临床儿科杂志 ›› 2020, Vol. 38 ›› Issue (9): 641-.doi: 10.3969/j.issn.1000-3606.2020.09.001

• 血液肿瘤疾病专栏 •    

儿童异基因造血干细胞移植术后巨细胞病毒感染临床分析

朱成琳 1, 陈广华 2, 翟宗 1, 杨琪瑜 1, 吕慧 1, 李捷 1, 王易 1, 胡绍燕 1   

  1. 1.苏州大学附属儿童医院血液肿瘤科(江苏苏州 215000); 2.苏州大学附属第一医院 江苏省血液研究所(江苏苏州 215000)
  • 发布日期:2020-09-17
  • 通讯作者: 王易 电子信箱:wangdoctor@aliyun.com
  • 基金资助:
    苏州市科技计划项目(No.SS2019065);江苏省妇幼健康科研项目(No.F201815);国家自然科学基金项 目( No.81300444);江苏省自然科学基金项目(No.BK20130273);苏州市“科教兴卫”青年科技项目(No. KJXW2019024)

Clinical analysis of cytomegalovirus infection after allogeneic hematopoietic stem cell transplantation in children

ZHU Chenglin1, CHEN Guanghua2, ZHAI Zong1, YANG Qiyu1, LYU Hui1, LI Jie1, WANG Yi1, HU Shaoyan1   

  1. 1.Department of Hematology and Oncology, Children’s Hospital Affiliated to Soochow University, Suzhou 215000, Jiangsu, China; 2. Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu, China
  • Published:2020-09-17

摘要: 目的 探讨儿童异基因造血干细胞移植(allo-HSCT)后巨细胞病毒(CMV)感染的危险因素及临床相关特征。 方法 收集2016年1月至2018年12月共269例allo-HSCT患儿的临床资料。监测移植后全血CMV-DNA拷贝数,分析 移植患儿CMV感染发生率、发生时间、危险因素及预后。结果 269例患儿中,男167例、女102例,中位年龄65个月 (33~115个月),其中165例发生CMV感染,感染率为61.3%,感染发生时间为移植后23 d(15~34 d),感染持续时间 38 d(25~66 d)。Logistic回归分析发现患儿移植年龄>65个月、移植后发生Ⅱ~Ⅳ级aGVHD是发生CMV感染的危险因 素,而亲缘全相合移植能降低CMV感染发生风险(P<0.05)。 发生Ⅱ~Ⅳ级急性移植物抗宿主病(aGVHD)及使用脐血移 植与发生难治性CMV感染相关(P<0.05)。 难治性CMV感染组与非难治性CMV感染组总体生存率及无病生存率的差异 有统计学意义(P<0.05)。 结论 移植患儿年龄大、Ⅱ~Ⅳ级aGVHD能增加CMV感染的发生风险,亲缘全相合移植能降低 CMV感染的发生风险。脐血移植后易发生难治性CMV感染;难治性CMV感染初次检测到CMV感染时间早,峰值高。

关键词: 异基因造血干细胞移植; 巨细胞病毒感染; 危险因素; 儿童

Abstract: Objective To explore the risk factors and clinical characteristics of cytomegalovirus (CMV) infection after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in children. Methods The clinical data of allo-HSCT in 269 children from January 2016 to December 2018 were collected. The copies of CMV-DNA in whole blood after transplantation were monitored. The incidence, time, risk factors, and prognosis of CMV infection were analyzed. Results A total of 269 cases (167 males and 102 females) were included and median age was months (33 - 115 months). Among them, 165 cases had CMV infection and the infection rate was 61.3%. The infection occurred 23 days (15 - 34 days) after transplantation, and the infection lasted 38 days (25 - 66 days). Multivariate logistic regression analysis showed that transplantation age > 65 months and grade Ⅱ-Ⅳ aGVHD after transplantation were risk factors for CMV infection, while sibling donor hematopoietic stem cell transplantation (Sib-HSCT) could reduce the incidence of CMV infection (P < 0.05). The occurrence of grade Ⅱ-Ⅳ aGVHD and the use of cord blood transplantation are associated with the incidence of refractory CMV infection (P < 0.05). The difference of the overall survival rate and disease-free survival rate between the refractory CMV infection group and the non-refractory CMV infection group was statistically significant (P < 0.05). Conclusion The risk of CMV infection can be increased by older children and Ⅱ-Ⅳ aGVHD, while the risk can be reduced by Sib-HSCT. Refractory CMV infection was likely to occur after umbilical cord blood transplantation, and the initial detection time of refractory CMV infection was early and the peak value was high.

Key words:  allogeneic hematopoietic stem cell transplantation; cytomegalovirus infection; risk factor; child