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目的:观察异基因造血干细胞移植(Allo-HSCT)治疗重型再生障碍性贫血(SAA)后巨细胞病毒(CMV)和EB病毒(EBV)的感染情况,并分析相关因素。方法:对41例行Allo-HSCT的SAA患者,通过实时定量PCR法每周监测CMV/EBV的DNA拷贝数,统计治疗后CMV/EBV血症和CMV/EBV病的发病率,分析移植后患者的治疗转归及相关危险因素。结果:CMV血症发病率为68%,首次发病的中位时间47(41~216)d,CMV血症中18%(5/28)的患者进展为CMV肺病,CMV肺病死亡率为0。EBV血症的发病率为56%,首次发病的中位时间48(28~82)d,EBV血症中17%(4/23)的患者进展为EBV病,EBV病死亡率为100%。患者CMV/EBV血症的发病情况仅与预处理强度及预处理中是否使用ATG相关。结论:SAA患者移植后CMV/EBV血症发病率、CMV/EBV病的发病率、病毒感染导致的病死率较高,采用的Flu+CY+TBI预处理方案,在保障移植物顺利植入的同时,能大大降低CMV/EBV感染的风险。
Objective: To observe the infection of cytomegalovirus (CMV) and Epstein-Barr virus (EBV) after allo-HSCT for treating severe aplastic anemia (SAA) and analyze the related factors. Methods: 41 SAA patients with Allo-HSCT were enrolled. The DNA copy number of CMV / EBV was monitored weekly by real-time PCR. The incidences of CMV / EBV and CMV / EBV after treatment were analyzed. Treatment outcome and related risk factors. Results: The incidence of CMV was 68%, the median time to first onset was 47 (41 ~ 216) d, and 18% (5/28) of CMV patients progressed to CMV lung disease with CMV lung disease mortality of 0. The incidence of EBV hyperlipidemia was 56%, the median time to first onset was 48 (28-82) days, and 17% (4/23) of patients with EBV hyperlipidemia progressed to EBV disease with an EBV mortality of 100%. The incidence of CMV / EBVmia in patients was only related to the intensity of pretreatment and the use of ATG in the pretreatment. CONCLUSIONS: The incidence of CMV / EBV sequelae, the incidence of CMV / EBV disease and the high mortality caused by virus infection in SAA patients after transplantation are better than those of Flu + CY + TBI preconditioning. At the same time, the risk of CMV / EBV infection can be greatly reduced.