红蛋白、WBC和血小板,干细胞植入嵌合率、肝功能、肾功能等。结果:预防组20例,随访12个月,除1例(5.0%)在出仓后14天(移植后45天)出现CMV感染(DNA量1.9×104/ml),一例出现血小板下降和血红蛋白下降,需要停药。未预防组出现感染22例(55.0%),其中15例(68.2%)的CMV感染发生在移植后90天以内,其中典型的巨细胞病毒肺炎2例。两组的血液学指标Hb、WBC、NEU、Plt无显著性差别,两组的干细胞植入嵌合率无显著性差别。2例出仓时已有CMV感染的患者使用阿昔洛韦缓释片治疗无效,需要改静脉使用更昔洛韦。两组的肝功能、肾功能参数无显著性差别。结论:干细胞移植术后长期口服阿昔洛韦缓释片预防CMV感染是有效和安全的。1)可明显降低CMV感染率;2)对移植后的干细胞植入嵌合率无影响;3)对移植后的血液学指标无明显影响;4)对肝肾功能无影响。
[Abstract]:Objective: to investigate the efficacy and safety of acyclovir sustained-release tablets in preventing CMV infection after Allo-he matopoietic Stem Cell Transplantationallo-HSCT (Allo-he matopoietic Stem Cell Transplantationallo-HSCT). Methods: in the prevention group, no CMV infection was confirmed at the time of stem cell transplantation (the amount of DNA was 5.0 脳 10 ~ 2 copies / ml), that is, acyclovir sustained release tablet was taken orally, weight 10~14kg was 0.2g / time twice a day, 15~25kg was 0.2g / time, three times a day, weight 25kg was 0.4g / time, twice a day. Use three days a week for four days. The control group was a stem cell transplant patient in the same period and did not use any anti-viral drugs to prevent CMV infection. Patients in both groups were treated with compound sulfamethoxazole orally to prevent secondary bacterial infection. CMV infection was assessed by serum CMV-DNA volume of 5.0 脳 102/ml, which was higher than that of the two groups. The safety indexes included hemoglobin WBC and platelet, chimerism rate of stem cell implantation, liver function, renal function and so on. Results: in the prevention group, 20 cases were followed up for 12 months, except 1 case (5.0%) developed CMV infection (104/ml volume 1.9 脳 104/ml) 14 days (45 days after transplantation), and one case had thrombocytopenia and hemoglobin decline. There were 22 cases (55.0%) with CMV infection in the untreated group, of which 15 cases (68.2%) had CMV infection within 90 days after transplantation, including 2 cases of typical cytomegalovirus pneumonia. There was no significant difference between the two groups in hematological index HbBCCnneuPlt. There was no significant difference in chimeric rate of stem cell implantation between the two groups. 2 cases of patients with CMV infection at the time of exit were not treated with acyclovir sustained-release tablets, so it was necessary to use ganciclovir intravenously. There was no significant difference in liver function and renal function between the two groups. Conclusion: Long-term oral administration of acyclovir sustained-release tablets after stem cell transplantation is effective and safe in preventing CMV infection. There was no significant effect on liver and kidney function.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.1;R457.7

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