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    异基因造血干细胞移植后EB病毒感染的临床分析

    Clinical analysis of Epstein Barr virus infection after allogeneic hematopoietic stem cell transplantation

    • 摘要: 目的 分析异基因造血干细胞移植术后EB病毒(EBV)感染的发生情况及其危险因素,为异基因造血干细胞移植(allo-HSCT)后EBV感染的防治提供依据。方法 回顾性分析2014年12月1日—2019年1月31日137例在徐州医科大学附属医院行allo-HSCT患者的临床资料,统计allo-HSCT术后EBV感染的发生情况、并分析发生EBV感染的危险因素。结果 137例患者中男72例,女65例,中位年龄35(18~59)岁,共有77例患者发生EBV感染,1年累积发生率为56.2%,发生的中位时间为55(17~257)d,其中66例患者发生在移植后100 d内,占全部EBV感染者的85.71%。共3例患者发生移植后淋巴增殖性疾病(PTLD),累积发生率为2.2%。移植前发生EBV感染患者在移植后发生EBV感染的比率(70.6%)明显高于移植前未发生EBV感染的患者(54.2%),但差异无统计学意义(P=0.202)。单因素及多因素分析均提示预处理过程中采用抗胸腺细胞球蛋白(ATG)、人类白细胞抗原(HLA)不全相合移植、慢性GVHD及移植后巨细胞病毒(CMV)感染是allo-HSCT后发生EBV感染的独立危险因素。结论 EBV感染是异基因造血干细胞移植后常见并发症,发生率较高。EBV感染发生的独立危险因素为预处理过程中采用ATG、HLA不全相合移植、慢性GVHD及移植后CMV感染。

       

      Abstract: Objective To analyze the prevalence of Epstein Barr virus (EBV) infection in patients following allogeneic hematopoietic stem cell transplantation (allo-HSCT), and provide evidence for the prevention and treatment of EBV infection after allo-HSCH. Methods A total of 137 patients who underwent allogeneic hematopoietic stem cell transplantation in the Affiliated Hospital of Xuzhou Medical University from December 1, 2014 to January 31, 2019 were enrolled and their clinical data were retrospectively analyzed. The incidence of EBV infection after allo-HSCT was calculated, and the risk factors of EBV infection were analyzed. Results Among the patients, there were 72 men and 65 women, with a median age of 35 (18 to 59) years. A total of 77 patients presented EBV infection, with a one-year cumulative incidence of EBV infection of 56.2% and a median time of 55 (17 to 257) days. Furthermore, EBV infection occurred in 66 patients within 100 days after transplantation, which accounted for 85.71% of all patients with EBV infection. PTLD occurred in 3 patients, with a cumulative incidence of 2.2%. The infection rate of EBV-DNA positive patients before transplantation (70.6%) was higher than that of EBV-DNA negative patients (54.2%), without statistical difference (P=0.202). According to univariate and multivariate analyses, anti-thymocyte globulin (ATG), HLA-mismatch HSCT, cGVHD and CMV reactivation were the independent risk factors for EBV infection after allo-HSCT. Conclusions Epstein Barr virus infection is a common complication in patients with allogeneic hematopoietic stem cell transplantation. ATG, HLA-mismatch HSCT, cGVHD and CMV reactivation are the independent risk factors for EBV infection.

       

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