中国组织工程研究

中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (33): 5292-5297.doi: 10.12307/2023.728

• 干细胞移植 stem cell transplantation • 上一篇    下一篇

异基因造血干细胞移植后带状疱疹病毒感染的危险因素分析

秦  菁，张素平，李  丽，张  然，彭英楠，高思雨，范金鹏，边志磊，万鼎铭   

  1. 郑州大学第一附属医院血液科造血干细胞移植中心，河南省郑州市   450052
  • 收稿日期:2022-10-09 接受日期:2022-11-23 出版日期:2023-11-28 发布日期:2023-03-30
  • 通讯作者: 万鼎铭，教授，博士，主任医师，硕士研究生导师，郑州大学第一附属医院血液科造血干细胞移植中心，河南省郑州市 450052
  • 作者简介:秦菁，女，1997年生，河南省商丘市人，汉族，郑州大学在读硕士，主要从事血液病与造血干细胞移植的基础和临床研究。 张素平，女，1986年生，河南省禹州市人，汉族，主治医师，主要从事血液病与造血干细胞移植的临床诊治。
  • 基金资助:
    国家自然科学基金面上项目(82170211)，项目负责人，边志磊；河南省高等学校重点科研项目计划(20A320021)，项目负责人，张然

Analysis of risk factors for varicella-zoster virus infection after allogeneic hematopoietic stem cell transplantation

Qin Jing, Zhang Suping, Li Li, Zhang Ran, Peng Yingnan, Gao Siyu, Fan Jinpeng, Bian Zhilei, Wan Dingming   

  1. Hematopoietic Stem Cell Transplantation Center, Department of Hematology, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
  • Received:2022-10-09 Accepted:2022-11-23 Online:2023-11-28 Published:2023-03-30
  • Contact: Wan Dingming, MD, Professor, Chief physician, Master’s supervisor, Hematopoietic Stem Cell Transplantation Center, Department of Hematology, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
  • About author:Qin Jing, Master candidate, Hematopoietic Stem Cell Transplantation Center, Department of Hematology, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China Zhang Suping, Attending physician, Hematopoietic Stem Cell Transplantation Center, Department of Hematology, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
  • Supported by:
    the National Natural Science Foundation of China (General Program), No. 82170211 (to BZL); the Major Scientific Research Project of Henan Provincial Universities, No. 20A320021 (to ZR)

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摘要：


文题释义：

异基因造血干细胞移植：是指对患者进行全身照射、大剂量化疗和免疫抑制剂预处理后，将健康供者的造血干细胞移植入患者体内，使之重建正常造血和免疫功能并治愈原发疾病，其中健康供者包括亲缘供者和骨髓库或脐血库的非血缘供者。
带状疱疹：是一种影响神经和皮肤的感染性疾病，由水痘-带状疱疹病毒引起，由于呈带状分布，故而称为带状疱疹，常发生于身体一侧，表现为沿着周围神经成簇分布的水疱，伴有疼痛，常发生于胸部、腰腹部、背部，严重时可累及内脏产生全身播散性疱疹。

背景：异基因造血干细胞移植是根治多种血液系统疾病的重要甚至唯一手段，移植后带状疱疹病毒感染严重影响患者的生活质量。
目的：探讨血液病患者行异基因造血干细胞移植后发生带状疱疹病毒感染的危险因素，旨在降低异基因造血干细胞移植后带状疱疹病毒感染的发生率及减轻其发病的严重程度。
方法：回顾性分析2016年11月至2021年6月于郑州大学第一附属医院血液科造血干细胞移植中心行异基因造血干细胞移植的654例血液病患者的临床资料，探究患者接受异基因造血干细胞移植后发生带状疱疹感染的相关因素。

结果与结论：654例异基因造血干细胞移植后患者中共有66例发生带状疱疹病毒感染，发病率为10.1%，带状疱疹病毒患者的中位年龄为21.5岁(4-62岁)，发病的中位时间为移植后149 d(19-1 179 d)，主要表现为区域性皮肤疱疹，其中7例发生带状疱疹性脑炎，17例发生带状疱疹后神经痛，1例患者右耳失聪。相关治疗措施包括更昔洛韦凝胶局部应用、喷昔洛韦等抗病毒治疗、丙种球蛋白提高免疫功能、减停免疫抑制剂等，治疗的中位时间为11 d(3-38 d)，疱疹均结痂或好转。异基因造血干细胞移植后带状疱疹病毒感染的发生与年龄(χ2=7.816，P=0.005)、预处理方案中是否使用氟达拉滨(χ2=5.004，P=0.025)、是否合并巨细胞病毒感染(χ2=5.983，P=0.014)、原发病类型(χ2=4.860，P=0.027)有关，与移植类型、干细胞来源等无关。带状疱疹病毒感染是异基因造血干细胞移植后的常见并发症，多发生于移植后1年内，具有发病危险因素的患者应注意及时防治，预防性应用抗病毒药物可降低带状疱疹病毒感染的发生率。

https://orcid.org/0000-0002-8623-5956(秦菁)；https://orcid.org/0000-0003-4931-3596(万鼎铭) 

中国组织工程研究杂志出版内容重点：干细胞；骨髓干细胞；造血干细胞；脂肪干细胞；肿瘤干细胞；胚胎干细胞；脐带脐血干细胞；干细胞诱导；干细胞分化；组织工程

关键词: 异基因造血干细胞移植, 水痘-带状疱疹病毒, 并发症, 感染, 预防

Abstract: BACKGROUND: Allogeneic hematopoietic stem cell transplantation is an important or even the only method to cure a variety of hematological diseases. Herpes zoster virus infection after transplantation seriously affects the quality of life.  
OBJECTIVE: To explore the risk factors of varicella-zoster virus infection in patients after allogeneic hematopoietic stem cell transplantation, in order to reduce the incidence of varicella-zoster virus infection after allogeneic hematopoietic stem cell transplantation and the severity of the disease.
METHODS: Clinical data of 654 patients who underwent allogeneic hematopoietic stem cell transplantation in the First Affiliated Hospital of Zhengzhou University from November 2016 to June 2021 were retrospectively analyzed to explore the related factors of the varicella-zoster virus infection after allogeneic hematopoietic stem cell transplantation.  
RESULTS AND CONCLUSION: 66 of the 654 patients developed varicella-zoster virus infection after allogeneic hematopoietic stem cell transplantation, and the morbidity was 10.1%. The average age of patients who infected with varicella-zoster virus was 21.5 (4-62) years old, and the average time of varicella-zoster virus infection was 149 days (19-1 179 days). The main manifestations were regional skin herpes, including 7 cases of herpes zoster encephalitis, 17 cases of post herpetic neuralgia, and 1 case of right ear deafness. The main treatments were topical use of ganciclovir gel, intravenous infusion of penciclovir, application of immunoglobulin to improve immune function and reduce the dosage of immunosuppressant. The median time of treatment was 11 days (3-38 days), and the herpes was scabbed or improved. Incidence of varicella-zoster virus infection after allogeneic hematopoietic stem cell transplantation was related to age (χ2= 7.816, P=0.005), whether fludarabine was used in the pretreatment scheme (χ2=5.004, P=0.025), whether there was cytomegalovirus infection (χ2=5.983, P=0.014), and the primary diseases (χ2=4.860, P=0.027). It was not related to the type of transplantation and the source of stem cells. The varicella-zoster virus infection is a common complication of allogeneic hematopoietic stem cell transplantation. It usually occurs within one year after transplantation. Patients with risk factors should pay more attention to prevention and treatment. Preventive application of antiviral drugs can reduce the incidence of varicella-zoster virus infection.

Key words: allogeneic hematopoietic stem cell transplantation, varicella-zoster virus, complication, infection, prevention

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