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目的:研究定量监测血浆巨细胞病毒(cytomegalovirus,CMV)DNA水平指导的抗病毒抢先治疗下,造血干细胞移植后CMV肺炎的临床特点及预后。方法:分析2005年1月至2008年8月之间行异基因造血干细胞移植(allogeneic hematopoietic stem-cell transplantation,allo-HSCT)后发生CMV肺炎的22例患者,总结发病的临床特征及评价影响预后的相关因素。结果:750例allo-HSCT患者中共22例发生24例次CMV肺炎(2.9%),发病中位时间为+51d(+30～180 d),16例(72.7%)患者在发病前后出现CMV血症,6例患者血浆CMV-PCR持续阴性。23例次患者胸部CT上出现间质性改变(如弥漫的磨玻璃影、多发斑片影等)。治疗上抗病毒药物联合皮质激素疗效较好,CMV肺炎总体治愈率为83.3%。单因素分析发现男性患者及重度急性移植物抗宿主病(acute graft-versus-host disease,aGVHD)是CMV肺炎的不良预后因素(P=0.034,P=0.023)。结论:通过定量PCR监测CMV-DNA水平,尽早诊断并给予适当抗病毒治疗可以明显改善CMV肺炎患者的预后。
Objective: To investigate the clinical characteristics and prognosis of CMV pneumonitis after hematopoietic stem cell transplantation under the pretreatment of antiviral drugs which is guided by quantitatively monitoring the DNA level of cytomegalovirus (CMV). Methods: Twenty-two patients with CMV pneumonia after allogeneic hematopoietic stem-cell transplantation (allo-HSCT) between January 2005 and August 2008 were analyzed. The clinical features and prognosis were analyzed Related factors. Results: Totally 24 cases of CMV pneumonia (2.9%) occurred in 22 out of 750 patients with allo-HSCT. The median time to onset was + 51d (+ 30-180d). In 16 patients (72.7%), CMV Six patients had persistent negative CMV-PCR. 23 cases of chest CT showed interstitial changes (such as diffuse glaucoma, multiple patches, etc.). Treatment of antiviral drugs combined with corticosteroids better effect, CMV pneumonia overall cure rate was 83.3%. Univariate analysis found that male patients and severe acute graft-versus-host disease (aGVHD) were poor prognostic factors of CMV pneumonia (P = 0.034, P = 0.023). CONCLUSIONS: To monitor the CMV-DNA levels by quantitative PCR, early diagnosis and appropriate antiviral therapy can significantly improve the prognosis of patients with CMV pneumonia.