不同异基因造血干细胞移植方案术后CMV及EBV感染差异及危险因素分析

Analysis of the Differences and Risk Factors of CMV and EBV Infections after Different Allogeneic Hematopoietic Stem Cell Transplantation Regimens

摘要: 本研究旨在探究异基因造血干细胞移植(allo-HCT)后不同人类白细胞抗原(HLA)配型与巨细胞病毒(CMV)及EB病毒(EBV)感染率的关联及危险因素。研究收集2019年至2023年于安徽医科大学第一附属医院造血干细胞移植中心首次行allo-HCT患者资料，共计128例，按HLA配型分为单相合组(n = 85)和全相合组(n = 43)，统计两组移植后3个月内CMV、EBV感染率及相关临床指标，采用卡方检验、t检验及非参数检验分析危险因素。结果显示，单相合组EBV和CMV感染率分别为49.4%和43.5%，显著高于全相合组的30.2%和20.9% (P < 0.05)。单相合组中，EBV感染与诊断至移植时长相关(P < 0.05)，而全相合组中，CMV感染与外周血CD34+细胞数、粒系及血小板植入时长相关(P < 0.05)，EBV感染仅与外周血CD34+细胞数相关(P < 0.05)。本研究为allo-HCT术后CMV及EBV感染的早期干预提供了理论依据。

Abstract: This study aimed to explore the association between different human leukocyte antigen (HLA) matching types after allogeneic hematopoietic stem cell transplantation (allo-HCT) and the infection rates of cytomegalovirus (CMV) and Epstein-Barr virus (EBV), as well as the related risk factors. Data from 128 patients who underwent their first allo-HCT at the Hematopoietic Stem Cell Transplantation Center of the First Affiliated Hospital of Anhui Medical University from 2019 to 2023 were collected. The patients were divided into the single-matched group (n = 85) and the fully-matched group (n = 43) based on HLA matching. The infection rates of CMV and EBV within 3 months after transplantation and related clinical indicators were statistically analyzed. Chi-square test, t-test and non-parametric test were used to analyze the risk factors. The results showed that the infection rates of EBV and CMV in the single-matched group were 49.4% and 43.5%, respectively, which were significantly higher than those in the fully-matched group (30.2% and 20.9%, P < 0.05). In the single-matched group, EBV infection was related to the time from diagnosis to transplantation (P < 0.05), while in the fully-matched group, CMV infection was related to the number of peripheral blood CD34 + cells, the time of granulocyte and platelet engraftment (P < 0.05), and EBV infection was only related to the number of peripheral blood CD34 + cells (P < 0.05). This study provides a theoretical basis for the early intervention of CMV and EBV infections after allo-HCT.