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异基因造血干细胞移植后巨细胞病毒肺炎临床特点分析

ISSN号：1671-167X
期刊名称：北京大学学报(医学版)
时间：0
页码：548-553
语言：中文
分类：R617[医药卫生—临床医学;医药卫生—外科学]
作者机构：[1]北京大学人民医院,血液病研究所,北京100044
相关基金：基金项目：国家杰出青年科学基金项目（30725038）、教育部创新团队发展计划项目（IRT0702）和首都医学科研发展基金项目（2005-1010）资助
相关项目：HSP-HA-1H重组核酸疫苗的构建及其诱导HSCT后GVL效应的研究

作者：许兰平|赵晓甦|陈育红|刘开彦|陈欢|黄晓军|韩伟|王昱|刘代红|张晓辉|

关键词：造血干细胞移植, 肺炎, 病毒性, 巨细胞病毒感染, Hematopoietic stem cell transplantation, Pneumonia, viral, Cytomegalovirus infections

中文摘要：

目的：研究定量监测血浆巨细胞病毒（cytomegalovirus,CMV）DNA水平指导的抗病毒抢先治疗下,造血干细胞移植后CMV肺炎的临床特点及预后。方法：分析2005年1月至2008年8月之间行异基因造血干细胞移植（allogeneic hematopoietic stem-cell transplantation,allo-HSCT）后发生CMV肺炎的22例患者,总结发病的临床特征及评价影响预后的相关因素。结果：750例allo-HSCT患者中共22例发生24例次CMV肺炎（2.9%）,发病中位时间为＋51d（＋30～180 d）,16例（72.7%）患者在发病前后出现CMV血症,6例患者血浆CMV-PCR持续阴性。23例次患者胸部CT上出现间质性改变（如弥漫的磨玻璃影、多发斑片影等）。治疗上抗病毒药物联合皮质激素疗效较好,CMV肺炎总体治愈率为83.3%。单因素分析发现男性患者及重度急性移植物抗宿主病（acute graft-versus-host disease,aGVHD）是CMV肺炎的不良预后因素（P=0.034,P=0.023）。结论：通过定量PCR监测CMV-DNA水平,尽早诊断并给予适当抗病毒治疗可以明显改善CMV肺炎患者的预后。

英文摘要：

Objective：To analyze the clinical features and prognosis of cytomegalovirus （CMV） pneumonia after allogeneic hematopoietic stem-cell transplantation （allo-HSCT） under the preemptive therapy based on monitoring CMV-DNA level quantificationally. Methods：We studied 750 patients underwent allo-HSCT from Jan, 2005 to Aug, 2008. A total of 22 patients who developed into CMV pneumonia were analyzed retrospectively. Results：Twenty-four episodes of CMV pneumonia occurred in the 22 patients （2.9%） and the majority of them developed into CMV pneumonia average 51 days （ 30 to 180 days） after allo-HSCT. Of the 22 patients 16 （72.7%） underwent CMV-DNAemia and 6 remained CMV-PCR negative throughout the course of the disease. The pulmonary CT manifestation of 23 episodes showed specific features of interstitial changes, including diffused or patchy ground-glass opacities. Better curative effects were obtained using antivirus drugs combined with glucocorticoid and the total curative ratio of CMV pneumonia was 83.3%. Male and the occurrence of severe acute graft-versus-host disease seemed to be correlated with an unfavorable outcome through univariate analysis （ P = 0. 034, P = 0. 023 ）. Condusion： Making a diagnosis as soon as possible and appropriate therapy will improve the outcome of patients with CMV pneumonia markedly.