CAJ | 학술논문

目的：观察异基因干细胞移植术（allo‐HSCT ）后患者血液巨细胞病毒DNA （CM V‐DNA ）阳性率，探讨巨细胞病毒感染的危险因素。方法收集30例在2012年7月至2014年9月行allo‐HSCT患者，用PCR方法定量检测患者移植术后第1个月（1次／周）、第2～3个月（1次／2周）、第4～6个月（1次／月）静脉血中CM V‐DNA的拷贝数，统计各时期的阳性率。结果30例患者有13例感染巨细胞病毒，感染率为43．3％。第1个月内阳性患者有4例（13．3％），第2个月有11例（36．7％），第3个月有2例（6．7％），第4个月0例，第5个月有2例（6．7％），第6个月0例。异基因干细胞移植术后半年内第2个月患者CM V‐DNA阳性率较高。相关分析提示CMV‐DNA阳性率与兔抗人胸腺细胞免疫球蛋白（ATG）、巴利昔单抗（CD25单抗）的使用、急性移植物抗宿主病（GVHD）的发生程度有关，与性别、年龄、原发病危险分层、人类白细胞抗原（HLA）相合情况、预处理方案、中性粒细胞恢复时间等无关。结论定期监测allo‐HSCT后患者血液CM V‐DNA可及时干预，减少巨细胞病毒感染并发症。
목적：관찰이기인간세포이식술（allo‐HSCT ）후환자혈액거세포병독DNA （CM V‐DNA ）양성솔，탐토거세포병독감염적위험인소。방법수집30례재2012년7월지2014년9월행allo‐HSCT환자，용PCR방법정량검측환자이식술후제1개월（1차／주）、제2～3개월（1차／2주）、제4～6개월（1차／월）정맥혈중CM V‐DNA적고패수，통계각시기적양성솔。결과30례환자유13례감염거세포병독，감염솔위43．3％。제1개월내양성환자유4례（13．3％），제2개월유11례（36．7％），제3개월유2례（6．7％），제4개월0례，제5개월유2례（6．7％），제6개월0례。이기인간세포이식술후반년내제2개월환자CM V‐DNA양성솔교고。상관분석제시CMV‐DNA양성솔여토항인흉선세포면역구단백（ATG）、파리석단항（CD25단항）적사용、급성이식물항숙주병（GVHD）적발생정도유관，여성별、년령、원발병위험분층、인류백세포항원（HLA）상합정황、예처리방안、중성립세포회복시간등무관。결론정기감측allo‐HSCT후환자혈액CM V‐DNA가급시간예，감소거세포병독감염병발증。
Objective To observe the positive rate of plasma cytomegalovirus DNA(CMV‐DNA) level after allogenic hema‐topoietic stem cell transplantation (allo‐HSCT) ,analysis and explore the risk factors related to CMV infection .Methods Choose 30 patients who had performed allo‐HSCT in our department from July 2012 to September 2014 .PCR were used regularly to detect the plasma CMV‐DNA levels in these patients .The regular monitoring times were as follow :the first month(once a week) ,the second to third month(twice a week) ,the fourth to sixth month(once a month) after allo‐HSCT respectively .The positive rates were coun‐ted in every period .Results Thirteen patients had CMV infection ,and the infection rate were 43 .3% .In the first month ,there were 4 cases (13 .3% )whose plasma CMV‐DNA levels were positive ,however ,the positive cases in the second month ,the third month , the fourth month ,the fifth month and the sixth month were 11(36 .7% ) ,2(6 .7% ) ,0 ,2(6 .7% ) and 0 respectively .Statistical data showed that it was in the second month after allo‐HSCT that the CMV‐DNA positive rate was higher than other periods .The anal‐ysis suggested that the positive rate of CMV‐DNA related to the administration of rabbit anti‐human thymocyte globulin(ATG) ,ba‐siliximab ,and the occurrence of acute graft versus host disease(GVHD) ,there were no relationship among gender ,age ,risk stratifi‐cation of primary disease ,HLA condition ,preparative project ,recovery time of neutrophile granulocyte .Conclusion It is necessary and beneficial to monitor blood CMV‐DNA level regularly and take treatment early to avoid CMV related comobidity after allo‐HSCT .