Risk factors analysis of cytomegalovirus reactivation after allogeneic hematopoietic stem cell transplantation
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摘要: 目的 分析血液病患者行异基因造血干细胞移植后发生巨细胞病毒(cytomegalovirus，CMV)再激活的危险因素及抗病毒治疗的临床疗效。方法 回顾性分析2020年9月至2022年3月我院血液内科接受异基因造血干细胞移植的患者共145例。结果 移植后CMV再激活率为60.7%(88/145)，移植前供者CMV IgG阳性率为97.2%(138/142)，3例供者数据缺失；受者CMV IgG阳性率为99.3%(144/145)，移植前供受者CMV IgG水平对移植后CMV的激活无明显影响。含抗胸腺细胞球蛋白方案(125例)与不含抗胸腺细胞球蛋白方案(20例)移植受者CMV再激活率分别为63.2%(79/125)和45.0%(9/20)，差异无统计学意义(P=0.374)。中性粒细胞重建的中位时间为10(8~19) d，与CMV激活无明显关系。移植后急性移植物抗宿主病(acute graft versus host disease，aGVHD)的发生率为46.2%(67/145)，主要表现为皮肤、肠道及肝脏损害。aGVHD患者CMV再激活率为74.6%(50/67)，明显高于未发生aGVHD患者的48.7%(38/78)(P=0.004)。抗病毒治疗2个月后复测CMV转阴率为81.8%(72/88)。结论 CMV再激活是造血干细胞移植患者常见的并发症；移植后CMV再激活与合并aGVHD有一定的相关性；大多数CMV再激活患者对抗病毒治疗有效。Abstract: Objective To analyze the risk factors of cytomegalovirus(CMV) reactivation after allogeneic hematopoietic stem cell transplantation in patients with hematological diseases and the clinical efficacy of antiviral therapy.Methods A total of 145 patients who received allogeneic hematopoietic stem cell transplantation from September 2020 to March 2022 were retrospectively analyzed.Results The reactivation rate of CMV after transplantation was 60.7%(88/145), and the positive rate of CMV IgG in donors before transplantation was 97.2%(138/142). The positive rate of CMV IgG in recipients was 99.3%(144/145), and the level of CMV IgG in recipients before transplantation had no significant effect on the activation of CMV after transplantation. The reactivation rate of CMV in transplant recipients with antithymocyte globulin(125 cases) and without antithymocyte globulin(20 cases) were 63.2%(79/125) and 45.0%(9/20), respectively, and there was no significant difference(P=0.374). The median time of neutrophil reconstruction was 10(8-19) days, and there was no significant relationship with CMV activation. The incidence of acute graft versus host disease(aGVHD) after transplantation was 46.2%(67/145), and the main manifestations were skin, intestinal, and liver lesions. The CMV reactivation rate of aGVHD patients was 74.6%(50/67), which was significantly higher than that of 48.7% without aGVHD(38/78)(P=0.004). The negative rate of CMV after 2 months of retesting was 81.8%(72/88).Conclusion The CMV reactivation is a common complication in patients with hematopoietic stem cell transplantation. There is a certain correlation between CMV reactivation and aGVHD after transplantation. Most patients with CMV reactivation respond to anti-viral therapy.
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表 1 移植后患者CMV感染情况受其他因素影响的单因素和多因素回归分析
变量名 单因素回归 多因素回归 OR 95%CI P OR 95%CI P 性别 女 参照组 男 0.931 0.445~1.945 0.848 0.991 0.429~2.292 0.983 年龄 18岁以下 参照组 18~45岁 0.737 0.211~2.571 0.632 0.796 0.213~2.996 0.733 45岁及以上 0.519 0.136~1.971 0.335 0.622 0.150~2.578 0.513 是否全相合 否 参照组 是 0.527 0.236~1.174 0.117 0.535 0.174~1.650 0.277 是含ATG方案 否 参照组 是 2.099 0.809~5.444 0.127 1.663 0.542~5.103 0.374 是否有aGVHD 否 参照组 是 3.096 1.527~6.279 0.002 2.909 1.412~5.993 0.004 供受关系 同辈 参照组 隔辈 0.942 0.483~1.835 0.860 0.613 0.254~1.480 0.277 
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