重型地中海贫血患者同胞异基因造血干细胞移植后巨细胞病毒感染的危险因素分析

发布时间：2018-04-14 04:38

本文选题：重型地中海贫血 + 同胞异基因造血干细胞移植　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:研究影响重型地中海贫血患者同胞异基因造血干细胞移植(allogenic hematopoietic stem cell transplantation,allo-HSCT)后巨细胞病毒(cytomegalovirus,CMV)感染的相关危险因素。方法:收集2007年7月至2017年1月在本院接受同胞异基因造血干细胞移植的重型地中海贫血患者的临床资料,进行回顾性分析。统计地贫患者allo-HSCT后CMV感染的发生率及中位发生时间。将患者性别、年龄、移植前血清铁蛋白水平、肝脏大小、人类白细胞抗原(Human leukocyte antigen,HLA)相合、干细胞来源、预处理方案抗人胸腺细胞球蛋白(antithymocyte globulin,ATG)使用剂量、急慢性移植物抗宿主病(graft-versus-host disease,GVHD)、移植后是否合并细菌、真菌感染、移植后粒缺时间等因素纳入研究,分析影响重型地贫患者allo-HSCT后CMV感染的相关危险因素。结果:共纳入233例病例,男160例,女73例,中位年龄4.5(1.5-19)岁。Allo-HSCT后25.8%的患者(60/233)发生CMV感染,初次感染的中位时间为移植后30(7-114)天,移植后100天内感染发生率为98.3%(59/60)。单因素分析提示性别、干细胞来源与移植后CMV感染相关。女性组CMV感染发生率较男性组高(40.2%vs 19.5%,P=0.001,χ2=10.226);脐血+骨髓(umbilical cord blood+bone marrow,UCB+BM)组较外周血+骨髓(peripheral blood+bone marrow,PB+BM)组CMV感染发生率高(37.9%vs13.5%,P0.001,χ2=17.615)。多因素分析也提示性别、不同来源干细胞是移植后CMV感染的独立危险因素。结论:女性患者和脐带血来源干细胞是重型地贫患者移植后发生CMV感染的独立危险因素。
[Abstract]:Objective: to study the risk factors of cytomegalovirus (CMV) infection after allogenic hematopoietic stem cell transplantation-HSCT in patients with severe thalassemia.Methods: the clinical data of severe thalassemia patients receiving sibling allogeneic hematopoietic stem cell transplantation from July 2007 to January 2017 were retrospectively analyzed.The incidence and median time of CMV infection after allo-HSCT in thalassemia patients were analyzed.Patients' sex, age, serum ferritin level before transplantation, liver size, human leukocyte antigen human leukocyte antigen-HLA), stem cell source, pretreatment regimen antithymocyte globulin globulinizing dose,Graft-versus-host disease of acute and chronic graft-versus-host disease (GVHD), whether the graft-versus-host disease was associated with bacteria, fungal infection, and the time of granulocytosis after transplantation were studied. The risk factors affecting CMV infection after allo-HSCT in patients with severe thalassemia were analyzed.Results: a total of 233 patients (160 males and 73 females with a median age of 4.5 1.5-19) developed CMV infection after Allo-HSCT (25.8%). The median time of initial infection was 307-114 days after transplantation. The incidence of infection within 100 days after transplantation was 98.359 / 60%.Univariate analysis showed that sex and stem cell origin were associated with CMV infection after transplantation.The incidence of CMV infection in the female group was higher than that in the male group (40.2 vs 19.5P = 0.001, 蠂 2 10.226), and the incidence of CMV infection in the umbilical cord blood cord blood bone marrowgroup was higher than that in the peripheral blood blood bone marrowPB group (P 0.001, 蠂 2 = 17.615).Multivariate analysis also suggested that different stem cells were independent risk factors for CMV infection after transplantation.Conclusion: stem cells derived from umbilical cord blood and female patients are independent risk factors for CMV infection after transplantation in severe thalassemia patients.
【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】：R556.61

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