成人骨髓移植中EB、CMV及BK病毒感染情况分析

Infection analysis of EB, CMV and BK viruses in adults after bone marrow transplant

关键词:  造血干细胞移植  EB病毒  CMV  BK病毒

Key words:  hematopoietic stem cell transplantation (HSCT), EBV, CMV, BKV

摘要:

目的　监测造血干细胞移植前后患者血液或尿液中EB病毒（Epstein-Barr virus，EBV）、巨细胞病毒（cytomegalovirus，CMV）、多瘤病毒（polyomavirus BK，PBK）的病毒感染情况及临床特征。方法　收集大连医科大学附属二院血液科2014年7月至2016年5月期间收治的45例成人造血干细胞移植（hematopoietic stem cell transplantation ，HSCT）患者的临床数据资料；从移植前3周开始应用实时荧光定量PCR法检测患者外周血EBV-DNA、CMV-DNA及尿液BKV-DNA的拷贝数，每周1次, 分析病毒感染情况。结果　实时荧光定量PCR扩增法检测出45例患者移植后的EBV感染率为26.7%（12/45），感染中位时间为移植后+45 d，病毒血症持续中位时间为39 d，其中仅1例男性患者发生淋巴细胞增殖性疾病（posttransplant lymphoproliferative disorders，PTLD）（1/45，2.22%）。CMV感染率为15.6%（7/45），病毒血症出现的中位时间为移植后+51 d，持续的中位时间为43 d，感染CMV病毒的成人患者中未出现疑似CMV相关并发症。BKV的感染率为46.7%（21/45），病毒尿症出现的中位时间为移植后+5 d，其持续中位时间为115 d，其中有12例（57.1%，12/21）发生出血性膀胱炎（hemorrhagic cystitis，HC）。结论　疾病类型、移植类型、移植物种类及年龄等是影响移植患者病毒感染的重要因素。实时荧光定量PCR检测病毒DNA较为敏感，能对移植患者血液及尿液常见病毒DNA进行实时检测，以便及时发现感染，并予以及时诊断及预防治疗。

Abstract:

Objective 　 To monitor viral infection and its clinical features in the patients after hematopoietic stem cell transplantation by detecting the gene copy numbers of Epstein-Barr virus (EBV) and Cytomegalovirus (CMV) in blood and polyomavirus BK (PBK) in urine via quantitative real-time PCR (QT-PCR).　Methods 　 The clinical data of 45 patients with hematopoietic stem cell transplantation (HSCT) were collected and analyzed. The copy numbers of EBV-DNA, CMV-DNA, BKV-DNA were examined via QT-PCR at least once a week from three weeks before transplantation.　Results 　 The EBV infection rate was 26.7% (12/45) by QT-PCR; the median time was +45 day after the transplantation, and the median time of continued viremia was 39 days. Only 1 male patient developed post-transplant lymphoproliferative disorders (PTLD) (1/45, 2.22%). The infection rate was lower in children than in adults (13.3% vs 26.7%), but with a longer duration. The CMV infection rate was 15.6% (7/45); the median time was +51 day, and the median time of continued viremia was 43 days. No adults had the relative syndrome. The BKV infection rate was 46.7% (21/45), the median time of viruria appeared was +5 day, and the median time of viruria continued was 115 days. Twelve cases developed hemorrhagic cystitis (HC), the BK infection and HC incidence were higher in children than in adults.　Conclusion 　 The disease type, transplantation type, graft type and age are factors that impact the infection rate in patients after HSCT. The QT-PCR is more sensitive to detect the DNA copies. We should regularly detect the viral DNA in blood or urine of the post-transplanted patients in order to monitor the viral infections in patients so that we can discover the infection in time and make a diagnosis and preventive treatment.