异基因造血干细胞移植后人类巨细胞病毒pp65的监测及疗效、危险因素分析.doc

异基因造血干细胞移植后人类巨细胞病毒pp65的监测及疗效、危险因素分析 作者：贾晋松，刘东平，黄晓军，吴彤，刘代红，张耀臣，苏宏，王静波， 周葭蕤，刘强，殷宇明，孙瑞娟，段萱，陆道培 【摘要】 　　本研究探讨异基因造血干细胞移植(allo HSCT)后受者外周血白细胞巨细胞病毒(CMV) pp65抗原阳性细胞数的变化及临床意义。以104例HSCT受者为研究对象，采集移植前后及恢复期受者的抗凝血标本，用CMV pp65单克隆抗体荧光免疫组织化学法检测CMV早期抗原，并进行动态观察。结果表明： 104例HSCT受者中29例移植后检出CMV pp65抗原阳性，检出率27.88%，其中16例为CMV血症，13例为CMV病。29例经抗病毒治疗后25例抗原转为阴性，有效率86.21%，死亡4例，病死率13.79%。CMV感染患者中，受非血缘或单倍体相合异基因HSCT的患者与受同胞全相合异基因HSCT的患者CMV感染率分别为39.29%和14.58%，两者相比较有显著性差异(P＜0.05)。0-Ⅰ度急性GVHD组CMV感染的发生率为19.44 %，而Ⅱ-IV度急性GVHD 组为46.88%，两者间的差异有显著意义(P＜005)。CMV抗原阳性与阴性患者的急性GVHD发生率有显著性差异(P＜005)。结论： 外周血白细胞CMV pp65病毒抗原检测可作为造血干细胞移植后CMV病的监测指标，用于指导移植后抗病毒的治疗和疗效评价。 【关键词】 造血干细胞移植； 巨细胞病毒； pp65抗原； 荧光免疫组织化学测定 　　Survellance of Cytomegalovirus for Antiviral Efficacy and Risk Factors in Allogeneic Hematopoietic Stem Cell Transplantation 　　Abstract The study was aimed to investigate the pp65 antigen of human cytomegalovirus (CMV) and its clinical significance in patients revived allogeneic hematopoietic stem cell transplantation (HSCT). 104 patients received allogeneic HSCT were studied. Anticoagulant blood samples were obtained from the recipients before and after transplantation and in the convalescence. CMV pp65 antigen in leukocytes was detected by indirect immunoflurescence assay using CMV Brite Kit weekly. The results showed that among the 104 patients，29 cases were CMV pp65 positive (27.88%). Out of 29 cases 16 were CMV antigenemia and 13 cases were CMV disease. There were 25 cases who positively responded to antiviral therapy (effective ratio 86.21%) and 4 cases died (case-fatality ratio 13.79%). The detection revealed a significant difference in the incidence of CMV infection between the patients received unrelated or haploidentical family donor HSCT (39.29%) and HLA-identical sibling donor HSCT (14.58%) (Plt;0.05). The incidence rate of CMV infection in patients with 0-Ⅰ grade aGVHD and patients with Ⅱ-IV grade aGVHD were 19.44% and 46.88% respectively，which had signif