Application of quantitative detection of multiple-source cytomegalovirus DNA in diagnosis of cytomegalovirus pneumonia after allogeneic hematopoietic stem cell transplantation
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摘要:
目的 研究不同来源[血浆、痰液、支气管肺泡灌洗液(BALF)]标本的巨细胞病毒(CMV)DNA定量检测对异基因造血干细胞移植后CMV肺炎的诊断价值。 方法 回顾性分析接受异基因造血干细胞移植的405例受者的临床资料,其中诊断为CMV肺炎的19例受者设为CMV肺炎组,选择同期仅发生CMV血症的229例受者、接受纤维支气管镜镜检的11例非CMV肺炎受者及根据病原学证据确诊细菌或真菌性肺炎进行痰培养的16例受者,分别设为对照A、B、C组。总结CMV肺炎的发生情况;分析CMV肺炎受者不同来源(血浆、痰液、BALF)标本的CMV DNA载量;总结CMV肺炎受者的预后情况。 结果 405例异基因造血干细胞移植受者中有19例发生了CMV肺炎,CMV肺炎总体发生率为4.7%(19/405)。CMV肺炎受者的血浆、痰液、BALF的CMV DNA载量均分别高于对照A、B、C组(均为P < 0.05)。19例受者中,有12例经抗病毒治疗后治愈,7例治疗失败死亡(其中3例放弃治疗),病死率为37%(7/19)。 结论 血浆、痰液、BALF的CMV DNA定量检测可提高CMV肺炎的诊断率,从而改善异基因造血干细胞移植受者的预后。 -
关键词:
- 异基因造血干细胞移植 /
- 巨细胞病毒(CMV) /
- 肺炎 /
- 支气管肺泡灌洗液(BALF) /
- DNA定量检测 /
- 移植物抗宿主病 /
- 更昔洛韦 /
- 膦甲酸钠 /
- CMV特异性静脉注射用免疫球蛋白(CMV-IVIG) /
- CMV特异性细胞毒T淋巴细胞(CMV-CTL)
Abstract:Objective To evaluate the diagnostic value of quantitative detection of cytomegalovirus (CMV) DNA from different sources [plasma, sputum and bronchoalveolar lavage fluid(BALF)] for CMV pneumonia after allogeneic hematopoietic stem cell transplantation. Methods Clinical data of 405 recipients undergoing allogeneic hematopoietic stem cell transplantation were retrospectively analyzed. Among them, 19 recipients diagnosed with CMV pneumonia were assigned into the CMV pneumonia group, and 229 recipients with CMV viremia alone, 11 recipients without CMV pneumonia who received fiberoptic bronchoscopy and 16 recipients diagnosed with bacterial or fungal pneumonia based on pathogenic evidence receiving sputum culture were assigned into the control A, B and C groups, respectively. The incidence of CMV pneumonia was summarized. The CMV DNA load of specimens from different sources (plasma, sputum and BALF) of recipients with CMV pneumonia was analyzed. The clinical prognosis of recipients with CMV pneumonia was evaluated. Results Among 405 recipients undergoing allogeneic hematopoietic stem cell transplantation, 19 cases developed CMV pneumonia, and the overall incidence of CMV pneumonia was 4.7%(19/405). The CMV DNA load in the plasma, sputum and BALF of recipients with CMV pneumonia was higher than those in the control A, B and C groups (all P < 0.05). In the 19 recipients, 12 cases were cured after antiviral treatment and 7 died from treatment failure(3 cases abandoned treatment). The fatality was 37%(7/19). Conclusions Quantitative detection of CMV DNA in the plasma, sputum and BALF may increase the diagnostic rate of CMV pneumonia, thereby improving clinical prognosis of recipients undergoing allogeneic hematopoietic stem cell transplantation. -
Key words:
- Allogeneic hematopoietic stem cell transplantation /
- Cytomegalovirus (CMV) /
- Pneumonia /
- Bronchoalveolar lavage fluid (BALF) /
- Quantitative detection of DNA /
- Graft-versus-host disease /
- Ganciclovir /
- Foscarnet sodium /
- CMV-intravenous immunoglobulin (CMV-IVIG) /
- CMV-cytotoxic T lymphocyte (CMV-CTL)
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表 1 CMV肺炎受者的治疗及预后情况
Table 1. Treatment and prognosis of recipients with CMV pneumonia
例序 性别 一线抗病毒治疗 二线/三线抗病毒治疗 辅助抗病毒治疗 ALG / ATG 预后 1 男 膦甲酸钠 无 人免疫球蛋白 ALG 治愈 2 男 膦甲酸钠+半量更昔洛韦 CMV-IVIG 人免疫球蛋白 ALG 治愈 3 男 更昔洛韦 无 人免疫球蛋白 ALG 治愈 4 男 膦甲酸钠+半量更昔洛韦 CMV-IVIG 人免疫球蛋白 ALG 治愈 5 女 膦甲酸钠 CMV-IVIG+CMV-CTL 人免疫球蛋白 ALG 治愈 6 男 阿昔洛韦 CMV-IVIG+CMV-CTL 人免疫球蛋白 ATG 治愈 7 男 更昔洛韦+半量膦甲酸钠 CMV-IVIG+CMV-CTL 无 ALG 治愈 8 男 膦甲酸钠 西多福韦+CMV-IVIG 无 ALG 死亡 9 男 更昔洛韦+半量膦甲酸钠 CMV-IVIG+CMV-CTL 无 ALG 治愈 10 男 更昔洛韦+半量膦甲酸钠 CMV-IVIG 无 ALG 放弃 11 女 更昔洛韦 CMV-IVIG 人免疫球蛋白 ALG 死亡 12 男 更昔洛韦或膦甲酸钠 CMV-CTL 无 ALG 治愈 13 女 更昔洛韦+半量膦甲酸钠 CMV-IVIG 无 ATG 放弃 14 男 更昔洛韦或膦甲酸钠 CMV-IVIG+CMV-CTL 人免疫球蛋白 ALG 治愈 15 男 膦甲酸钠+半量更昔洛韦 CMV-IVIG+CMV-CTL 无 ALG 治愈 16 男 膦甲酸钠+半量更昔洛韦 CMV-IVIG+CMV-CTL 人免疫球蛋白 ALG 放弃 17 男 膦甲酸钠+更昔洛韦 CMV-IVIG 无 ALG 治愈 18 男 膦甲酸钠+更昔洛韦 CMV-IVIG 人免疫球蛋白 ALG 死亡 19 男 更昔洛韦或膦甲酸钠 CMV-IVIG 人免疫球蛋白 ALG 死亡 -
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