CMV和EBV共感染可影响造血干细胞移植患者预后

doi:10.3969/j.issn.1673-8640.2023.08.010

摘要/Abstract

摘要：

目的探讨巨细胞病毒（CMV）和EB病毒（EBV）共感染与造血干细胞移植（HSCT）患者预后的相关性。方法选取2018年1月—2019年1月北京大学人民医院血液科327例接受HSCT的患者，其中CMV和EBV共感染75例（共感染组），CMV或EBV感染165例（单一感染组），CMV和EBV均未感染87例（无感染组）。收集HSCT患者的临床基本资料和移植后CMV、EBV感染情况。采用Kaplan-Meier生存曲线和Cox比例回归分析CMV和EBV共感染是否是HSCT患者预后的危险因素。结果 327例患者中，有226例（69.1%）年龄≤40岁。共感染组≤40岁患者所占比例高于>40岁患者（P<0.05）。人白细胞抗原（HLA）匹配方面，共同感染组半相合所占比例高于单一感染组和无感染组（P<0.05）。共感染组、单一感染组、无感染组患者1年总体生存率（OS）分别为86.7%、85.4%、95.4%，差异有统计学意义（P<0.05）。Kaplan-Meier生存曲线分析结果示，CMV和EBV共感染是HSCT术后患者1年OS的危险因素（P<0.05）。Cox比例回归分析结果显示，CMV和EBV共感染、单一感染均是HSCT术后患者1年OS的危险因素[风险比（HR）值分别为12.553、13.108，95%可信区间（CI）分别为1.456~108.230、1.683~102.062，P值分别为0.021、0.014）。结论 CMV感染（无论是否伴有EBV感染）可降低HSCT患者术后1年OS。

关键词: 巨细胞病毒, EB病毒, 共感染, 造血干细胞移植, 预后

Abstract:

Objective To investigate the correlation between cytomegalovirus（CMV） and Epstein-Barr virus（EBV） co-infection and the prognosis of patients after hematopoietic stem cell transplantation（HSCT）. Methods Totally，327 patients with CMV and EBV co-infection（75 cases），CMV or EBV infection group（165 cases） and no infection group（87 cases） were enrolled in the Hematology Department of Peking University People's Hospital. The clinical data and CMV and EBV infection status were collected. Kaplan-Meier survival curve and Cox proportional regression analysis were used to analyze whether CMV and EBV co-infection was a risk factor for the prognosis of patients after HSCT. Results The patients was mainly ≤40 years old（226 cases，69.1%），and the proportion of patients ≤40 years old in CMV and EBV co-infection group was higher than that in patients >40 years old（P<0.05）. In terms of human leukocyte antigen（HLA） matching，the proportion of haploidentical in CMV and EBV co-infection group was higher than that in CMV or EBV infection group and no infection group（P<0.05）. The one-year overall survival（OS） rates of CMV and EBV co-infection group，CMV or EBV infection group and no infection group were 86.7%，85.4% and 95.4%（P<0.05）. Kaplan-Meier survival curve results showed that CMV and EBV co-infection was a risk factor for one-year OS after HSCT（P<0.05）. Cox proportional regression analysis showed that CMV and EBV co-infection and CMV or EBV infection were risk factors for one-year OS after HSCT [hazard ratios（HR） were 12.553 and 13.108，95% confidence interval（CI） 1.456-108.230 and 1.683-102.062，P=0.021 and 0.014，respectively]. Conclusions CMV infection（with or without EBV infection） may reduce one-year OS after HSCT.

Key words: Cytomegalovirus, Epstein-Barr virus, Co-infection, Hematopoietic stem cell transplantation, Prognosis

中图分类号:

R446.1

张娜, 牛伟华, 孙媛媛, 贾玫. CMV和EBV共感染可影响造血干细胞移植患者预后[J]. 检验医学, 2023, 38(8): 760-765.

ZHANG Na, NIU Weihua, SUN Yuanyuan, JIA Mei. CMV and EBV co-infection affecting patient prognosis after hematopoietic stem cell transplantation[J]. Laboratory Medicine, 2023, 38(8): 760-765.

图/表 5

参考文献 22

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临床指标	1年OS		1年LFS
临床指标	HR（95%CI）	P值	HR（95%CI）	P值
年龄
>40岁	1		1
≤40岁	1.626（0.735~3.597）	0.230	1.035（0.609~1.760）	0.898
性别
女性	1		1
男性	1.190（0.529~2.679）	0.674	0.994（0.601~1.643）	0.980
基础疾病
急性未分化细胞白血病和慢性粒细胞白血病	1	0.404	1	0.155
AML		0.932		0.924
ALL		0.930		0.924
MDS和再生障碍性贫血		0.366		0.915
诊断到移植的时间
<1年	1		1
≥1年	0.286（0.035~2.337）	0.243	0.831（0.342~2.017）	0.682
HLA 匹配
半相合	1	0.836	1	0.949
全相合	0.694（0.074~6.496）	0.749	1.075（0.294~3.936）	0.913
无血缘关系	0.730（0.258~2.071）	0.555	0.923（0.475~1.795）	0.767
GVHD
无	1		1
有	0.617（0.245~1.553）	0.306	2.129（1.152~3.935）	0.016
白细胞植活
植活	1		1
未植活	1.050（0.935~1.179）	0.407	1.043（0.965~1.127）	0.263
疾病缓解状态
白血病第1次完全缓解	1		1
白血病第2次完全缓解和白血病未缓解	2.579（0.305~21.818）	0.385	1.441（0.326~6.376）	0.630
CMV、EBV感染情况
均无感染	1	0.049		0.494
共感染	12.553（1.456~108.230）	0.021	1.178（0.522~2.658）	0.693
单一感染	13.108（1.683~102.062）	0.014	1.443（0.751~2.772）	0.096

临床指标	1年OS		1年LFS
临床指标	HR（95%CI）	P值	HR（95%CI）	P值
年龄
>40岁	1		1
≤40岁	1.626（0.735~3.597）	0.230	1.035（0.609~1.760）	0.898
性别
女性	1		1
男性	1.190（0.529~2.679）	0.674	0.994（0.601~1.643）	0.980
基础疾病
急性未分化细胞白血病和慢性粒细胞白血病	1	0.404	1	0.155
AML		0.932		0.924
ALL		0.930		0.924
MDS和再生障碍性贫血		0.366		0.915
诊断到移植的时间
<1年	1		1
≥1年	0.286（0.035~2.337）	0.243	0.831（0.342~2.017）	0.682
HLA 匹配
半相合	1	0.836	1	0.949
全相合	0.694（0.074~6.496）	0.749	1.075（0.294~3.936）	0.913
无血缘关系	0.730（0.258~2.071）	0.555	0.923（0.475~1.795）	0.767
GVHD
无	1		1
有	0.617（0.245~1.553）	0.306	2.129（1.152~3.935）	0.016
白细胞植活
植活	1		1
未植活	1.050（0.935~1.179）	0.407	1.043（0.965~1.127）	0.263
疾病缓解状态
白血病第1次完全缓解	1		1
白血病第2次完全缓解和白血病未缓解	2.579（0.305~21.818）	0.385	1.441（0.326~6.376）	0.630
CMV、EBV感染情况
均无感染	1	0.049		0.494
共感染	12.553（1.456~108.230）	0.021	1.178（0.522~2.658）	0.693
单一感染	13.108（1.683~102.062）	0.014	1.443（0.751~2.772）	0.096