摘要
目的 分析异基因造血干细胞移植后巨细胞病毒 (CMV)肠炎的诊断及治疗情况并作文献复习。方法 6例中男 5例 ,女 1例。慢性髓细胞白血病 5例 ,急性淋巴细胞白血病 1例。非血缘HLA相合的骨髓移植 (allo BMT) 1例 ,非血缘HLA不相合的allo BMT 1例 ,HLA相合的同胞供髓的allo BMT 3例 ,HLA相合的同胞供干细胞的外周造血干细胞移植 (allo PBSCT) 1例。结果 6例中 5例分别于移植后 42、2 6、6 6、45、5 7d发生Ⅱ～Ⅲ级急性移植物抗宿主病 (aGVHD) ,经免疫抑制剂治疗好转 ,但于移植后 5 0、5 7、80、138及 6 5d出现腹痛腹泻加重及 (或 )消化道出血 ,1例无明显GVHD ,但于移植后 35d出现腹痛腹泻及消化道出血。 6例中 5例于症状出现后即行纤维结肠镜检查 ,见回肠和(或 )结肠黏膜水肿、溃疡 ,活检发现炎性病变、巨细胞和 (或 )核内及胞浆病毒包涵体 ,免疫组化染色部分黏膜上皮、血管内皮对CMV抗体阳性 ,确诊为CMV肠炎 ;1例结合症状、血CMV IgM阳性及对抗CMV治疗有效 ,结合临床诊断为CMV肠炎。经联用更昔洛韦、磷甲酸钠、大蒜素和静脉滴注免疫丙种球蛋白治疗 ,6例患者CMV肠炎均已治愈。结论 结肠镜及病理检查对CMV肠炎的诊断具决定作用 。
Objective To report 6 cases of cytomeganlovirus (CMV) enteritis in allogeneic bone marrow transplantation (allo BMT) or peripheral blood stem cell transplantation(PBSCT) recipients and the outcome after treatment. Methods The 6 patients suffered from leukemia and received allo BMT or allo PBSCT.Results Five of the 6 patients had acute GVHD Ⅱ～Ⅲ at 42, 26, 66, 45 and 57 days after transplantation respectively and they recovered after proper treatment. However they soon had severe diarrhea ?abdominal pain or/ and gastrointestinal bleeding, 5 of the 6 patients received endoscopic examination with biopsy at 50, 57, 80, 65, 35 days after transplantation respectively.They were all diagnosed as having CMV enteritis based on the presence of cytomegalic cells on mucosal biopsy specimens stained with hematoxylin and eosin. Meanwhile the immunoperoxidase stain of histologic specimens for CMV antigen or in situ hybridization by CMV DNA probe was positive. One patient was diagnosed CMV enteritis at 138 days after transplantation based on the clinic and response to therapy. They received antiviral treatment with ganciclovir (DHPG) 500 mg/d for 4 to 21 days, foscarnet 2.4 g q8 h or 4.8 g q12 h for 21 to 90 days, garlic extract 60～120 mg/d, globulin and other supportive measures. All the 6 cases had complete clinical response.Conclusion CMV enteritis should be diagnosed as soon as possible with histopathologic examination and early proper treatment may lead to good clinical response.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2001年第8期546-549,T002,共5页
Chinese Journal of Internal Medicine
关键词
造血干细胞移植
同种异体移植
巨细胞病毒属
病毒性肠炎
Hematopoietic stem cell transplantation
Transplantation, allogeneic
Cytomegalovirus
Enteritis
